The geographical and temporal evolution of sexually transmitted disease epidemics

In developing appropriate interventions to control sexually transmitted infections (STIs) it is important to understand the distribution of infections, and how this distribution is influenced by the dynamic nature of epidemics. The epidemiology of STIs has been described as a series of phases, which loosely positions a population within the history of an epidemic. The relation between a mathematical theory describing STI epidemiology and the taxonomy of "phases" is explored in this review of the transmission dynamics of STIs. The likelihood of spread and persistence of infection depends upon the basic reproductive number, whereas the endemic prevalence of infection depends upon the way in which heterogeneity in risk focuses the density dependent constraints limiting the spread of infection. All interventions aimed at reducing the prevalence and incidence of infection must act through the reproductive number. The key parameters determining the reproductive number and the relevance of risk behaviours depend upon the biology of the particular infection. The division between high transmission probability, short duration infections and low transmission probability, long duration infections is explored.