To the Editor: With the political changes in eastern Europe in the last 10 years have come social and economic changes (1). Ukraine not only faces almost insurmountable problems as it tries to form a new government, it also faces many serious health issues including sexually transmitted diseases (STDs).

Surveillance data from the Ukrainian STD Center from January 1, 1989, through December 31, 1995, were analyzed on the basis of reports received through 1997. In western Europe, the incidence of syphilis and gonorrhea declined from 1980 to 1991 to less than 2% per 100,000 persons for syphilis and less than 20% per 100,000 persons for gonorrhea. However, in Ukraine, since 1989, the notification rate of syphilis has skyrocketed—from 5 per 100,000 persons in 1990 to 170 in 1995. In some regions, this rate exceeds 220 cases per 100,000 persons. Moreover, cases among children younger than 14 years of age are also increasing. In 1995, the syphilis rate for persons older than 30 years of age was 170 per 100,000; 600 per 100,000 girls younger than 15 years of age; and 1,550 to 2,000 per 100,000 girls 15 to 16 years of age. The large number of girls with the disease is in part due to teenage prostitution (1).

Most syphilis and gonorrhea cases are attributed to sexual transmission. Explanations of this phenomenon include the rapid growth of the sex industry, increasing numbers of homeless persons and refugees in Ukrainian cities, poor diagnostic facilities, punitive legislation that reduces the likelihood of going to treatment services, and limited or inadequate treatment (2).

The Ukrainian government is reviewing its arrangements for the control of STDs, including HIV/AIDS, to identify clear objectives and priorities. Education and treatment would be effective in preventing the spread of STDs in Ukraine, but these measures are inadequately funded (3). Evaluation and risk reduction are also great weapons in preventing the spread of STDs (4). However, the response of the local and world communities has been inadequate in stemming a major STD epidemic in Ukraine.

United Nation's Children's Fund (UNICEF) is developing a long-term program in Ukraine with a focus on STDs in adolescents and youth. This comprehensive program will tackle not only STDs but other related issues, such as HIV and teenagers' reproductive health (5).

Greater coordination of the agencies responsible for STD control in Ukraine will be sought, together with an expansion of health promotion and prevention projects for young persons and groups at high risk (6). An effective strategy for the control of STDs in Ukraine will, therefore, need to find ways to modify current programs and the way they interact to create effective control interventions.

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