SEXUALLY TRANSMITTED DISEASES IN AND AROUND GUWAHATI (ASSAM).

Abstract

Dear Editor, The prevalence of sexually transmitted diseases (STDs) in any community is an index of socioeconomic status, moral outlook and practice, presence of efficient machinery for early diagnosis, availability of treatment facilities and mass awareness of preventive measures. There are few regional studies available from India, the pattern of STDs in which has varied widely [1, 2, 3, 4, 5, 6]. Herein we present what we believe to be first reported study on STD pattern in and around Guwahati (Assam). Records of 405 fresh STD patients admitted at Military Hospital Guwahati from Jan 1995 to Dec 1999 were analysed. Only those STD patients with source of sexual contact in and around Guwahati area were included in our study. Diagnosis was based on history, clinical examination and relevant laboratory investigations. In the present study majority of the study subjects were in the age group of 19-35 years (91%). This is in accordance with most of the studies as sexual activity in this age group is at peak [1, 2, 3, 4, 5, 6], Dimapur, Silchar, Shillong and Guwahati were the main pockets of infection (42%). In the Armed Forces soldiers very often stay away from their families for a long time and this might be an important factor for high incidence of STDs among married persons in the present study. The incidence of chancroid varies from 5-38.9% in different reports [1, 2, 3, 4, 5, 6]. lt was the commonest STD (31.4%) in present study. This is in accordance with most of the reports but in contrast to reports from Port Blair [1], Chandigarh [2] and Pondicherry [3]. We feel it could be due to treatment of genital sores by general practitioners with pernicillin and when these cases do not respond to treatment they report to STD centers. Condyloma acuminata was the second common STD with incidence amounting to 20.74%. This is in contrast to most of the studies but in agreement to report from Chandigarh [2]. Non-gonococcal urethritis (NGU) was the third common STD amounting to 15.6%. This is in contrast to almost all studies except the report from Kurnool [4]. In the industrialized countries. NGU is more common than gonococcal urethritis. C trachomatis can be isolated from 20-50% of men with NGU and from 15-30% with gonococcal urethritis. The reason for high incidence of NGU in our study is probably because of the fact that private practitioners generally treat a case of urethritis as gonococcal urethritis by single dose of drug of quinolones or cephalosporins and when the discharge persists due to concomitant C trachomatis infection they report to the STD clinic. Lymphogranuloma venereum (LGV) was the fourth common STD (11.1%). On comparing our data we found the incidence was almost equal to that reported from Pondicherry [3] and Jammu & Kashmir [5] but much higher than those reported by others. Syphilis was the next common STD (6.91%) and early syphilis constituted the bulk. Early diagnosis, effective treatment and good follow up system are probably responsible for low incidence of late syphilis in the Armed Forces. Surprisingly the incidence of gonorrhoea in the present study was very low (4.93%). This is in contrast to most of the studies except the report from Chandigarh [2]. This declining trend could be attributed to the fact that most of the gonorrhoea cases are treated at the primary level with newer effective single dose regimen. TABLE 1 STDs in study population The incidence of psychosexual problem was seen in 4.7% of cases. Majority of the cases were of ‘dhat syndrome’. Only two patients presented with venereophobia. Herpes genitalis was seen in only 1.23%, which is in contrast to most of the reports. This low incidence may be due to under diagnosis of H genitalis due to lack of sophisticated laboratory facilities. Though the incidence of donovanosis in our country varies from 3.5-7.7% with highest from Pondicherry [3], interestingly not even a single case was seen in our study. To conclude chancroid appears to be the commonest STD in and around Guwahati followed by condyloma acuminata, NGU, LGV and syphilis. Moreover as the incidence of various STDs varies from place to place and from time to time it is advisable to have more and more such regional studies which will help in identifying the pattern of STDs all over the country and in turn facilitating formulation and implementation of national STD control programme more effectively.