INTRODUCTION

Background

Sexually transmitted diseases (STDs) are a major health problem affecting mostly young people, not only
in developing, but also in developed countries.

Over the period 1985-1996, a general decrease of gonorrhoea, syphilis and chlamydia infections was
noted in developed countries, both in the general population and among adolescents [1]. From the mid-
1990s however, increases in the diagnoses of sexually transmitted diseases, in particular syphilis,
gonorrhoea and chlamydia have been reported in several European countries, especially among
teenagers 16-19 years old [2–7].

The problem with most STDs is that they can occur symptom-free and can thus be passed on unaware
during unprotected sexual intercourse. On an individual level, complications can include pelvic
inflammatory diseases and possibly lead to ectopic pregnancies and infertility [8–11]. Female
adolescents are likely to have a higher risk of contracting an STD than their male counterparts as their
partners are generally older and hence more likely to be infected [2, 12].

The declining age of first sexual intercourse has been proffered as one possible explanation for the
increase in numbers of STDs [7]. According to data from different European countries, the average age
of first sexual intercourse has decreased over the last three decades, with increasing proportions of
adolescents reporting sexual activity before the age of 16 years [13–18]. An early onset of sexual activity
not only increases the probability of having various sexual partners, it also increases the chances of
contracting a sexually transmitted infection [19]. The risk is higher for female adolescents as their
cervical anatomic development is incomplete and especially vulnerable to infection by certain sexually
transmitted pathogens [20–23].

The reluctance of adolescents to use condoms is another possible explanation for the increase in STDs.
Some surveys of adolescents have reported that condoms were found to be difficult to use for sexually
inexperienced, detract from sensual pleasure and also embarrassing to suggest [24–26]. Condoms have
also been reported to be used primarily as a protection against pregnancy, not STD, with their use
becoming irregular when other contraceptives are used [15, 27]. Furthermore, many adolescents do not
perceive themselves to be at risk of contracting an STD [27].
We conducted this systematic review in order to determine awareness and knowledge of school-going
adolescents in Europe of sexually transmitted diseases, not only concerning HIV/AIDS, but also other
STDs such as chlamydia, gonorrhoea, syphilis and human papillomavirus (HPV). Where possible we will
identify differences in awareness and knowledge by key demographic variables such as age and gender,
and how awareness has changed over time.

Although knowledge and awareness have been reported to have a limited effect on changing attitudes
and behaviour, [16, 28–30] they are important components of sex education which help promote
informed, healthy choices [31–33]. As schooling in Europe is generally compulsory at least up to the age
of 15 years [34] and sex education is part of the school curriculum in almost all European countries,
school-going adolescents should be well informed on the health risks associated with sexual activity and
on how to protect themselves and others. In view of the decreasing age of sexual debut and the
reported increasing numbers of diagnosed STDs among young people, results of our review can help
point out areas where STD risk communication for school-attending adolescents needs to be improved

STATEMENT OF PROBLEM

More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual
contact. Eight of these pathogens are linked to the greatest incidence of sexually transmitted disease. Of
these, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other 4 are viral
infections which are incurable: hepatitis B, herpes simplex virus (HSV or herpes), HIV and human
papillomavirus (HPV).

STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can also
be transmitted from mother-to-child during pregnancy, childbirth and breastfeeding.

A person can have an STI without showing symptoms of disease. Common symptoms of STIs include
vaginal discharge, urethral discharge or burning in men, genital ulcers and abdominal pain.

Scope of the problem

STIs have a profound impact on sexual and reproductive health worldwide.

More than 1 million STIs are acquired every day. In 2020, WHO estimated 374 million new infections
with one of four STIs: chlamydia (129 million), gonorrhoea (82 million), syphilis (7.1 million) and
trichomoniasis (156 million). More than 490 million people were estimated to be living with genital HSV
(herpes) infection in 2016, and an estimated 300 million women have an HPV infection, the primary
cause of cervical cancer. An estimated 296 million people are living with chronic hepatitis B globally.
Both HPV and hepatitis B infections are preventable with vaccination.

STIs can have serious consequences beyond the immediate impact of the infection itself.

STIs like herpes, gonorrhoea and syphilis can increase the risk of HIV acquisition.

Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth weight and
prematurity, sepsis, pneumonia, neonatal conjunctivitis and congenital deformities. Approximately 1
million pregnant women were estimated to have active syphilis in 2016, resulting in over 350 000
adverse birth outcomes, of which 200 000 occurred as stillbirth or neonatal death.

HPV infection causes cervical cancer. Cervical cancer is the fourth most common cancer among women
globally, with an estimated 570 000 new cases in 2018 and over 311 000 cervical cancer deaths each
year (2).

Hepatitis B resulted in an estimated 820 000 deaths in 2019, mostly from cirrhosis and hepatocellular
carcinoma (primary liver cancer).

STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease (PID) and
infertility in women.

Aim
The aim of the study is to determine the management of sexually transmitted diseases in Rafi local
government area

Objective of the study

The specific objectives are

1. To prevent new sexually transmitted infections in Rafi local government area, Niger state.
2. To improve the health of people by reducing adverse outcome of STIs in Rafi local government
area, Niger state.
3. To achieve integrated, coordinate efforts that address the STIs epidemic
4. To reduce STI-related health disparities and health inequalities
5. To accelerate progress in STIs research technology, and innovation
Research Questions
1. What are the effective way of preventing sexually transmitter infection?
2. What is the difference between STDs and STIs?
3. Can HIV be transmitted through kissing?
4. Who is more at risk of becoming infected with an STIs, men or women?

The Scope of STDs

May 22, 2000 -- Sexually transmitted diseases (STDs) are a worldwide problem, with
research underway in several countries towards developing better drugs and other
treatments, as well as more effective prevention strategies, such as a possible
vaccine for cervical cancer caused by the human papilloma virus (HPV). Here are
some of the most common STDs, as well as the scope of the problem in the United
States and abroad:
 Herpes simplex virus-2 (HSV-2), also known as genital herpes: About one in five
Americans over the age of 12 is infected -- some 45 million people -- according to
the Centers for Disease Control and Prevention (CDC). An estimated 1 million
new cases occur every year.
 Human papilloma virus (HPV): Approximately 20 million Americans are infected
and about 5.5 million new cases are identified annually.
 Chlamydia: Because most victims do not exhibit symptoms, estimates of
prevalence and incidence are difficult to make. The World Health Organization
(WHO) says about 89 million new chlamydial infections occurred in 1997, and
the American Social Health Association (AHSA) estimates that about 3 million
new infections occur in the United States each year.
 Hepatitis B: About three-quarters of a million people in the United States are
estimated to have the disease, with nearly 80,000 new cases occurring annually
as the result of sexual activity.
 Gonorrhea: The WHO estimated that there were 62 million new cases worldwide
in 1997; the AHSA says some 650,000 new cases occur annually in the United
States.
 Syphilis: While "virtually non-existent in most parts of the United States,"
according to the CDC, about 12 million new cases occurred worldwide in 1997,
and about 70,000 new cases are diagnosed each
The significance of STDs
STDs1 are not only a cause of acute morbidity in adults but may result in
complications with sequelae such as infertility in both men and women, ectopic
pregnancy, cervical cancer, premature mortality, congenital syphilis and fetal
wastage, low birth weight, and prematurity and ophthalmia neonatorum.

The term sexually transmitted disease (STD) is used throughout this document to
describe sexually transmitted infections and the diseases, complications and
sequelae which result. For instance, a sexually transmitted infection, gonorrhoea,
results in a disease, cervicitis, which may lead to a complication, salpingitis.
Permanently impaired fertility would be a sequela.
The STDs that are caused by bacterial, mycological and protozoal agents have been
curable by appropriate antibiotics and chemotherapeutic agents for more than 40
years. In spite of this, such STDs have continued to be a public health problem in
both industrialized and developing countries. An equilibrium has been reached,
however, in most industrialized countries with low (and often still falling) rates of
infection. In contrast, the equilibrium reached in many developing countries has
been with highly endemic levels of disease. In many developing countries STDs have
for several decades ranked among the top five diseases for which adults seek health
care services. Reliable surveillance is rarely in place and the exact magnitude of the
problem is frequently unknown. Where data are available they show significantly
greater rates in the 15-44 age group.

Using information on STD prevalence from developing countries (including those in

Africa, Asia, Latin America and the Caribbean), official STD prevalence estimates
from industrialized countries and WHO archival information from country-specific
reports, prevalence rates of gonorrhoea, chlamydia, syphilis and trichomonas
infections have been estimated by sex and by region. Regional adult prevalence for
1995 was calculated using mid-year population estimates of adults 15-49 years of
age.