To tackle a growing problem of sexually transmitted diseases, Nepal's largest health services NGO recently added STD treatment, prevention and counselling to one its key family planning and maternal and child health clinics.

This has turned out to be a cost-effective way to deal with the STD problem, Yagya B. Karki, head of the Family Planning Association of Nepal (FPAN), told Monday’s session on access to STD diagnosis and treatment. The integrated service, called the FPAN Chitwan Centre, also means lower costs for clients, mostly poor women.

"When you go to an integrated clinic that includes family planning services, people do not frown on you," Karki added. "So STD clients can maintain confidentiality and privacy."

HIV prevention measures -- brochures and free condoms, for example -- are now routine. In the past, there was no such service and no STD treatment available, even though Chitwan is a crossroads for commercial sex.

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As trade routes have opened up to neighbouring India, men from the capital Kathmandu and other regions have travelled by road through Chitwan, across the border in search of work. Growing promiscuity has pushed up STD rates, said Karki. At the same time, many women have been forced by economic realities into the sex trade to support their families, despite the high value that most Nepalese place on sexual fidelity.

FPAN recently applied the integrated approach to two other smaller clinics in other regions, and will do the same in seven others over the next seven years.

G.P. Poumerol of the WHO's gonococcal susceptibility surveillance programme (GASP) presented data on the resistance of gonorrhoea to antibiotics in the Western Pacific. The region, including China, has some 60 million cases of the STD.

Resistance to quinolone is on the rise, Poumerol said, and some strains of gonorrhoea aren't vulnerable to any form of the antibiotic. There is also emerging resistance to tetracycline. No resistance has been observed, however, to third-generation cephalosporins, and very little has been seen in spectinomycin. Penicillins are rarely used in the region, as resistance has been widespread for some time.

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