Translational Epidemiology: Developing and applying theoretical frameworks to improve the control of HIV and other sexually transmitted infections

Ward, H; Gregson, S; Watts, C; Garnett, GP The Journal of Infectious Diseases, 2014;

The continued burden of disease caused by sexually transmitted infections (STIs) – 499 million cases of curable infections each year – constitutes a public health failure. Even in high-income countries, where extensive testing and treatment is available, STIs remain stubbornly endemic.

It seems likely that this failure reflects our limited understanding of the complex individual, social and cultural drivers of epidemics and of the interventions required in different contexts. Theoretically driven statistical analysis, social science and mathematical modelling can to help improve our understanding of the transmission of STI.

This article provides additional quantification of the risk of pelvic inflammatory disease (PID) following chlamydial infection. In a population cohort of 74,000 women in Manitoba, Canada, the lifetime risk of PID was 55% higher following a positive test result, compared with a negative test result.

Of importance for future intervention, there was heterogeneity in the PID risk, with girls aged under 16 years with a repeat infection having an almost 5-fold greater risk than older women. This example demonstrates the ways in which theoretical frameworks can be further developed and used to help guide the development of combination interventions to control STIs.

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