Sexually Transmitted Disease Patients Research Articles

Risk Factors And Impacts Of Sexually Transmitted Diseases Among Adult Females In Cairo

This study was conducted on ninety sexually transmitted disease (STD) adult female patients, attending Dermato-Venereology and Gynaecology Clinics, Al-Hussein University Hospital and an equal number of females as controls. The aim of the study was to determine sociodemographic, sexual and health care behaviours risk factors for STDs and to determine their impacts on the studied females. A retrospective, case-control, clinic based study was chosen to perform this research. Vaginal, cervical and urethral swabs and smears were taken. Also, scrapes from any suspicious lesions together with blood samples were taken from STD patients for various laboratory examinations. The most common STD was candidiasis (35.6%). Shared house and unskilled occupations were the most important sociodemographic risk markers, odds ratio (OR) =11.62 and 2.92, respectively. While, vaginal douche use and divorce were the most important gynaecological and reproductive risk factors, OR=7.16 and 4.06, respectively. Furthermore, premarital sexual practice and non-vaginal sexual practice were the most important sexual behaviours risk factors, OR=13.40 and 10.97, respectively. Also, previous infection with STDs and no partner referral were the most important health care behaviours risk factors, OR=6.45 and 4.93, respectively. Moreover, no religious obligation and drugs and/or alcohol use were the most important life style risk markers, OR=12.89 and 6.77, respectively. Lastly, history of pelvic inflammatory disease (18.9%) and pregnancy wastage (17.8%) were the most important impacts of

Risk Factors And Impacts Of Sexually Transmitted Diseases Among Adult Females In Cairo

This study was conducted on ninety sexually transmitted disease (STD) adult female patients, attending Dermato-Venereology and Gynaecology Clinics, Al-Hussein University Hospital and an equal number of females as controls. The aim of the study was to determine sociodemographic, sexual and health care behaviours risk factors for STDs and to determine their impacts on the studied females. A retrospective, case-control, clinic based study was chosen to perform this research. Vaginal, cervical and urethral swabs and smears were taken. Also, scrapes from any suspicious lesions together with blood samples were taken from STD patients for various laboratory examinations. The most common STD was candidiasis (35.6%). Shared house and unskilled occupations were the most important sociodemographic risk markers, odds ratio (OR) =11.62 and 2.92, respectively. While, vaginal douche use and divorce were the most important gynaecological and reproductive risk factors, OR=7.16 and 4.06, respectively. Furthermore, premarital sexual practice and non-vaginal sexual practice were the most important sexual behaviours risk factors, OR=13.40 and 10.97, respectively. Also, previous infection with STDs and no partner referral were the most important health care behaviours risk factors, OR=6.45 and 4.93, respectively. Moreover, no religious obligation and drugs and/or alcohol use were the most important life style risk markers, OR=12.89 and 6.77, respectively. Lastly, history of pelvic inflammatory disease (18.9%) and pregnancy wastage (17.8%) were the most important impacts of

Prevalence of, and risk factors for, HSV-2 antibodies in sexually transmitted disease patients, healthy pregnant females, blood donors and medical students in Tanzania and Norway

The prevalence of specific HSV-2 antibodies was studied in Tanzanian and Norwegian sexually transmitted disease (STD) patients (1095) and non-STD patients (488). Correlates to demographic and behavioural factors were evaluated. Seropositivity was determined by the non-commercial peptide-55 enzyme-linked immunoassay. The prevalence of HSV-2 antibodies was 70% in Tanzanian and 17% in Norwegian STD patients, 35% in Tanzanian blood donors and pregnant women, and 4, 7 and 14% in Norwegian medical students, blood donors and pregnant women respectively. A higher HSV-2 prevalence was associated with female sex, increasing age, previous STDs, history of genital HSV infection, coitarchal age (age at first intercourse) <15 years and HIV seropositivity. Compared to previous data, the prevalence of HSV-2 antibodies in Tanzanian STD patients has increased remarkably. In Norwegian STD patients our results are consistent with, or lower than, the prevalence previously reported in Western Europe. Demographic rather than behavioural factors were associated with higher prevalence of HSV-2 antibodies in STD patients.

High-risk behaviour in young men attending sexually transmitted disease clinics in Pune, India

The present study reports sexual risk factors associated with HIV infection among men attending two sexually transmitted disease (STD) clinics in Pune, India and compares these behaviours between young and older men. Between April 1998 and May 2000, 1,872 STD patients were screened for HIV infection. Data on demographics, medical history and sexual behaviour were collected at baseline. The overall HIV prevalence was 22.2%. HIV risk was associated with being divorced or widowed, less educated, living away from the family, having multiple sexual partners and initiation of sex at an early age. The risk behaviours in younger men were different to older men. Younger men were more likely to report early age of initiation of sex, having friends, acquaintances or commercial sex workers as their regular partners, having premarital sex and bisexual orientation. Young men were more educated and reported condom use more frequently compared with the older men. Similar high HIV prevalence among younger and older men highlights the need for focused targeted interventions aimed at adolescents and young men and also appropriate interventions for older men to reduce the risk of HIV and STD acquisition.

Sero-prevalence of Hepatitis B Surface Antigen (HBsAg), in Sexually Transmitted Disease Patients

Aim: To determine the sero-prevalence of hepatitis B surface antigen (HBsAg), in sexually transmitted diseases(STD) patients and to determine the sex-related risk factors associated with HBsAg Patients and Methods: A descriptive study was performed at the University of Benin Teaching Hospital, on 155 (79males and 76 females) between the ages of 24 and 63years (mean age 35±2.4 years ).Patients were consecutively selected from all adults attending the STD clinic. A questionnaire was administered to each patient, in order to ascertain the possible risk factors, for the transmission of HBsAg, with STDs as the main risk factor. The sex-related factors included a history of multiple partners in the past 6 months, a history of a number of episodes of STDs, history of heterosexual exposure to partners at risk, for example prostitutes; a history of symptoms of an STD at the commencement of the study. Sera were screened for HBsAg, using a rapid chromatographic immuno-assay. Results: The number of HBsAg positives was 14.1%(males 5.1% and females 9%).The sex-related risk factors identified were a history of exposure to partners at risk; a history of HIV antibody; a history of clinical symptoms of an STD at the commencement of the study. Conclusion: The HBsAg sero-prevalence rate of 14.1% is high. The study showed that exposure to sex-related risk factors are liable for the high prevalence of HBsAg observed. In order to curb the further spread of the hepatitis B virus, we recommend prompt treatment of STDs; avoidance of people at risk of STDs; cost effective HBsAg screening and public health education based on the epidemiology of sex-related HBsAg acquisition. Key Words: HbsAg, Seroprevalence, STD Patients. Journal of College of Medicine 2005: 9(2): 107-109

HIV/AIDS epidemics in Vietnam: evolution and responses.

The goal of this study was to describe the evolution of the HIV epidemic in Vietnam and its responses. Surveillance was conducted in 8 provinces in 1994, expanded to 12 in 1995, 20 in 1996, and 30 in 2001. Sentinel populations were sexually transmitted disease (STD) patients, female sex workers (FSWs), injection drug users (IDUs), tuberculosis (TB) patients, antenatal women, and military conscripts. Vietnam is in the concentrated epidemic stage. HIV prevalence had increased significantly in all surveillance population groups in the 1990s. HIV prevalence in the south is higher than in other regions of the country. The national HIV prevalence increased from 10.1% in 1996 to 32% in 2002 among IDUs, from 0.6% in 1994 to 6.6% in 2002 among FSWs, from 0.4% in 1994 to 2.4% in 2002 among STD patients, from 0.03% in 1994 to 0.34% in 2002 among pregnant women, from 0% in 1994 to 0.7% in 2002 among army military recruits, and from 0.5% in 1994 to 3.6% in 2002 among TB patients. The government has a strong commitment to control the epidemic and has implemented many activities for HIV prevention and control. Vietnam's HIV epidemic is predominantly among IDUs. Current intervention activities have not been sufficient to reduce HIV transmission. Vietnam needs to strengthen responses by scaling up the best practices in the most affected population groups by implementing internationally recognised effective interventions appropriately.

Misconceptions about Condom Efficacy Linked to High Risk of Unprotected Sex among Chinese STD Patients

In southern China 71% of males and 28% of females with a newly diagnosed sexually transmitted disease (STD) had had sex with a nonregular partner in the previous six months according to a survey conducted in public clinic. Most respondents with new STDs did not consistently use condoms either with non-regular partners or with regular partners. In addition two-thirds stated that it was likely that they would have unprotected sex with nonregular partners before their STD was cured Misconceptions about HIV STDs and condoms were common among respondents overall but were more common among those with less education. The odds that respondents had had or anticipated having unprotected sex before their STD was cured was elevated among those who had more misconceptions those who believed that condoms were not effective for prevention and those who perceived themselves to be very likely to contract HIV or STDs in the future. (excerpt)

CLINICAL PROFILE AND SEXUAL BEHAVIORS IN PATIENTS OF SEXUALLY TRANSMITTED DISEASES IN A TEACHING HOSPITAL OF EASTERN NEPAL

A hospital based prospective cross sectional study was under taken over one-yearperiod from April 1998 to March 1999 to study the clinical profile and sexual behaviorin sexually transmitted diseases (STDs) patients at Dermatology and Venereology OPDat BPKIHS, Dharan, Nepal. A total of 105 patients giving history suggestive of STDswere studied. These patients were also enquired for their sexual behaviors. Therewere 85 males and 20 females; and the majority (55.2%) was in the age group of 21-30 years. Most of the patients (25.7%) were students followed by housewives (17.2%).service holders (13.3%), businessmen (13.3%), unemployed (9.5%) and fanners(8.5%).. Literates were 80%. Sixty-eight percent males and 90% females were married.Majority of the males contracted infection from CSW (58.8%). Females got theinfection from husbands and friends. More than 50% of male had multiple partnerswhereas in case of females it was only 5%. Homosexual and bisexual were 3.5% and4.7% respectively in males. Unprotected sexual contact was found in 94.1% of malesand 100% of females. Syphilis (30.5%) was the commonest type of STD followed bygonorrhea (14.3%), genital warts (14.3%), chancroid (6.7%), candidiasis (6.7%),herpes genitalis (5.7%), mixed infection (4.7%), donovanosis (2.8%), andLymphogranuloma venereum (0.9%). In homosexual and bisexual, only NGU andsyphilis were seen. STDs constituted 0.97% of all new dermatology patients. In spiteof high proportion of promiscuous sexual behavior, there was only one HIV positivepatient.Key Words: Clinical profile, Sexual behavior, STD patients, Nepal.

Sexual habits and human papillomavirus infection among females in three New Independent States of the former Soviet Union.

On a global scale, the New Independent States (NIS) of the former Soviet Union have an intermediate incidence of cervical cancer, the main etiologic factor of which is human papillomavirus (HPV), a major sexually transmitted disease (STD). Recently, the prevalence of all STDs has exploded in these countries. The goal of this study was to examine the sexual habits and HPV prevalence among females in three NIS countries. In this multinational (European Community-funded) trial, a series of 3,175 consecutive female patients were examined for HPV status (by Hybrid Capture II) at six clinics in Russia, Belarus, and Latvia. A meticulous survey of their sexual habits and other potential risk factors of HPV infections was made by structured questionnaire. Three categories of patients were examined: those attending STD clinics (n=722), gynecological patients (n=761), and those who participated in cervical cancer screening (n=1,692). These three categories were significantly differentiated by a large number of key variables, including the HPV detection rate (44.9% of STD patients, 39.8% of gynecological patients, and 24.5% of those who were screened). A wide variety sexual habits of these subjects were predictors of the HPV status in univariate analysis. Binary logistic regression analysis found that six different variables remained as independent predictors of HPV status. Patient category (STD) and (young) age were two highly significant predictors of increased risk (P<0.0001), whereas having a nonsmoking partner and having zero or one partner during the past 2 years were significant protective factors (P=0.004 and P=0.007, respectively). The results of this study indicate that women and girls in these NIS countries are conservative in many key characteristics of "high-risk" sexual behavior, such as age at onset of sexual activity, number of partners, and casual sex partners. HPV-positive and HPV-negative groups are clearly distinguished by the same variables identified as the key risk factors of HPV infection and cervical intraepithelial neoplasia in Western countries.

Sexually transmitted diseases in children.

Sexually transmitted diseases (STDs) cause considerable morbidity among their victims. This is true even for children. Unfortunately, this aspect has not received due attention and remains a relatively ignored field. We carried out a study of the clinico-epidemiological profile of STDs among the pediatric patients who attended the STD clinic of a tertiary care hospital. Pediatric patients who presented with STDs from January of 1995 to February of 2001 constituted the subject material of this study. A detailed clinical examination and relevant laboratory investigations were carried out in all patients. A total of 15,453 STD patients were seen during this period, out of which 127 were children, giving a prevalence of 0.82% pediatric STD cases. The peak incidence of STDs was seen in the age group of 10-14 years (66.1%). Most of them were illiterate (61.4%) and from low socio-economic backgrounds (70.9%). Notably, 17.3% were from remand homes. The predominant STDs observed among these children were syphilis (25.2%), including six cases of congenital syphilis, vulvo-vaginal candidiasis (11.8%), condyloma-acuminata (14.2%), herpes progenitalis (8.7%) and traumatic lesions (7.9%). Histories or signs of abuse were present in 74% of the patients. Only two cases during the span of the study were HIV positive. Pediatric STDs remain a hidden and neglected problem. Children constituted 0.82% of all STD patients in our series. This may represent only the tip of the iceberg, because several features, including some operational problems, are responsible for underdiagnosis of pediatric STDs. If not treated promptly and adequately, they may result in significant physical and emotional sequelae in children. Thus, it is essential to develop strategies to prevent sexual abuse and to have adequate counselling measures, especially in juvenile delinquents.

Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990–2001

Several studies in sub-Saharan Africa have reported that HIV prevalence in young women is higher than in young men. We used data from Kenya HIV sentinel surveillance conducted from 1990 to 2001 among sexually transmitted disease (STD) patients (15-49 years old) to investigate consistency of gender differentials over time and their risk factors. Of the 15,889 STD patients, the HIV prevalence ranged from 16.0% in 1990 to 41.8% in 1997. The odds ratios (ORs) of HIV infection for women compared to men decreased by age; women 15-24 years were nearly twice as likely as men of the same ages to be HIV infected (OR 1.7 [1.5-2.0]), but risk in those >44 years was almost equal (OR 0.8 [95% CI 0.7-1.2]). The odds of HIV infection for women compared to men were twice in unmarried patients (OR 2.1 [95% CI 1.8-2.3]). This association persisted after controlling for age groups or marital status, residence, level of education, and presence of STD syndromes. This pattern had been consistent over 12 years. Adolescent women with symptoms of STDs should be a focus for the HIV/STD intervention programmes because of their high risk for HIV.

Quality and equity of private sector care for sexually transmitted diseases in South Africa.

The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case study. Private general practitioners (GPs) were interviewed by telephone. Each was presented with a set of STD syndromes and requested to describe how s/he would manage the patient, first if the patient was insured, then secondly if the patient was paying cash (uninsured). Reported prescriptions were costed and assessed for effectiveness against main causative pathogens using local standard clinical guidelines. Knowledge of recent developments in STD syndromic management and effectiveness of prescribed drugs was poor, especially for genital ulcer and pelvic inflammatory disease, and less than half the prescriptions overall were judged as effective. Although the effectiveness of prescriptions for insured and uninsured patients were similar, for most syndromes uninsured patients were offered significantly cheaper and less convenient antibiotic regimens. Effective regimens were also significantly more expensive than ineffective regimens. The results suggest that GPs' perceptions of patients' willingness or ability to pay for drugs have a bearing on quality of care. The paper concludes that STD patients who present to GPs are often offered poor quality of care, and the choice of inconvenient antibiotics impacts disproportionately on the poor. Improvements in the quality and equity of GP care will require interventions that address the factors that determine their behaviour.

Transmission of human herpesvirus 8 by sexual activity among adults in Lagos, Nigeria.

Human herpesvirus 8 (HHV-8) infection is common in Africa, but prevalence varies geographically. Studies in Europe and America suggest spread through homosexual contact, but evidence of heterosexual spread is inconsistent. We examined the association between HHV-8 and markers of risky sexual activity in Nigeria. The study subjects included an adult referent population at relatively low risk of HIV infection, patients attending a sexually transmitted disease (STD) clinic, and female commercial sex workers (CSW). Sera were collected between 1991 and 1994 to study the epidemiology of retroviruses and STD in Lagos, Nigeria. Residual samples were tested for HHV-8 antibodies using a K8.1 enzyme immunoassay and for antibodies to syphilis, chancroid, herpes simplex virus 2, HIV-1/2, and HTLV-1. Associations were sought using chi square tests and logistic regression. Overall, HHV-8 prevalence was 26.5% in 2002 study subjects, being higher among CSW and STD patients (31% in each) than in the referent population (19%). HHV-8 prevalence in women was approximately half that in men in both the referent and the STD populations. Increasing age and STD were each associated with HHV-8-seropositivity in men and women, and among women being a CSW was also a risk factor. HHV-8 antibodies were more frequently detected in those with laboratory evidence of STD in each group. Having at least one STD was associated with having HHV-8 antibodies. The higher prevalence of HHV-8 antibody in groups with multiple sexual partners and the association with STD among individuals both support the sexual transmission of HHV-8 in African adults.

Assessment of emergency department health care professionals' behaviors regarding HIV testing and referral for patients with STDs.

The objective of this study was to evaluate human immunodeficiency virus (HIV) counseling, testing, and referral practices of emergency department health care professionals (i.e., medical doctors [MD], physician assistants [PA], nurse practitioners [NP], and registered nurses [RN]) for patients presenting with other sexually transmitted diseases (STD). All health care professionals from 10 emergency departments in a northeastern county were asked to complete an anonymous survey. The surveys were returned by 154 (41%) health care professionals (RN = 99, NP = 5, PA = 7, MD = 39, other = 4). The average years in practice were 11. Only 7% of respondents were certified to provide state mandated HIV pretest counseling (certification not required for MD). Respondents reported caring for an average of 13 patients per week with suspected STD. Fifty-five percent of respondents reported that they always or usually warn STD patients of their HIV risk, yet only 10% always or usually encouraged these patients to consent to HIV testing in their emergency department (RN = 7%, NP = 25%, PA = 0%, MD = 16%). Reasons for not offering HIV testing in their emergency department were follow-up concerns (51%), not certified to provide pretest/posttest counseling (45%), and too time consuming (19%). Twenty-seven percent of respondents indicated HIV testing was not available in their emergency department despite all hospital laboratories reporting HIV testing capability. Ninety-three percent of respondents were aware that confidential testing sites were available, but only 35% always or usually referred patients not tested in the emergency department elsewhere for testing. Emergency department health care professionals frequently fail to provide HIV counseling, testing, and/or referral for patients with suspected STD.

Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases.

Victimization by intimate partner violence (IPV) may play an important role in sexual decision-making, increasing the risk for sexually transmitted diseases (STDs) and HIV. To explore the relationship between IPV and high-risk sexual behaviors, substance abuse, partners who had sex outside the relationship, and history of STD among women attending an STD clinic. A self-administered survey of patients attending a public STD clinic in San Francisco was conducted from October 1996 to March 1997. Topics included STD history, sexual risk behaviors, partner violence history, partner characteristics, and demographics. Logistic regression analysis was used to assess the independent effect of IPV on STD risk factors. Overall, 2115 patients participated, for a response rate of 96%. Data were analyzed for a subgroup of 409 female patients who reported recent male sexual partners. Among these women, 11% reported IPV in the past 12 months; lifetime history of IPV was 24%. A history of IPV was associated with a self-reported history of STD (adjusted odds ratio [OR], 2.15; 95% CI, 1.23-3.77). IPV in the past 12 months was associated with alcohol or drug use before sex (adjusted OR, 2.36; 95% CI, 1.17-4.77) and main partners who had sex outside the relationship (adjusted OR, 3.75; 95% CI, 1.94-7.26). IPV is common among female STD patients and is associated with risk behaviors and partner factors that increase patients' risk of contracting STD and HIV. Screening and referral for IPV should be routinely conducted for female patients attending STD clinics.

Seroprevalence and determinants of herpes simplex type 2 infection in an STD clinic in Milan, Italy.

A number of studies have shown that the seroprevalence of herpes simplex virus type 2 (HSV-2) is higher among persons attending clinics for sexually transmitted diseases (STD) than among the general population. The HSV-2 seroprevalence among STD patients, however, varies greatly among studies, possibly reflecting differences in the baseline prevalence of the infection among different general populations or in the distribution of risk factors. A cross-sectional study was carried out to determine the seroprevalence of and the risk factors for HSV-2 infection among 776 HIV-negative persons attending an STD clinic in Milan, Italy. All samples were tested with a commercial HSV type-2 specific gG ELISA test. The HSV-2 seroprevalence was 29.5% (95% CI: 26.3-32.7%). The seroprevalence increased with age, yet it did not differ by gender. Among persons with a current STD, the seroprevalence was 44.3%. At the multivariate analysis, older age was independently associated with HSV-2 infection. A self-reported history of genital herpes was predictive of HSV-2 infection. The agreement between history of genital herpes and HSV-2 seroprevalence was poor, however, stressing that in clinical practice, caution should be used in interpreting the presence or absence of a history of genital herpes as an indicator of the presence or absence of HSV-2 infection. Our data show that HSV-2 seroprevalence among persons attending an STD clinic in Italy is high; thus serological screening for HSV-2 might be advisable for STD patients.

Human Papillomavirus Testing and Conventional Pap Smear Cytology as Optional Screening Tools of Women at Different Risks for Cervical Cancer in the Countries of the Former Soviet Union

Human papillomavirus (HPV) infection is a sexually transmitted disease (STD) and the single most important etiological agent of cervical cancer. In parallel with the increase of STDs and because of the lack of any organized cancer screening in the new independent states of the former Soviet Union, the incidence and mortality rates of cervical cancer are rapidly rising. This is the first report from an ongoing European Commission-funded (INCO-Copernicus Program) cross-sectional and cohort study (focused on the key issues of this major health problem in the new independent states) analyzing the performance of the HPV DNA (Hybrid Capture II) test as a potential screening tool for cervical cancer in these countries. A series of 3,175 women (screening, gynecological, or STD patients) from six clinics in Russia, Belarus, and Latvia received routine cytology and HPV testing with Hybrid Capture II (HCII). All women with HPV-positive results or abnormalities in cytology were subjected to colposcopy and biopsy. The sensitivity, specificity, receiver operating characteristics, as well as positive (PPV) and negative predicting values (NPV), were determined for HCII and quality-controlled cytology in detecting significant pathology (cervical intraepithelial neoplasia [CIN] 3 and cancer). Significant pathology was strongly associated with high-grade cytology (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 4.1-17.8; chi-square, p < .0001). Pap smear cytology detected high-grade lesions with a sensitivity of 64.0% (44.8-83.2), specificity of 89.1% (84.5-93.7), PPV of 44.4% (28.8-61.0), and NPV of 94.8% (91.2-98.4). Of the 3,086 samples analyzed by HCII, 33.0% were positive for oncogenic HPV types, with a wide variation (from 23% to 45%) between the three patient groups (p < .0001). The presence of high-grade cytology was significantly associated with HCII positivity at all cutoff levels (OR = 14.4; 95% CI = 8.4-24.5; chi-square, p < .0001; 1 pg/mL threshold). In the receiver operating characteristics curve, the HCII cutoff point most closely balancing sensitivity (83.1%) and specificity (75.6%) was 2 pg/mL. The presence of high-grade histology was associated with HCII positivity (cutoff 1 pg/mL; OR = 4.8; 95% CI = 0.7-34.2;p = .047). At the cutoff (1 pg/mL), sensitivity of the HCII test was 96.6% (90.0-100), specificity was 15.9% (10.6-21.2), PPV was 15.1% (9.9-20.3), and NPV was 96.8% (90.3-100). Changing the cutoff significantly affected sensitivity at 20 pg/mL and NPV at 500 pg/mL. HCII assay is a sensitive tool in detecting significant pathology, but less specific than the Pap test. A negative HCII test practically precludes high-grade CIN (NPV, >95%). Because the performance characteristics of the HCII test depend on the prevalence of HPV and CIN in the study population, the cost-benefit issues in different settings will be the limiting factor for the application of this test as a screening tool.

SEXUALLY TRANSMITTED DISEASES IN AND AROUND GUWAHATI (ASSAM).

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.

Comparing quality of care for sexually transmitted diseases in specialized and general clinics

Objective. The objective of this study was to compare quality of care for patients with sexually transmitted diseases (STDs) in specialized vs. general clinics. Methods. The authors conducted a retrospective chart review evaluating compliance with a set of STD-related process of care quality indicators for adult patients seen in six Los Angeles County clinics (two STD specialized clinics and four general medical clinics). Results. Thirty-two quality indicators were selected using a modified Delphi process. From March 1, 1996, to June 31, 1996, there were 205 STD-related visits to the two specialized STD clinics and 373 STD-related visits to the four general medical clinics. For patients with classic STDs (those for which sexual contact is the primary means of transmission), STD clinics achieved greater compliance than general medical clinics on 14 quality indicators, while general medical clinics achieved greater compliance on 4 indicators. Conclusion. STD clinics provide better overall STD care than general medical clinics. Possible explanations include differences in clinician experience with STD patients and greater use of standardized protocol sheets.

Comparing Quality of Care for Sexually Transmitted Diseases in Specialized and General Clinics

The objective of this study was to compare quality of care for patients with sexually transmitted diseases (STDs) in specialized vs. general clinics. The authors conducted a retrospective chart review evaluating compliance with a set of STD-related process of care quality indicators for adult patients seen in six Los Angeles County clinics (two STD specialized clinics and four general medical clinics). Thirty-two quality indicators were selected using a modified Delphi process. From March 1, 1996, to June 31, 1996, there were 205 STD-related visits to the two specialized STD clinics and 373 STD-related visits to the four general medical clinics. For patients with "classic" STDs (those for which sexual contact is the primary means of transmission), STD clinics achieved greater compliance than general medical clinics on 14 quality indicators, while general medical clinics achieved greater compliance on 4 indicators. STD clinics provide better overall STD care than general medical clinics. Possible explanations include differences in clinician experience with STD patients and greater use of standardized protocol sheets.