Limitations of current surveillance programs for sexually transmitted infections and allied conditions affecting reproductive health care.

The present communication concerns the potential of current surveillance programs for understanding the epidemiology of sexually transmitted infections. The often limited knowledge or the negligence of such infections both among health providers and in the general population, and the non-existence of laboratory services or poor utilization thereof, for example the lack of sampling material, lack of transport services for samples, lack of laboratory reagents and the use of unsensitive and unspecific detection methods, challenge the value of almost any surveillance system of these infections. Other factors are poor health-seeking behavior in the population, including hard-core groups for sexually transmitted infections, poor health economy, limited possibilities for attendees themselves to pay for etiological tests and lack of educated health providers for this type of infectious disease. Still other factors adding to the difficulty of interpreting sexually transmitted infection epidemics on the basis of monitored data are, for example, anonymous testing, double or multiple registration of detected sexually transmitted infection cases, and the chronicity of many sexually transmitted infections with relapses, which makes it difficult to differentiate between incidence and prevalence. Furthermore, partner notification legislations and bureaucracy in reporting cases can influence surveillance programs for sexually transmitted infections.