Evento: II Curso de Ginecologia de Consultório do HU/USP
Data: 13/03, 17/04, 08/05,19/06, 11/09 e 16/10
Cidade: São Paulo-SP
Coordenação: Divisão Obstétrica e Ginecológica do Hospital Universitário da USP
Supervisão: Prof. Dr. José Aristodemo Pinotti e Prof. Dr. Ricardo Muniz Ribeiro
Contato: Secretaria da Divisão Obstétrica e Ginecológica do HU/USP
Telefone: 11-3039-9468 Anie ou Rozangela

Evento: XV Encontro de Atualização em Patologia do Trato Genital Inferior e Colposcopia Tipo: ENCONTRO
Data: 2/4/2004 a 4/4/2004 Cidade: Atibaia - SP Telefone: (11) 5611 7347 / (11) 5611 2702 Patrocínio: Sociedade Brasileira de Patologia do Trato Genital Inferior e Colposcopia
E-mail: sbptgicsp@uol.com.br
Site: www.cervicolp.com.br

Evento: V Jornada de Ginecologia e Obstetrícia do Vale do Paraíba e I Encontro Cultural de Campos do Jordão Tipo: JORNADA
Data: 17/6/2004 a 20/6/2004 Cidade: Campos do Jordão - SP Telefone: / Patrocínio: Sociedade de Obstetrícia e Ginecologia do Estado de São Paulo E-mail: techne@technecom.com.br

Evento: XXX Curso Teórico-prático de Colposcopia e Citopatologia do Trato Genital Inferior Tipo: CURSO
Data: 16/7/2004 a 21/7/2004 Cidade: São Paulo - SP
Telefone: (11) 5611 7347 / (11) 5611 2702
Patrocínio: Centro de Estudos da Disciplina de Ginecologia da UNIFESP
E-mail: sbtgicsp@uol.com.br
Site: www.cervicolp.com.br

EVENTOS INTERNACIONAIS

2nd SCIENTIFIC MEETING OF THE ASIA PACIFIC MENOPAUSE FEDERATION
Data: 09-12/03/04
Local: Pattaya, Thailand
http://www.docguide.com/

14 th CONGRESS ON PEDIATRIC & ADOLESCENT GYNECOLOGY
Data: 06-09/05/04
Local: Athens, Greece
http://www.docguide.com/

NFOG 2004 - 34 th CONGRESS OF NORDIC FEDERATION OF SOCIETIES OF OBSTETRICS AND GYNECOLOGY
Data: 12-15/06/04
Local: Helsinki, Finland
http://www.docguide.com/

NOTÍCIAS e ARTIGOS RECENTES

JORNAL ZERO HORA 09.02.04

Aids em mulheres

A prevenção da Aids em mulheres e meninas está fracassando, diz o Fundo das Nações Unidas para a Infância (Unicef). Para combater a desinformação, na próxima segunda-feira a entidade lançará uma campanha para conscientizar mulheres quanto ao contágio do HIV.

De acordo com o Unicef, o número de mulheres africanas infectadas pelo HIV é duas vezes maior do que o de homens. A falta de informação é a grande vilã: 80% das jovens de países com altos índices de contaminação não têm conhecimentos sobre a doença.

Para a diretora executiva do Unicef, Carol Bellamy, é necessário buscar mais métodos de prevenção da doença entre as mulheres. Ela afirma que, em muitos lugares, as mulheres sofrem por causa da desigualdade nos relacionamentos com os homens e pelo fato de se sentirem incapazes de negar relações sexuais. Segundo a Organização das Nações Unidas, a cada 14 segundos um jovem é infectado pelo HIV.

BBC BRASIL.COM 10.02.04

Médicos da Universidade de Tóquio anunciaram ter encontrado uma maneira de combinar células-tronco com partículas de gordura para fazer uma prótese de seios natural.
Essas células são encontradas na medula óssea e em outras partes do organismo humano e são responsáveis pela produção de vários outros tipos de células.
O método poderia ser uma alternativa aos implantes de silicone, largamente utilizados atualmente.
A tentativa de usar gordura da própria paciente para aumentar o tamanho dos seios falharam porque alguns tecidos morrem, formando nódulos.
Mas os cientistas japoneses dizem, em artigo publicado no site da revista Nature, que a adição de células-tronco poderia provocar o surgimento de novos vasos sanguíneos, que alimentariam os tecidos.
A equipe de médicos japonesa acredita ter encontrado uma maneira de superar essas complicações.
Durante a cirurgia, as células de gordura são aspiradas da barriga ou das coxas. Em seguida, essa mistura é enriquecida com células-tronco e injetada na área dos seios.
Essas células-tronco são capazes de produzir novas células de gordura.
O cirurgião plástico americano Adam Katz, da Universidade da Virgínia, disse à revista Nature que existem grandes chances de o método desenvolvido no Japão dê certo.
Ele sugere, no entanto, que sejam realizados mais testes com animais antes de se passar a humanos.BRITISH MEDICAL

JOURNAL 7.02.04 (Vol 328, No 7435)
NOTÍCIAS

Instrumental delivery makes future vaginal delivery more likely
Instrumental vaginal delivery is better than caesarean section for future delivery outcomes. Three years after the delivery, Bahl and colleagues (p 311) surveyed 283 women who had had instrumental delivery or caesarean section. They found that subsequent spontaneous vaginal delivery was more likely after an instrumental delivery than after a caesarean section, that fear of childbirth was common after all types of operative delivery, and that difficulty conceiving was more likely after caesarean section. Operative delivery in the second stage of labour has important implications for future delivery outcomes, the authors say, and its psychological impact needs urgent attention.

ESTUDOS
Outcome of subsequent pregnancy three years after previous operative delivery in the second stage of labour: cohort study
ARTIGO DISPONÍVEL NA ÍNTEGRA NO www.bmj.bmjournals.com

Rachna Bahl, specialist registrar1, Bryony Strachan, consultant1, Deirdre J Murphy, professor2
Objective To evaluate the reproductive outcome and the mode of delivery in subsequent pregnancies after instrumental vaginal delivery in theatre or caesarean section at full dilatation.
Participants A cohort of 393 women with term, singleton, cephalic pregnancies who needed operative delivery in theatre during the second stage of labour from February 1999 to February 2000. Postal questionnaires were received from 283 women (72%) at three years after the initial delivery.
Main outcome measure Mode of delivery in the subsequent pregnancy.
Results 140 women (49%) achieved a further pregnancy at three years. 91/283 (32%) women wished to avoid a further pregnancy. Women were more likely to aim for vaginal delivery (87% (47/54) v 33% (18/54); adjusted odds ratio 15.55 (95% confidence interval 5.25 to 46.04)) and more likely to have a vaginal delivery (78% (42/54) v 31% (17/54); 9.50 (3.48 to 25.97)) if they had had a previous instrumental vaginal delivery rather than a caesarean section. There was a high rate of vaginal delivery after caesarean section among women who attempted vaginal delivery 17/18 (94%). In both groups, fear of childbirth was a frequently reported reason for avoiding a further pregnancy (51% after instrumental vaginal delivery, 42% after caesarean section; 1.75 (0.58 to 5.25)).
Conclusion Instrumental vaginal delivery offers advantages over caesarean section for future delivery outcomes. The psychological impact of operative delivery requires urgent attention.

Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour

ARTIGO DISPONÍVEL NA ÍNTEGRA NO www.bmj.bmjournals.com

Elizabeth R Cluett, lecturer in midwifery1, Ruth M Pickering, senior lecturer in medical statistics2, Kathryn Getliffe, professor of nursing1, Nigel James St George Saunders, medical director3
Objectives To evaluate the impact of labouring in water during first stage of labour on rates of epidural analgesia and operative delivery in nulliparous women with dystocia.
Design Randomised controlled trial.
Setting University teaching hospital in southern England.
Participants 99 nulliparous women with dystocia (cervical dilation rate < 1 cm/hour in active labour) at low risk of complications.
Interventions Immersion in water in birth pool or standard augmentation for dystocia (amniotomy and intravenous oxytocin).
Main outcome measures Primary: epidural analgesia and operative delivery rates. Secondary: augmentation rates with amniotomy and oxytocin, length of labour, maternal and neonatal morbidity including infections, maternal pain score, and maternal satisfaction with care.
Results Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% v 66%, relative risk 0.71 (95% confidence interval 0.49 to 1.01), number needed to treat for benefit (NNT) 5). They showed no difference in rates of operative delivery (49% v 50%, 0.98 (0.65 to 1.47), NNT 98), but significantly fewer received augmentation (71% v 96%, 0.74 (0.59 to 0.88), NNT 4) or any form of obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery) (80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of women in the water group were admitted to the neonatal unit (6 v 0, P = 0.013), but there was no difference in Apgar score, infection rates, or umbilical cord pH.
Conclusions Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.

AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
January 2004 • Volume 190 • Number 1
O RESUMO DESTES ESTUDOS PODEM SER ACESSADOS NO www.us.elsevierhealth.com
OU SOLICITE-NOS POR E-MAIL E OS MESMOS SERÃO ENVIADOS IMEDIATAMENTE.

Cannabinoids and the human uterus during pregnancy
Michael C. Dennedy, MB, BSc, Ann M. Friel, PhD, BSc, Diarmaid D. Houlihan, MB, BSc, Venita M. Broderick, MB, Terry Smith, PhD, BSc, John J. Morrison, MD
Galway, Ireland
Expression of CB1 and CB2 receptors was demonstrated in human myometrium; endogenous and exogenous cannabinoids exert a potent relaxant effect on human myometrial contractility by selective modulation of the CB1 receptor.
Commentary
This article demonstrates one of the ways that basic science research can help solve clinical questions. Cannabis use during pregnancy in some studies is associated with an increased frequency of premature labor, whereas in other studies this is not the case. This study, with its findings that cannabis relaxes oxytocin-generated uterine contractions, would favor the latter findings. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: A prospective randomized study
Christopher F. Maher, MBBS, Aymen M. Qatawneh, MD, Peter L. Dwyer, MBBS, Marcus P. Carey, MBBS, Ann Cornish, RN, Philip J. Schluter, PhD
Brisbane, Australia
Abdominal Sacral colpopexy and sacrospinous colpopexy are equally effective in the treatment of vaginal vault prolapse.A prospective randomized study
Christopher F. Maher, MBBS, Aymen M. Qatawneh, MD, Peter L. Dwyer, MBBS, Marcus P. Carey, MBBS, Ann Cornish, RN, Philip J. Schluter, PhD
Brisbane, Australia
Sacral colpopexy and sacrospinous colpopexy are equally effective in the treatment of vaginal vault prolapse.

Objective The purpose of this study was to compare the abdominal sacral colpopexy and vaginal sacrospinous colpopexy in the treatment of vaginal vault prolapse.
Study design Ninety-five women with vaginal vault prolapse were allocated randomly to sacral colpopexy (47 women) or sacrospinous colpopexy (48 women). Primary outcome measurements include subjective, objective, and patient-determined success rates. Secondary outcomes include the impact on bowel, bladder, and sexual function, cost, and quality of life.
Results Two years after the operation (range, 6-60 months), the subjective success rate was 94% in the abdominal and 91% in the vaginal group (P=.19). The objective success rate was 76% in the abdominal group and 69% in the vaginal group (P=.48). The abdominal approach was associated with a longer operating time, a slower return to activities of daily living, and a greater cost than the sacrospinous colpopexy (P<.01). Both surgeries significantly improved the patient's quality of life (P<.05).
Conclusion Abdominal sacral colpopexy and vaginal sacrospinous colpopexy are both highly effective in the treatment of vaginal vault prolapse.

OBSTETRÍCIA

Clinical signs predict 30-month neurodevelopmental outcome after neonatal encephalopathy
Steven P. Miller, MD, CM, Beatrice Latal, MD, Howard Clark, MD, Alison Barnwell, MD, David Glidden, PhD, A. James Barkovich, MD, Donna M. Ferriero, MD,, J. Colin Partridge, MD, MPH
San Francisco, Calif
The severity of neonatal encephalopathy and the presence of seizures, as early as the first day of lire, are valuable predictors of 30-month neurodevelopmental outcome

Accuracy of home pregnancy tests at the time of missed menses
Laurence A. Cole, PhD, Sarah A. Khanlian, Jaime M. Sutton, Suzy Davies, PhD, William F. Rayburn, MD
Albuquerque, NM
Claims that home pregnancy tests accurately detect pregnancy on day of missed menses are misleading because human chorionic gonadotropin concentrations are often too low and sensitivity is too variable.

Subcapsular liver hematoma in HELLP syndrome: Evaluation of diagnostic and therapeutic options—A unicenter study
Corinna Wicke, MD, Philippe L. Pereira, MD, Eva Neeser, MD, Ingo Flesch, MD, Enno A. Rodegerdts, MD, Horst Dieter Becker, MD
Tuebingen, Germany
This unicenter five-case series illustrates the full diagnostic and therapeutic spectrum in conservative and operative management of subcapsular liver hematoma in HELLP syndrome.

Dystocia in nulliparous patients monitored with fetal pulse oximetry
Richard P. Porreco, MD, Frank H. Boehm, MD, Gary A. Dildy, MD, Hugh S. Miller, MD, Elizabeth A. Wickstrom, MD, Thomas J. Garite, MD, David Swedlow, MD
Nashville, Tenn, New Orleans, La, Tucson, Ariz, Kansas City, Mo, and Irvine and Pleasanton, Calif
Significantly nonreassuring fetal heart rate patterns predict cesarean delivery for dystocia among nulliparous patients whose fetuses are oxygenated normally.

Unselected low-risk pregnancies and the effect of continuous intrapartum fetal heart rate monitoring on umbilical blood gases and cerebral palsy
Hiroshi Sameshima, MD, Tsuyomu Ikenoue, MD, Tomoaki Ikeda, MD, Masato Kamitomo, MD, Satoshi Ibara, MD
Miyazaki and Kagoshima, Japan
In unselected low-risk pregnancies, intrapartum fetal heart rate monitoring is useful to detect fetal acidemia, and cerebral palsy is restricted to unavoidable accidents.

THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION VV
VOLUME 291 Nº 6 11.02.04
Tertiary Contact Vaccinia in a Breastfeeding Infant
Vinaya Garde, MD; David Harper, MD; Mary P. Fairchok, MD
JAMA. 2004;291:725-727.
On May 4, 2003, a US Army soldier received primary smallpox vaccination and experienced a primary uptake reaction at the inoculation site on days 6 through 8. The vaccinee reported observing all of the standard precautions to avoid household spread. In mid May, his breastfeeding wife developed vesicles on both areolas. On May 29, their infant daughter developed a papule on her philtrum. Contact vaccinia was confirmed by positive polymerase chain reaction and culture for vaccinia of both the maternal and infant lesions. This is the first documented case of inadvertent contact vaccinia transmission from a mother to her infant through direct skin-to-skin and skin–to–mucous membrane contact while breastfeeding. The mechanism of transfer from the vaccinee to the spouse is uncertain. This report demonstrates that breastfeeding infants living in close contact with smallpox vaccinees are at potential risk for contact vaccinia, even if the vaccinee is not the breastfeeding mother, and highlights the need for special precautions to prevent secondary transfer to breastfeeding mothers.

Author Affiliations: Department of Pediatrics, Madigan Army Medical Center, Tacoma, Wash.

International Journal of Gynecology & Obstetrics
Volume 84, Issue 2 , February 2004

Laparoscopic tubal anastomosis

S. C. Ribeiro, R. A. Tormena, C. G. Giribela, C. R. Izzo, N. C. Santos and J. A. Pinotti

Department of Obstetric and Gynecology, Clinics Hospital of São Paulo University School of Medicine (HCFMUSP), São Paulo, SP, Brazil
Received 5 February 2003; revised 5 May 2003; accepted 7 May 2003. ; Available online 27 November 2003.

Abstract
Objectives: To evaluate the pregnancy outcome after laparoscopic tubal anastomosis. Methods: From December 1998 to December 2001, 26 patients with bilateral tubal ligation who underwent laparoscopic tubal anastomosis were prospectively evaluated. Patients' age varied from 28 to 37 years. Results: Laparoscopic tubal reversal was performed in 23 patients. Bilateral reversal was possible in all but two patients. The operation time ranged from 95 to 155 min and all patients were discharged in the following morning after surgery. After 3 months, tubal patency was confirmed in 15 patients (15/23). Pregnancy rate was 56.5% (13/23), without ectopic pregnancies. The average time from tubal reversal and pregnancy was 6 months. Conclusions: In selected cases, laparoscopic tubal reversal can be offered to patients who had been submitted to tubal sterilization and desire new pregnancies. Patient selection as well as meticulous surgical technique are key factors in achieving satisfactory pregnancy rates.

GYNECOLNEWS

Nipple-Sparing Mastectomy Reasonable Option for Carefully Screened Patients

CLEVELAND, OH -- February 10, 2004 -- Research conducted at The Cleveland Clinic is challenging the long-held belief that nipple-sparing surgery is not a reasonable option for women undergoing total breast removal. Instead, the study concludes that carefully screened patients may have the option of undergoing a nipple-sparing mastectomy, which more closely preserves the body's natural appearance.
Joseph P. Crowe, M.D., director of the Breast Center at The Cleveland Clinic, developed the nipple-sparing procedure and led the study of 54 nipple- sparing mastectomy procedures involving 44 Clinic patients who were carefully screened and deemed eligible for the procedure. Results for the study, conducted between September 2001 and June 2003, appear in the Feb. 9 issue of Archives of Surgery.

Climara Pro (Estradiol/Levonorgestrel) Transdermal Therapy, to Help Alleviate Menopausal Hot Flashes and Night Sweats, Now Available in US

New Once-A-Week Patch Offers Effective and Convenient Treatment with Lowest Estrogen Dose Available in Combination Therapy
MONTVILLE, NJ -- February 10, 2004 -- Berlex, Inc., a U.S. affiliate of Schering AG, Germany (NYSE: SHR), announced today that Climara Pro™ (estradiol/levonorgestrel transdermal system), is now available to U.S. women in pharmacies nationwide. Climara Pro effectively relieves moderate to severe vasomotor symptoms such as hot flashes and night sweats with the lowest estrogen dose of any combined hormone therapy in a convenient, once-a-week patch.
" The availability of Climara Pro provides the thousands of U.S. women impacted by these debilitating menopausal symptoms with a significantly different and much-needed new option," said Marie Foegh, M.D., D.Sc., Vice President of Medical Affairs for Female Healthcare at Berlex. "Climara Pro offers effective symptom relief with one-twentieth of the estradiol dose of standard oral hormone therapy products and is the first HT to use the trusted progestin, levonorgestrel."
The transdermal technology of Climara Pro allows for continuous delivery of the hormones estradiol, which simulates the estrogen made by the ovaries (0.045 mg/day), and levonorgestrel, (0.015 mg/day) at doses substantially lower than in pills, through a thin, translucent patch that is easily affixed to the skin and virtually invisible after being applied. Transdermal delivery, unlike oral therapy, also avoids first-pass effects through the liver during absorption. This translates to no increase in triglycerides or sex hormone binding globulin (SHBG).

REVISTA SAÚDE PÚBLICA v.38 n.1 São Paulo fev. 2004

NOMURA, Roseli Mieko Yamamoto, ALVES, Eliane Aparecida e ZUGAIB, Marcelo.
Complicações maternas associadas ao tipo de parto em hospital universitário. Rev. Saúde Pública, fev. 2004, vol.38, no.1, p.9-15. ISSN 0034-8910.
OBJETIVO: Analisar as complicações maternas associadas ao tipo de parto e comparar o parto cesáreo com o via vaginal. MÉTODOS: Estudo retrospectivo de 1.748 partos realizados em hospital universitário de São Paulo no período de abril a dezembro de 2001, cujos recém-nascidos apresentaram peso superior a 500 gramas. Foram analisadas as complicações maternas ocorridas durante o parto e as diagnosticadas durante o puerpério, necessitando de nova internação da paciente. Para análise estatística, foram utilizados o teste t de Student e o teste Exato de Fisher. Adotou-se como nível de significância o valor de 0,05. RESULTADOS: O parto cesáreo foi realizado em 988 pacientes (56,5%) e o por via vaginal em 760 (43,5%). As complicações hemorrágicas ocorreram em 1,2% dos casos de cesárea e em 0,8% dos casos de parto via vaginal, sem diferença significativa entre esses grupos. A endometrite ocorreu em 0,4% dos casos de cesárea e em 0,1% dos partos por via vaginal, não sendo observada diferença significativa. Dois casos de infecção puerperal evoluíram para histerectomia no grupo cujo parto foi cesáreo. Não foi observado nenhum caso de óbito materno relacionado à cesárea. CONCLUSÕES: Não foram constatadas associações entre as complicações maternas e o tipo de parto no período analisado.

THE NEW ENGLAND JOURNAL OF MEDICINE Volume 350 February 12, 2004 Number 7

Circulating Angiogenic Factors and the Risk of Preeclampsia
Richard J. Levine, M.D., M.P.H., Sharon E. Maynard, M.D., Cong Qian, M.S., Kee-Hak Lim, M.D., Lucinda J. England, M.D., M.S.P.H., Kai F. Yu, Ph.D., Enrique F. Schisterman, Ph.D., Ravi Thadhani, M.D., M.P.H., Benjamin P. Sachs, M.B., B.S., D.P.H., Franklin H. Epstein, M.D., Baha M. Sibai, M.D., Vikas P. Sukhatme, M.D., Ph.D., and S. Ananth Karumanchi, M.D.
ABSTRACT
Background The cause of preeclampsia remains unclear. Limited data suggest that excess circulating soluble fms-like tyrosine kinase 1 (sFlt-1), which binds placental growth factor (PlGF) and vascular endothelial growth factor (VEGF), may have a pathogenic role.
Methods We performed a nested case–control study within the Calcium for Preeclampsia Prevention trial, which involved healthy nulliparous women. Each woman with preeclampsia was matched to one normotensive control. A total of 120 pairs of women were randomly chosen. Serum concentrations of angiogenic factors (total sFlt-1, free PlGF, and free VEGF) were measured throughout pregnancy; there were a total of 655 serum specimens. The data were analyzed cross-sectionally within intervals of gestational age and according to the time before the onset of preeclampsia.
Results During the last two months of pregnancy in the normotensive controls, the level of sFlt-1 increased and the level of PlGF decreased. These changes occurred earlier and were more pronounced in the women in whom preeclampsia later developed. The sFlt-1 level increased beginning approximately five weeks before the onset of preeclampsia. At the onset of clinical disease, the mean serum level in the women with preeclampsia was 4382 pg per milliliter, as compared with 1643 pg per milliliter in controls with fetuses of similar gestational age (P<0.001). The PlGF levels were significantly lower in the women who later had preeclampsia than in the controls beginning at 13 to 16 weeks of gestation (mean, 90 pg per milliliter vs. 142 pg per milliliter, P=0.01), with the greatest difference occurring during the weeks before the onset of preeclampsia, coincident with the increase in the sFlt-1 level. Alterations in the levels of sFlt-1 and free PlGF were greater in women with an earlier onset of preeclampsia and in women in whom preeclampsia was associated with a small-for-gestational-age infant.
Conclusions Increased levels of sFlt-1 and reduced levels of PlGF predict the subsequent development of preeclampsia.

THE LANCET Volume 363, Number 9408 14 February 2004

Sexually transmissible infections other than HIV
Basil Donovan
Lancet 2004; 363: 545-56

School of Public Health, University of Sydney, NSW 2006, Australia (Prof B Donovan MD)
Sexually transmitted infections (STIs) are notable for their fastidious requirements for transmission and growth in the laboratory and for their high physical and psychosocial morbidity. The combination of subtle or absent symptoms and stigma preventing the seeking of health care, leaves many infections undiagnosed. The development of nucleic-acid amplification tests heralded a new era in sensitive and robust diagnostic procedures for STIs. Unfortunately, many of these tests are not commercially available or are too expensive for the populations that need them most. Single-dose oral azithromycin has improved the treatment of several bacterial STIs, but quinolones are rapidly becoming ineffective for gonorrhoea. Self-treatment of genital warts with podophyllotoxin or imiquimod preparations is attractive to patients and might be cost effective for health services. The prospect of effective vaccines against genital papillomaviruses in the near future is real. Such vaccines could reduce the global incidence of some anogenital cancers. Episodic treatment of genital herpes is getting easier and cheaper, and suppressive treatment can reduce transmission to regular sexual partners. A vaccine against herpes simplex virus type 2 has shown some limited efficacy. Ultimately, better control of STIs, and reduction of their contribution to the spread of HIV, will require a broad health-sector response with adequate resourcing, and a change in social and political attitudes.