"Sexually Transmitted Infections: Prevention, Treatment, and UNFPA's Role"

EXECUTIVE SUMMARY

Sexually transmitted infections (STIs) — including chlamydia, gonorrhoea, syphilis, trichomoniasis, HPV, herpes, and hepatitis B — represent an enormous and often neglected component of SRHR. WHO estimates over 1 million new curable STI acquisitions daily (374 million annually), with the vast majority occurring in LMICs where diagnostic capacity, treatment availability, and partner notification systems are limited. Congenital syphilis (mother-to-child transmission) causes approximately 200,000 stillbirths and neonatal deaths annually — a wholly preventable tragedy.

UNFPA's engagement with STIs operates primarily through: condom programming (condoms prevent both pregnancy and STIs — "dual protection"); integration of STI screening into SRHR services (particularly syphilis screening in ANC); support for the UNAIDS Division of Labour on HIV prevention; and advocacy for comprehensive SRHR that includes STI services. STI prevention and treatment is explicitly included in the Guttmacher-Lancet Commission's essential SRHR package, yet it remains one of the most underfunded and underprioritised components of SRHR programming.

KEY FACTS

Curable STIs: 374 million new infections annually of chlamydia (129M), gonorrhoea (82M), syphilis (7.1M), and trichomoniasis (156M) (WHO 2024)
Congenital syphilis: Approximately 200,000 stillbirths and neonatal deaths annually; nearly all preventable through ANC syphilis screening and penicillin treatment
HPV: Most common STI globally; causes cervical cancer, genital warts, and other cancers; vaccine available
Herpes (HSV-2): Approximately 491 million people aged 15–49 living with genital herpes; no cure; increases HIV acquisition risk 2–3 fold
Hepatitis B: 296 million chronically infected; sexual transmission significant; vaccine available
AMR: Antimicrobial resistance in gonorrhoea is a critical global health threat; WHO classifies N. gonorrhoeae as a high-priority pathogen for AMR
Condom effectiveness: Consistent condom use reduces STI transmission by approximately 80% for bacterial STIs and 70% for viral STIs
UNFPA condom procurement: Approximately 1 billion male condoms distributed annually through UNFPA-supported programmes
Syndromic management: In settings without laboratory diagnostics, STIs are managed based on symptoms — effective for some STIs but misses asymptomatic infections and leads to antibiotic overuse
Point-of-care diagnostics: Rapid syphilis tests and dual HIV/syphilis tests are available and recommended by WHO for ANC; UNFPA supports their deployment

DETAIL

UNFPA's STI Work

Condom programming: UNFPA's largest direct contribution to STI prevention. As the world's largest multilateral condom procurer, UNFPA ensures condom availability across programme countries. Condom programming includes: procurement and supply, social marketing, demand creation, and community distribution.

ANC syphilis screening: UNFPA supports integration of syphilis testing into routine ANC using rapid diagnostic tests. Universal ANC syphilis screening and treatment with benzathine penicillin could virtually eliminate congenital syphilis — one of the most achievable SRHR goals.

Dual HIV/syphilis testing: Point-of-care tests that simultaneously screen for HIV and syphilis are being deployed in ANC settings, improving efficiency and coverage.

STI-SRHR integration: UNFPA advocates for STI services as part of comprehensive SRHR, not a separate vertical programme.

Challenges

STI programmes are chronically underfunded globally (approximately USD 200 million annually in development assistance — a fraction of HIV funding)
Laboratory diagnostic capacity is absent in many primary care settings in LMICs
Antimicrobial resistance in gonorrhoea threatens treatment effectiveness
Stigma around STIs reduces health-seeking and partner notification
Asymptomatic STIs (particularly chlamydia in women) go undiagnosed without screening

CURRENT STATUS

WHO's Global Health Sector Strategies on HIV, Hepatitis, and STIs (2022–2030) set targets for STI reduction
Congenital syphilis elimination is achievable with existing tools; several countries have been validated
Point-of-care diagnostics are expanding but not yet universally available in LMIC ANC settings
Antimicrobial resistance in gonorrhoea remains a growing threat
STIs remain the "poor cousin" of SRHR programming in terms of funding and attention

SOURCES

WHO: "Global Health Sector Strategies on HIV, Viral Hepatitis and STIs 2022–2030"
WHO: "Sexually Transmitted Infections Fact Sheet" (2024)
Korenromp, Eline et al.: "Global burden of maternal and congenital syphilis" (PLoS ONE, 2019)
UNFPA: Condom procurement and distribution data