STI Prevention Research: An International Effort
Some common sexually transmitted infections (STIs) are curable, while others are incurable but treatable. All, however, are preventable. That’s why a team of researchers spread across multiple institutions and continents is working toward a clearer understanding of the way HIV and other STIs are acquired and spread. Their striking results have attracted the attention of international health organizations and could potentially influence public health policy.
Since the late 1990s, a team of researchers from NIAID’s Laboratory of Immunoregulation (LIR), the Johns Hopkins Bloomberg School of Public Health, and the Rakai Health Sciences Program in Uganda has sought better ways to diagnose and prevent HIV, chlamydia, herpes, syphilis, and gonorrhea. A large portion of the team’s research has taken place in the Rakai district of Uganda, where a study of a group of 12,000 people has led to breakthroughs in STI diagnosis and prevention. The program is headed by Thomas Quinn, M.D., M.Sc., director of the Johns Hopkins Center for Global Health and senior investigator in the International HIV and STD Section of LIR at NIAID.
Male Circumcision Helps Reduce STI Infection Rates
In 2005, a Rakai study overseen by Ronald Gray, M.B.B.S., M.Sc., and Maria Wawer, M.D., M.H.S., both of Johns Hopkins, revealed a startling result: After surgical circumcision, heterosexual men in the Rakai cohort showed a 60 percent reduction in the rate of HIV infection compared to heterosexual male study participants who were not circumcised. A follow-up study showed that even the wives of the men who were circumcised at the start of the study experienced a reduction in HIV acquisition.
The results were so definitive that Dr. Quinn’s team halted the study and offered circumcision to the control group. This astounding proof of circumcision as an effective HIV prevention method was named the top medical breakthrough of 2007 by Time magazine. That same year, the World Health Organization and UNAIDS both endorsed male circumcision as an effective means of decreasing the spread of HIV.
The study’s success raised another question: Would circumcision have any secondary outcomes? The researchers decided to test their success against other common STIs, and the results were equally promising: Men circumcised at the beginning of the study had a 50 percent reduction in rates of genital ulcer disease due to herpes, syphilis, and chancroid, and a 30 to 35 percent reduction in rates of human papillomavirus (HPV), including the types of HPV that cause cancer. Once again, the benefits also extended to the wives of the circumcised men: a 50 percent reduction in rates of genital ulcer disease, as well as a dramatic reduction in trichomoniasis and bacterial vaginosis.
Using the Web to Improve Chlamydia Prevention
Dr. Quinn’s lab is also working to make chlamydia easier to diagnose and, as a result, easier to prevent among uninfected people. The typical method of diagnosing chlamydia among women is a pelvic exam in a physician’s office. But researchers in Dr. Quinn’s lab, in conjunction with Charlotte Gaydos, Dr.P.H., professor of infectious diseases at Johns Hopkins, helped to develop a method of chlamydia screening using a urine test that makes diagnosis more convenient and private.
Dr. Gaydos and colleagues created a Web site, www.iwantthekit.org, where teens and young adults can read about chlamydia and request a diagnostic kit. Using the kit, a person collects a sample at home, drops it into the provided packet, and mails it to the lab for testing. This program was successfully piloted for women in Maryland, and the service has been expanded to serve men and women in Maryland; West Virginia; Washington, DC; Denver; and some counties in rural Illinois. Dr. Quinn and his team were among the first to demonstrate that such a non-invasive screening for STIs could extend public health efforts to control STIs beyond the hospital or physician’s office.
back to top