Because they frequently go undiagnosed or untreated, sexually transmitted infections remain a major public health problem, in spite of the existence of tools to control them. Now, with the increasing resistance to antibiotics of some of the sexually transmitted pathogens, windows of opportunity for the cost-effective control of sexually transmitted diseases are closing. Gonorrhea, for example, which could be treated easily with affordable penicillin and tetracycline during the 1960s, has remained unchecked in many countries, including those of sub-Saharan Africa. Today, with increasing resistance, the failure of treatment for gonorrhea with penicillin and tetracycline is high, the cost of treatment with second- and third-line antibiotics is beyond most national health budgets, and chronic gonorrhea continues to be an important cause of infertility in women. At the same time, untreated gonorrhea is a driving force in the human immunodeficiency virus epidemic, since it is thought to facilitate both transmission and infection. Sexually Transmitted Diseases: Vaccines, Prevention and Control is therefore timely. It is divided into three sections: the first describes the epidemiology, physiology, and immunology of sexually transmitted pathogens, the second outlines strategies for their control, and the third provides a complete update on the state of the art in the development of vaccines for sexually transmitted diseases.
The first section provides clear maps and tables that complement the textual overview of the geographic distribution of sexually transmitted diseases worldwide. The high prevalence of each pathogen in sub-Saharan Africa is clearly demonstrated. Also covered in the first several chapters are complete descriptions of each pathogen and the pathogenesis of the associated diseases, the immunogenicity of each pathogen and the parts played by the mucosa and cell mediation in the development of immunity, and the unique challenges that each pathogen poses for the development of vaccines.
The first section also includes a chapter on the spread of sexually transmitted diseases in Russia, with trends in syphilis given as an example. The detailed analysis clearly demonstrates how social, biomedical, and political factors such as changing political systems with open borders, ill-adapted policies, and decreased investment in public health can alter the epidemiology of sexually transmitted diseases and permit the spread of disease because of increasing opportunities for transmission.
The second section comprehensively describes nonspecific strategies for the control of sexually transmitted diseases. This section clearly identifies the behavioral factors associated with the risk of infection and the multifaceted behavioral phenomena that lead to the spread of disease. It highlights these factors and phenomena as issues that must be addressed by primary prevention, such as the use of condoms and other changes in behavior, and in the complementary activities of secondary prevention, such as the notification and treatment of sexual partners. This section then goes on to discuss in detail the use and effectiveness of condoms and other barrier methods of prevention, emphasizing the need for safe and effective topical microbicides as well as the complexity of evaluating their safety and effectiveness in vivo.
The third section provides more detailed information about sexually transmitted pathogens and the development of immunity, describes current vaccine-related research, and precisely identifies areas that require more research. This section is rightfully the longest and most detailed; antimicrobial resistance continues to decrease the effectiveness of existing antiinfective drugs, and if the current pace of research into replacement therapy does not increase, the development of vaccines is the best solution for both primary prevention and the fight against antimicrobial resistance.
The book is at times repetitive, with information about pathogenesis, for example, threaded throughout the text as if the authors of individual chapters were not aware of what had been covered previously. However, it presents an abundance of information that provides a clear understanding of sexually transmitted pathogens, factors that must be addressed in efforts to control the spread of disease, and the state of research on barrier methods of prevention and vaccines. Because of the wide range of topics covered in the book, it will be important reading for students, scientists, and public health practitioners, providing guidance on how best to use the tools we have today while clearly describing the tools needed to complete the armamentarium and the road toward their development. Its usefulness for clinicians, however, is limited, but supplementary information on specific treatment options can be found in other books about sexually transmitted diseases.
David L. Heymann, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
"...presents an abundance of information that provides a clear understanding of sexually transmitted pathogens, factors that must be addressed in efforts to control the spread of disease, and the state of research on barrier methods of prevention and vaccines. ...it will be important reading for students, scientists, and public health practitioners, providing guidance on how best to use the tools we have today while clearly describing the tools needed to complete the armamentarium and the road toward their development."
--David L. Heymann, World Health Organization, in THE NEW ENGLAND JOURNAL OF MEDICINE (April 2001)
"...the book comprehensively presents the important pathogens of sexually transmitted infections and the research aimed at developing vaccines against them. Past and recent vaccine strategies, current state of vaccine development and their future prospects are discussed in different chapters with great care and sincerity...This book is useful and important reading for those interested in infectious diseases and their prevention, control and vaccine development."
--S. Das in THE JOURNAL OF MEDICAL MICROBIOLOGY (April 2001)
"very useful and comprehensive information for clinicians, microbiologists and virologists interested in pathogenesis and prevention of STD."
--ACTA VIROLOGICA
