Sexually Transmitted Diseases Syndromes Research Articles

Syndromic Trends in the Sexually Transmitted Diseases (STD) among Patients Visiting STD Clinic of a Tertiary Hospital in the National Capital Region

Sexually transmitted diseases or infections are a major threat to the public. Every year more than one million people acquire it globally. The objectives of this study were: a) to identify the number of patients tested for STDs, b) to assess the number of patients tested positive for STDs, c) to understand the trends of STD syndrome among the patients from January 2018 to June 2019. Data of patients visiting the STD Outpatient Department (OPD) of Safdarjung Hospital, New Delhi with symptoms related to STI/ STD was analysed. Data of patients who visited the OPD for consultation was available, and was used as proxy denominator to guide the analyses. Descriptive analyses were conducted using this dataset. The total number of patients in 2018 was 7363, out of which 4089 (55.53%) were males. In 2019, the total number of patients between January and June was 4346, with an almost similar proportion of males (2241- 51.56%). Of 7363 patients that visited the clinic, 19.7% of patients tested positive for one or the other STD in 2018, whereas from January to June 2019, 18.38% patients tested positive for STD. A total of 1561 cases of Vaginal/ Cervical discharge was seen across the span of 18 months in 2018. This analysis gives an understanding of the number of patients with STD symptoms and syndromes over a period of 18 months at a tertiary level STD centre in Delhi. Since the data available is only for one centre, the results cannot be generalized to the wider population.

Sexually transmitted diseases at Queen Elizabeth Central Hospital, Blantyre, Malawi

Objectives: To re-assess attendance at the sexually transmitted diseases (STDs) clinic in relation to age, sex and seasonal variation over a three-year period, and to determine the pattern of STD syndromes presenting at the STDs clinic, Queen Elizabeth Central Hospital, Blantyre, Malawi.Design: A retrospective study.Setting: STDs clinic, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.Results: The study findings indicate that of the 50,524 attendees, 52.72% and 47.28% were males and females respectively. Over the period there was a significant (30.7%) increase in the number of attendees from 14,622 (28.94%) in 1996 and 16,794 (33.24%) in 1997 to 19,008 (37.82%) in 1998, a trend that was also observed among the sexes. The age range was between 11 and 72 years. More than half(53.55%) of the patients were within 21 to 30 years age rangewhile a total of 48,054 (95.11%) were below 50 years. The most frequently presented STDs syndromes among the 21- 30 year age group were genital ulcer disease (GUD) (40.86%), genitourinary symptoms high risk (GUS - HR) (20.46%), urethral discharge (UD) (15.65%) and pelvic inflammatory diseases (PID) (13.37%). The four constituted 90.34% of all case presentations. Balanitis (BA) was the least common at 0.32% or 86 cases in three years. Whilethe incidence of genitourinary symptoms low risk (GUS - LR) decreased over the years and no clear pattern could be established with (GUS - HR), acute scrotal swelling/pain (SS), and BA, numerical increase in the presentation of UD, PID and enlarged inguinal lymph nodes(BU) was observed. However, the phenomenal increase in the prevalence of STDs particularly GUD rising from 2,988 (37.70%) in 1996 and 3,674 (40.27%) in 1997 to 4,392 (43.88%) in 1998 respectively was noted with concern. There seemed to be a link between seasonal variation and attendance at the STD clinic as more cases presented between March and May peaking in April of each year while December period recorded the least attendance.Conclusion: Attendance rate at the STDs clinic, Queen Elizabeth Central Hospital, Blantyre, is still on the increase in spite of the various STDs/HIV/AIDS awareness campaign programmes.

Prevalence of sexually transmitted disease syndromes in tribal population of central India

Background:A syndromic approach has been advocated for identification and management of sexually transmitted diseases (STDs) in countries where diagnostic laboratory tests are not consistently available. A community-based cross-sectional study was...

Comparative study of syndromic and etiological diagnosis of reproductive tract infections/sexually transmitted infections in women in Delhi

The adequacy of the World Health Organization's syndromic approach for the diagnosis and management of sexually transmitted diseases (STDs), especially at primary health centers (PHCs) and at other levels, is still debatable in different settings in India and requires validation. A cross-sectional study was carried out in women attending the peripheral government clinics of Delhi in order to (1) enumerate their self-reported reproductive tract infection (RTI)/sexually transmitted infection (STI) symptoms; (2) assess their clinical status; (3) determine the syndromic diagnosis of RTI/STI in symptomatic women and etiological diagnosis in both symptomatic and asymptomatic women; and (4) compare the level of agreement between self-reporting of morbidity and syndromic and etiological diagnosis. The study was conducted over 26 months in 4090 women attending peripheral government healthcare centers, both rural and urban, in four zones of Delhi. They were recruited into four different study groups: group I, non-pregnant, reporting with symptoms of RTI/STI; group II, with a bad obstetric history or infertility; group III, pregnant women in any trimester attending the antenatal clinic; and group IV, the control group. Gynecological examination, followed by the collection of genital specimens and blood, were performed after informed and written consent was obtained. Every symptomatic patient was managed on the basis of algorithms of the syndromic approach as recommended by the National AIDS Control Organisation (NACO), India. All specimens were transported to the STD Reference Laboratory, Safdarjung Hospital, New Delhi and processed by standard methods to diagnose the various STDs. Laboratory reports were sent to the clinicians and appropriate treatment was instituted. Data were analyzed by applying statistical methods. Overall, self-reporting of morbidity was 65.0%. However, the percentage of women with some STD-related syndrome was 71.4%. The rural women were observed to have significantly more STD syndromes than their urban counterparts. The etiological diagnosis could be established in only 32.2% of cases. This study highlights the wide variation between self-reporting of morbidity and syndromic- and etiology-based diagnosis in women from both rural and urban settings. This has implications for the syndromic approach to STI case management. These observations call for a review of the diagnostic policy for RTIs/STIs by national authorities in order to avoid the overuse of antimicrobials. The study also highlights the need for the introduction and/or strengthening of facilities for simple diagnostic tests for RTIs/STIs, especially at the peripheral healthcare level.

Aetiology of sexually transmitted disease (STD) and comparison of STD syndromes and aetiological diagnosis in Taipei, Taiwan

Between July 2002 and July 2004, all male patients (n=307) presenting to a sexually transmitted disease (STD) clinic who reported unprotected sex were enrolled in the study. Of these, 63 (20.5%), 19 (6.2%) and one (0.3%) were infected with one, two and three pathogens, respectively. The prevalences of chlamydial infection, gonorrhoea, syphilis, human immunodeficiency virus infection and trichomoniasis were 14.3%, 10.1%, 6.8%, 2.2% and 0%, respectively. The sensitivities of urethral discharge syndrome for detection of chlamydial, gonococcal, and combined forms of infection were 31.8%, 58.5% and 70.0%, respectively, with specificities of 93.5%, 97.1% and 93.9%, respectively. Positive predictive values (PPVs) were 56.0%, 68.0% and 28.0% for chlamydial and gonococcal infections and combinations of the two forms, respectively. In contrast, the sensitivity of genital ulceration syndrome for syphilis detection was only 38.0%, although the specificity was 82.5%, and the PPV was 32.0%. To reduce the number of false-positive results for STD patients who practise unprotected sex, incorporation of risk assessment and rapid diagnostic tests are recommended.

Unexpectedly high prevalence of sexually transmitted diseases in married women attending family planning clinics in Yaounde, Cameroon

The increased number of sexually transmitted diseases (STD) and HIV screening and counselling centres in major cities in sub-Saharan Africa facilitates epidemic investigations elucidating the extent method of transmission and clinical consequences of STD. The aim of the present study was to evaluate the prevalence of STD and HIV/ AIDS among women attending family planning clinics in Yaounde Cameroon and presenting with clinical signs and symptoms related to these infections. From December 1997 to December 1998 783 women of reproductive age attending the three main family planning clinics in Yaounde were prospectively enrolled. These centres offered multipurpose reproductive health services including provision of STD services as well as operating as voluntary HIV testing and counselling centres in Yaounde. Written informed consent was obtained from all women. Reasons for attendance sociodemographic and behavioural data obstetric and STD histories were elicited in a structured interview. Women underwent general genital and pelvic examination during which serum vaginal and cervical samples were collected. Clinical immunosuppression or AIDS-related symptoms were assessed using the World Health Organization Bangui clinical case definition for AIDS in Africa. A seven-day follow-up appointment was arranged for all women and appropriate treatment was provided for any treatable STD syndrome or genital pathogen diagnosed. (excerpt)

Changing patterns in sexually transmitted disease syndromes in Kenya after the introduction of a syndromic management program.

The objective of this study was to evaluate patterns in sexually transmitted disease (STD) syndromes after the introduction of an STD syndromic management program. We used the HIV sentinel surveillance in patients with STDs (1990-2001) to compute the proportions of STD syndromes (as a proportion of all patients with STDs) before and after the introduction of the syndromic management program. A decline in the proportion of genital ulcer disease (GUD), urethral discharge (UD), and vaginal discharge (VD) was observed from the baseline (1990-1994) to the year 2000 (P <0.0001). GUD declined from 27.6% at baseline to 11.0% in 2000; UD from 31.8% at baseline to 22.2% in 2000; and VD from 36.7% at baseline to 20.1% in 2000. Similar declines for these syndromes were also observed in sex and age groups. The proportions of GUD, UD, and UV increased again in 2001. These changing patterns of STD syndromes were coincident with the introduction of the STD syndromic management program in 1995 and the termination of free STD medication in 2001.

The cost-effectiveness of syndromic management in pharmacies in Lima, Peru.

Many people with sexually transmitted diseases (STDs) in Lima, Peru, seek treatment in pharmacies. The goal was to assess the cost-effectiveness of training pharmacy workers in syndromic management of STDs. Cost-effectiveness from both the program and societal perspectives was determined on the basis of study costs, societal costs (cost of medicine), and the number of cases adequately managed. The latter was calculated from estimated incidence, proportion of symptomatic patients, proportion seeking treatment in pharmacies, and proportion of cases adequately managed in both comparison and intervention districts. Univariate and multivariate sensitivity analyses were performed. Under base-case assumptions, from the societal perspective the intervention saved an estimated US$1.51 per case adequately managed; from the program perspective, it cost an estimated US$3.67 per case adequately managed. In the sensitivity analyses, the proportion of females with vaginal discharge or pelvic inflammatory disease who seek treatment in pharmacies had the greatest impact on the estimated cost-effectiveness, along with the medication costs under the societal perspective. Training pharmacists in syndromic management of STDs appears to be cost-effective when only program costs are used and cost-saving from the societal perspective. Our methods provide a template for assessing the cost-effectiveness of managing STD syndromes, on the basis of indirect estimates of effectiveness.

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.

Knowledge of Sexually Transmitted Diseases Management Among Pharmacists in Dar es Salaam Tanzania: A Case Study

This study was conducted to find out if pharmacists are conversant with the management of sexually transmitted diseases (STDs) and whether they use their knowledge appropriately in managing their clients with STDs syndromes. A comparison was made between community pharmacists who graduated before and after the introduction of STDs/HIV management program in the Faculty of Pharmacy, University of Dar es Salaam, Tanzania in 1992. The aim was also to find out if these pharmacists have attended any training on STDs management after their formal training, and whether they are able to make correct diagnosis and give the right drug(s) to their clients suffering from STDs. Self-administered questionnaires were distributed to eighty-seven pharmacists operating in Dar es Salaam. The response was 74.7% (n=65), with female to male ratio of 1:1.8. Of the responding pharmacists, 73.8% reported to have had formal training on STDs management during their undergraduate course. All pharmacists reported that they normally see clients at their pharmacies with complaints suggestive of STDs. All pharmacists were able to list three or more STDs. About 65% of post-curricula pharmacists were able to list one or more STDs causative agents. Ninety four and hundred percent of pre- and post-curricular pharmacists, respectively were found to give the right drug(s) for various STDs. Twenty seven percent post- and 64.7% pre-curricula pharmacists had attended training on STDs management since they graduated. (E & C Afr Jnl Pharm Sci: 2002 5(1): 3-7)

Operational performance of an STD control programme in Mwanza Region, Tanzania

Objectives: To describe important details of the design and operational features of the Mwanza sexually transmitted diseases (STD) control programme. To assess the feasibility of the intervention, the distribution of...

Syndrome packets and health worker training improve sexually transmitted disease case management in rural South Africa: randomized controlled trial

Sexually transmitted diseases (STD) are important co-factors in HIV transmission. We studied the impact of health worker training and STD syndrome packets (containing recommended drugs, condoms, partner notification cards and information leaflets) on the quality of STD case management in primary care clinics in rural South Africa. A randomized controlled trial of five matched pairs of clinics compared the intervention with routine syndromic management. Outcomes were measured by simulated patients using standardized scripts, and included the proportion given recommended drugs; correctly case managed (given recommended drugs plus condoms and partner cards); adequately counselled; reporting good staff attitude; and consulted in privacy. At baseline, the quality of STD case management was similarly poor in both groups. Only 36 and 46% of simulated patients visiting intervention and control clinics, respectively, were given recommended drugs. After the intervention, intervention clinics provided better case management than controls: 88 versus 50% (P < 0.01) received recommended drugs; 83 versus 12% (P < 0.005) were correctly case managed; 68 versus 46% (P = 0.06) were adequately counselled; 84 versus 58% experienced good staff attitude (P = 0.07); and 92 versus 86% (P = 0.4) were consulted privately. A syndrome packet cost US$1.50; the incremental cost was US$6.80. The total intervention cost equalled 0.3% of annual district health expenditure. A simple and affordable health service intervention achieved substantial improvements in STD case management. Although this is a critical component of STD control and can reduce HIV transmission, community-level interventions to influence health-seeking behaviour are also needed.

Quality of sexually transmitted disease treatments in the formal and informal sectors of Bangui, Central African Republic.

Interventions for upgrading sexually transmitted disease (STD) management in sub-Saharan Africa have focused on the public sector, and to a much lower extent on private medical practitioners and pharmacies. However, in most African cities there is a large informal sector that provides care to many patients with STD symptoms. To compare the quality of treatments offered to patients with major STD syndromes in the public sector, pharmacies, and the informal sector of the same city. Healthcare providers in health centers, pharmacies, private laboratories, and market drug peddlers in Bangui, Central African Republic, were asked to complete a short form for every patient consulting them with genital complaints. The treatments they ordered were evaluated for their potential efficacy against the major etiologic agents of the syndrome for which the patient consulted. The majority of male patients with STDs preferred to seek care in pharmacies and in the informal sector. The STD treatments offered to patients with urethral discharge or genital ulcers in pharmacies and in the informal sector tended to focus on a single etiologic agent. The quality of STD treatments offered by drug peddlers and private laboratories was poor, apart from adequate coverage of syphilis in patients with genital ulcers and of candidiasis in women with vaginal discharge. For instance, 41% and 34% of patients with urethral discharge managed by drug peddlers and private laboratories did not receive a drug active against either Neisseria gonorrhoeae or Chlamydia trachomatis, whereas this proportion was 22% in pharmacies and 14% in health centers. For patients with genital ulcers, the proportion offered a drug active against Haemophilus ducreyi was 2% if seen by drug peddlers, 0% in laboratories, 10% in pharmacies, and 25% in health centers. For each syndrome and each category of provider, between one fourth and two thirds of patients had already received another ineffective treatment elsewhere. National STD and HIV control programs will have to improve STD management in pharmacies and in the informal sector if they are to have any impact on the dynamics of HIV infection in urban centers.

Evaluation of the use of calendar blister packaging on patient compliance with STD syndromic treatment regimens.

Good compliance with antibiotic therapy is critical for successful management of sexually transmitted diseases (STDs). To evaluate the use of user-friendly drug packaging as a means of improving patient compliance with STD therapy and the acceptability of the packaging. Compliance of patients with STDs with treatment regimens for three different STD syndromes, using antibiotics packed in standard medicine packaging (SP), was compared to that of patients using calendar blister packaged drugs. Compliance was measured by counting the remaining pills at two return visits. Questionnaires were used to evaluate acceptability of the packs. Compliance was significantly better among patients using the calendar blister packs than among those using standard packs, irrespective of dosing frequency. The degree of poor compliance increased with increasing dosing frequency. There was a high level of satisfaction with the blister pack among patients and health care workers. Compliance can be improved by the introduction of user-friendly drug packaging, especially for more complex dosing regimens.

Inadequate treatment for sexually transmitted diseases in the South African private health sector.

Correct management of sexually transmitted diseases (STDs) is important for their control, and to reduce HIV transmission. Guidelines on syndromic management of STDs were introduced by the provincial Department of Health in KwaZulu/Natal (KZN) in South Africa in 1995. The drug treatment provided for STDs by the 11 private general practitioners in one rural district was assessed and compared with provincial guidelines. Information was gathered through semistructured interviews which asked the 11 doctors, who all dispense prescribed drugs as part of the consultation fee, how they would treat 3 hypothetical cases of STD syndromes. In all 33 prescriptions, the treatment did not correspond exactly with provincial recommendations and only 3 (9%) were adequate. All other prescriptions were inadequate because dose or duration was incorrect in 6 (18%), or because incorrect drugs were prescribed in 24 (73%) of cases. Eight of the 11 doctors did not provide adequate treatment for any of their cases. A continuing medical education programme for the doctors and their staff was devised to improve the STD treatment in the private sector in this South African district.

From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection.

OBJECTIVES: To review the scientific data on the role of sexually transmitted diseases (STDs) in sexual transmission of HIV infection and discuss the implications of these findings for HIV and...

Incidence of HIV and sexually transmitted diseases (STD) in a cohort of HIV-negative men who have sex with men (MSM).

To determine the prevalence of sexually transmitted diseases (STD) and incidence of and risk factors for STD, including HIV-1, among a cohort of HIV-negative men who have sex with men (MSM). Seattle, Washington, United States. Prospective cohort of 578 HIV-negative MSM in which risk factors for acquiring a STD over 12 months follow-up were evaluated using a cumulative incidence analysis. Baseline tests obtained were: herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) Western blots, hepatitis B, and syphilis serologies; anorectal and pharyngeal Neisseria gonorrhoeae (GC) cultures; first-catch urine for leukocyte esterase (LE) and Chlamydia trachomatis (CT) ligase chain reaction (LCR). Men with a positive urine LE had urethral GC cultures obtained. The following outcomes were measured over 12 months follow-up: incident symptomatic bacterial STD (urethritis, proctitis, epididymitis), HSV-1 and HSV-2 seroconversion, and HIV-1 seroconversion. The 31 incident cases of STD (men with bacterial STD) were compared with those 489 men without symptomatic bacterial STD or seroconversion to HSV-1, HSV-2 or HIV-1 infection. Bacterial STD were found in nine participants at enrollment; there were two cases of nonchlamydial urethritis, two cases of nonchlamydial epididymitis, and five cases of asymptomatic GC infection. At enrollment, HSV-2 antibodies were detected in 149 (26.0%) of 572 men and prior hepatitis B infection in 145 (34.8%) of 417 unvaccinated men. During the 1-year of follow-up, 31 men (5.7/100 person-years) had 34 episodes of a symptomatic bacterial STD syndrome (urethritis, epididymitis or proctitis). Urethritis was the most common STD syndrome, detected in 29 men, of whom 10 had GC and 19 had nongonococcal urethritis. In the 1-year of follow-up, five participants seroconverted to HIV-1 (1.3/100 person-years), four to HSV-2 (1.0/100 person-years), and seven to HSV-1 (4.3/100 person-years). Unprotected insertive anal sex [odds ratio (OR) 2.6; 95% confidence interval (CI) 1.2-5.6]; and nitrite inhalant ('poppers') use (OR, 2.3; 95% CI, 1.0-5.0) were independently associated with incident STD. STD and HIV infection continue to be acquired even in a city with an overall low bacterial STD prevalence and among educated MSM receiving regular HIV screening and risk-reduction. Urethritis was the most common STD detected, and public health messages aimed at MSM need to emphasize safe insertive as well as receptive sexual practices.

MANAGING SEXUALLY TRANSMITTED DISEASES IN ADOLESCENTS

Control of sexually transmitted diseases (STDs) in adolescents is a primary responsibility of health care providers. Using the tools of history and physical examination, and drawing on the awareness of different stages of adolescent development, health care providers can define at-risk for STDs. This article discusses screening practices, disease control through reporting and preventive counseling, and treatment guidelines for common STD syndromes.

Sexually transmitted disease syndromes in rural South Africa. Results from health facility surveillance.

Surveillance for sexually transmitted diseases (STD) is important for priority setting, service development, and evaluating interventions. To conduct health facility-based surveillance for STDs to inform design of a control program and to provide baseline measures for evaluation of interventions. Surveillance system for patients with STD syndromes in public and private sector health facilities in Hlabisa, South Africa. Over a 5-month period, 4,781 patients with an STD were reported, 3,126 (65%) by clinics and 1,655 (35%) by general practitioners; 2,582 (54%) were in men. Most were diagnosed with a single syndrome. Discharge was most common (49% of both male and female patients), followed by ulcer (36% of men and 14% of women). Mean symptom duration was 18 days for women and 10 days for men (p < 0.0001). A quarter reported having another STD in the previous 3 months. The highest age-specific incidence was estimated at 16.4% among women 20 to 24 years of age. The burden of STDs is high in rural South Africa. There is considerable scope for improved disease control, and the private sector has an important role to play.