Experts: Lack of Sex Education Fuels Illness

Russia has 136 cases of syphilis per 100,000 compared to just 1.5 cases per 100,000 in Western Europe, they said.

"In periods of economic turbulence, the number of people with STIs always increases," said Marius Domeika, professor at Uppsala University in Sweden. "This has been well demonstrated by the dramatic rise in syphilis infection [in Eastrn Europe ]after the fall of the Berlin Wall."

St. Petersburg and the Leningrad Oblast are no exceptions, he added.

A survey conducted by Yuventa, the city's first youth center, showed that as many as 61 percent of teenage interviewees said they had no or poor quality sex education and were not getting information about the nearest youth centers, Yuventa director Pavel Krotin said.

There has been little change since 1998, when the comparable proportion was 68.5 percent, he added.

However, Tatyana Smirnova, chief physician at the city dispensary of dermatology and venerology, said STI rates in the Northwest region are 50 percent to 67 percent lower than the overall Russian average.

According to the data provided at the conference, Russian STI rates are highest in Siberia and the Far East.

The Swedes were in the city to report the first results of a joint Russian-Swedish project to improve STI control and prevention in the city and the oblast.

Aiming to share Western Europe's strong tradition of sex education and provide a comprehensive network of institutions to assist young people and risks groups free of charge, the project was organized by the Swedish Institute for Infectious Disease Control and supported by the city and the oblast's health committees, the Ott Institute of Obstetrics and Gynecology at the Russian Academy of Sciences, the WHO Collaborating Center and Uppsala University.

St. Petersburg coordinator Natalya Vorobyova said the program can already report some successes.

From 1998 to 2003, the rate of primary syphilis among 15- to 19-year-olds went down five times, chlamydia by 20 percent, gonorrhea by 2.5 times, and trichomoniasis cases were almost halved, Vorobyova said.

These results are against the rising worldwide trend for the rates of chlamydia and gonorrhea in young people.

Uppsala University's Domeika said the figures for chlamydia, gonorrhea and syphilis in Russia indicate a steady decline, but the figures do not correspond to reality, because of the lack of an effective epidemiological surveillance system.

"Knowledge means power, power over your own life, young persons have the right to knowledge and high quality education, counseling and treatment", Barbro Gustafsson, of Stockholm's South Hospital, said in her report.

The Swedish STI control system has proved reliable enough to export to other countries, even though STIs and abortion rates have risen in Sweden, she said. Nevertheless, the original rates were incomparably lower than those in Russia.

"Sweden's STI rate would be a dream come true for Russia," said Alevtina Savicheva, head of microbiological lab at the Ott Institute.

More than 300 Russian specialists have been trained at Yuventa in the six years that the project has been running in the oblast and the three years it has been operating in the city.

New centers, where teenagers can come for free information and therapy, have opened in the Krasnogvardeisky and Petrogradsky districts under the project's "13 plus" program.

Vorobyova said the Admiralteisky, Kalininsky, Kolpinsky and Frunzensky districts have followed suit, with their centers being financed mainly by district administrations.

Many Russians belonging to high -risk groups, such as homosexuals, prostitutes and the homeless, often do not apply for medical check-ups due to lack of information, finance or the fear of identification. This leads to the monitoring of STI in Russia being even less sophisticated than that of HIV/AIDS. STI rates are especially high among convicts, the conference was told.

The project has been successful at introducing specific best practices at microbiological labs. The project established a direct microscopy or bedside STI patient management training center at the Ott Institute.

Representatives of all the 19 Lenin-grad Oblast districts have attended the 144 hours of training offered.

The project also pays much attention to quality control, such as traceability via carefully updated computer databases and standardized procedures at all clinics, often lacking in Russia.

One more important element in therapy and STI prevention that is frequently neglected in Russia, is what Swedes call "partner notification," including both current and recent partners, and current partners of recent partners.

Staffan Sylvan, a medical officer from Uppsala, said that in Sweden, only 16 percent of partners of people with STI are unidentified, because patients could not remember their details. As many as 30 to 40 percent of the partners notified were diagnosed STI-positive, he said.

The project's organizers say STI control can be efficient only if a cooperation network is created for gynecologists, obstetricians, microbiologists, venerologists, dermatologists and social workers.

With no other network available, the project itself has become one. Under its umbrella, manuals for both doctors and patients have been published. Every STI specialist in the oblast got one.

Once a diagnostic standard changes, the corresponding pages in the folder can be replaced, which makes it a lasting directory, compared with books that quickly go out of date.

In St. Petersburg, cooperation among specialists also suffers from a large number of private clinics that do not share their statistics, as well as easy access to self-treatment in St. Petersburg.

The wide use of antibiotics, cursory examinations for gonorrhea and examinations that fail to detect infections make official records on STI inaccurate, Smirnova said.

The project will continue into 2005. For more information see

www.medsci.uu.se/STIrus/

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