In the United States, estimates of neonatal herpes incidence range from 1 in 3000 to 1 in 25,000 births; global data are lacking [31] and [32]. In areas of high HBV endemicity (e.g., East Asia), HBV is most commonly transmitted from mother to child at birth [3]. These infections lead to chronic HBV infection in 80–90% of cases [33]. HPV and HBV are oncogenic. Infection with high-risk types of HPV is a necessary causal factor for cervical cancer [34], and can also cause anal, vulvar, vaginal, penile, and some oropharyngeal cancers. Worldwide, HPV infection results in 530,000 cases of cervical ATR inhibitor cancer and 275,000 cervical cancer deaths each year, with the vast majority of deaths

(88%) occurring in resource-poor settings [35]. In some areas of the world, cervical cancer is the most common cancer and the main cause of cancer death among women. Among women in Eastern Africa, cervical cancer leads to more than twice as many deaths as the next most common PERK inhibitor cause, breast cancer [35]. Chronic infection with HBV can lead to liver cirrhosis and hepatocellular carcinoma, especially if acquired at birth. Mathematical models have estimated that approximately 600,000 people die from these adverse outcomes of HBV infection annually

[36]. Chlamydia and gonorrhea can ascend to the upper genital tract in women and cause acute pelvic inflammatory disease (PID), tubal factor infertility, potentially fatal ectopic pregnancy, and chronic pelvic pain.

Data on the global STI-related burden of these outcomes are limited. Based on prospective studies in high-income countries, about 10–15% of untreated chlamydia infections lead to clinical PID [37] and [38], and about 10–15% of clinical PID cases lead to tubal factor infertility [37] and [39]. Chlamydia can also lead to asymptomatic tubal infection and infertility, but the extent of this is unknown. The proportion of gonorrhea infections leading to PID and infertility may be even higher, especially in areas without access to early treatment [40]. As an estimated 95.5 million cases of chlamydia and gonorrhea occurred among women in 2008 [9], the numbers of women with adverse reproductive outcomes could be sizable. Estimates of global infertility have ranged from 45 million to 186 million couples PD184352 (CI-1040) unable to have a child over 5 years [41] and [42]. The proportion of infertility that is primarily caused by scarring from genital infection varies by population. In the United States, the proportion of infertility that is tubal factor ranges from 10–40% [43] and [44]. However, in sub-Saharan Africa, tubal infertility may be the cause of up to 85% of infertility [45]. Several STIs increase the risk of both acquiring and transmitting HIV. A large body of literature demonstrates that people with HSV-2 infection have a three-fold increased risk of acquiring HIV infection [46].