Journal of Contraception Reproductive Health Care - The European ...

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The 8th Congress of The European Society of Contraception Abstracts of Invited Speakers IS-01 STIs – trends and epidemiology M.J.W. van de Laar (RIVM) and the European Surveillance of Sexually Transmitted Infections (ESSTI) Network Bilthoven, The Netherlands Sexually transmitted infections (STIs) are a major public health problem in Europe. Their substantial morbidity and disproportionate burden upon women, marginalized communities, and those with high-risk sexual lifestyles continue to drive their prioritisation in European public health. Behavioural changes in response to the HIV/AIDS pandemic resulted in initial reductions in the incidence of STIs. However, these have not been maintained and STI rates are on the rise again in many countries. Specific population sub-groups are disproportionately affected: Homosexual men and young people (aged less than 24 years) contribute highly to the rising trends of acute STIs in Europe and are at high risk for infection and re-infection. The prevalence of genital chlamydial infection is high in young females; and gonorrhoea remains fairly concentrated among those with high rates of partner change or the economically deprived in many EU states. In the past 5 years, many previously low incidence European countries have reported outbreaks of STIs, suggesting a changing epidemiology and deterioration in sexual health. Gains in STI control may be achieved though greater European collaboration in laboratory diagnosis, harmonising treatment protocols and strengthening disease surveillance. Recent trends in, and the epidemiology of, acute STIs will be discussed. IS-02 Abstract not available at the time of printing 12 The European Journal of Contraception and Reproductive Health Care
The 8th Congress of The European Society of Contraception Abstracts of Invited Speakers IS-03 Integrated sexual health services P. Greenhouse Milne Centre for Sexual Health, Bristol Royal Infirmary, Bristol, UK Integrated sexual health services are designed to overcome the problems of the separation of medical specialisation – across most of Europe – between Gynaecology and (Dermato)-Venereology, which had disadvantages for women’s health. An holistic approach takes the patient’s needs as the central consideration, combining care for contraception, sexually transmitted infections (STI), unwanted pregnancy, sexual assault etc., thus putting women’s sexual health under one roof. This logical, commonsense approach has little formal evidence base as public health policy, apart from substantial work on acceptability to patients, particularly among adolescents, and is being investigated as an appropriate model of service delivery in Britain, the Russian Federation and elsewhere. This paper reviews the existing evidence base, with particular emphasis on the case of need for joint contraception & STI services demonstrated by a precisely inverse relationship between gonorrhoea rates and live birth rates when preferred contraceptive method changes from hormonal methods to condoms. The paper also identifies potential therapeutic advantages of the integrated clinical approach, with an increasing recognition of the need to consider hormonal influences on genital infection in the management of conditions such as recurrent bacterial vaginosis and genital herpes. IS-04 Benefit and harm J. Drife University of Leeds, Leeds, UK On 25 May 1965 in London, Professor Sir Dugald Baird of Aberdeen delivered a lecture entitled The Fifth Freedom. Published in the BMJ, it became a classic. To Roosevelt’s four freedoms – freedom of speech and worship and freedom from want and fear – Baird added a fifth: ‘‘freedom from the tyranny of excessive fertility’’. Like the other four, this freedom is still denied to many people today. Baird divided the benefits of contraception into those affecting populations and those affecting individuals. Population growth no longer hits the headlines but perhaps it should. Too many nations still rely on disease, war and famine to control their population. Contraception is a more beneficial option. Specific methods of contraception have specific benefits. The combined oral contraceptive prevents ovarian and endometrial cancer. Long-acting progestogens prevent menstrual disorders, which cause not only inconvenience but also major ill-health. Condoms prevent the transmission of HIV. And yet contraception is still regarded as harmful by some. Male-dominated institutions may see little benefit in liberating women from their traditional role. In some countries, reducing the demand for therapeutic abortion is financially harmful to gynaecologists. We should understand views with which we do not sympathise. By breaking the link between coitus and pregnancy, contraception has altered people’s attitudes to sex. The change is not entirely beneficial. Today in the UK, over 25% of girls have had intercourse by the age of 16. In 1965 the BMJ predicted that ‘‘the use of the ‘pill’ must lead to a considerable spread of venereal disease.’’ Nearly forty years on in Britain, there is indeed an epidemic of chlamydia. The pill causes venous thromboembolism and the IUCD is associated with pelvic infection. These risks are low but they have received major publicity in the media, perhaps because people feel that a price must be paid for sexual freedom. The risks of contraception must be set against the risks of conception, which vary from country to country. Worldwide, pregnancy causes one maternal death every mnute, mainly in developing countries, where pregnancy is seen as less harmful than the pill. This misperception is one reason why many women are still denied access to contraception, which otherwise could save thousands of lives every year. The European Journal of Contraception and Reproductive Health Care 13
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