Syndromic Management Of Sexually Transmitted Infections Research Articles

Factors Affecting the Utilization of Sexually Transmitted Infections Health Services at the Primary Health Centers in El-Damazin locality at Blue Nile State, Sudan 2015-2016

Sexually transmitted Infections (STIs) constitute a public health problem, especially in developing countries and among poor people, women and adolescent. In Sudan, despite the endorsement of STIs health services in 2004, within the primary health care (PHC) service package, the uptake of STIs by those in need remains limited. This study aimed at exploring the factors affecting the utilization of STIs health services at the PHC in El-Damazin locality in Blue Nile State (BNS) in Sudan, 2015 -2016. The Specific objectives of this study were: Assessing the capacity of PHC and care providers, in El-Damazin locality in (BNS), in providing quality STIs health services. The study was descriptive, analytical, cross-sectional health facility based study. The study investigated eight PHC and ten care providers during the study period. The study findings indicated that while 62.5% of the investigated PHC centers provide the STIs health services behind closed door, yet 75% of the investigated PHC centers do not abide by the necessary confidentiality measures in maintaining the records of the patients, as well as lacking some medical equipment. All the investigated eight PHCs centers lack management protocol of the STIs. Female health care providers (CPs) are only 30%. While medical doctors represent 80% of the care providers, only 20% of them received training in STIs syndromic case management. Eighty percent of health CPs specified the lack of protocols and guidelines affects the quality of service to STIs patients. The study concluded that the lack of STIs management protocols and guidelines, lack of specific capacity in STIs syndromic case management, limited numbers of female care providers, insufficient medical equipment adversely affect the quality STIs services.

High prevalence of asymptomatic sexually transmitted infections among human immunodeficiency virus-infected pregnant women in a low-income South African community.

There is a lack of evidence on the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) among HIV-infected pregnant women in South Africa. We conducted a cross-sectional analysis of HIV-infected pregnant women in two healthcare facilities in a South African township to determine the prevalence of CT, NG and TV. HIV-infected pregnant women were recruited during the first antenatal care visit for their current pregnancy and requested to self-collect vulvovaginal swab specimens. Specimens were tested for CT, NG and TV using the Xpert® assay (Cepheid, Sunnyvale, CA). Of 247 tested for CT, NG and TV, 47.8% tested positive for at least one organism; CT = 36.8%, TV = 23.9%, NG = 6.9%. Forty three (17.4%) had multiple infections, of which 42 included CT as one of the infecting organisms. Of the 118 participants who tested positive for at least one sexually transmitted infection (STI), 23.7% reported STI-like symptoms. Among women who tested positive for CT, 29.7% reported symptoms while 47.1 and 27.1% of those who tested positive for NG and TV, respectively, reported symptoms. The high STI prevalence coupled with the low symptom prevalence among infected individuals justifies the use of diagnostic screening approaches rather than syndromic management of STIs in this setting.

The treatment of sexually transmitted infections

The high level of sexually transmitted infections (STIs) in South Africa can be attributed to a large number of factors including low socio-economic conditions, social stigma, gender inequalities, inability to access adequate health care systems and lack of preventative programmes. The main curable STIs consist of chlamydia, gonorrhoea, syphilis and trichomoniasis, most of which occur in the developing world. The inability to adequately treat the infections leads to morbidity and has wide-ranging consequences on reproductive health and the health of infants. Due to the inefficient treatment of STIs, the World Health Organisation (WHO) recommended and promoted the syndromic management of STIs in developing countries at the point of contact with the health service provider with the intention of improving the quality of care of these patients. The syndromic approach to STI management depends on patient symptoms and the signs presented at the clinical examination. The four main syndrome management protocols are for urethral discharge and swollen testes, genital ulcers, vaginal discharge and lower abdominal pain in women. After identification of a syndrome, combined therapy is utilised to treat the common causes of the infection. A diagnosis can be made quite rapidly without the need for expensive equipment and tests or special skills. Health care providers make use of flow charts or algorithms for diagnosis and treatment. Algorithms or flowcharts should be adapted to local conditions taking into consideration aetiology, local antimicrobial susceptibility patterns and drug availability. These protocols will help with the prevention and treatment STIs in South Africa.

Looking for sufficient change: Evaluation of counsellor training for STI syndromic management in India

In India, public health care of Sexually Transmitted Infections is delivered through Designated STI/RTI Clinics (DSRCs) using syndromic management. This paper describes efforts, over three years, to improve in-service training for counsellors positioned at DSRCs—using a data approach. The programme managers realised, through rigorous monitoring of initial induction training reports that, while knowledge and attitudes of most trainees had improved as evident from t-tests, at least one-quarter scored worse on post-training assessments (n=859). Therefore, they undertook a survey using a competency approach to diagnose what critical competencies are influenced through training: counselling skills, risk reduction suggestions, labelling male and female anatomy, record-keeping and STI patient education (n=132). Survey results demonstrated that trainees failed to pass a two-thirds cutoff score in most competencies. These findings led the programme managers to modify training and implement tighter quality measures. In the second round of training – refresher training – outcomes on competency assessments before and after training showed more acceptable performance (n=833). The paper describes how programme managers, after an acceptance of such initial short-comings, developed customized assessments when literature provided limited guidance and how they worked to achieve change that was acceptable for programme needs.

Awareness and Opinion regarding Syndromic approach towards STI/RTI management among private practioners in Patiala, north India

Introduction: Sexually Transmitted Infections (STIs) and Reproductive Tract Infections (RTIs) have been a major public health problem in all the developing countries. STDs and their complications are amongst the top five disease categories for which adults seek health care. The health-seeking behaviour among the general population in India shows that for STI/RTI treatment people prefer non-modern medicine private practitioners. Aims and objectives: 1) To determine awareness and opinion regarding syndromic approach towards STI / RTI case management among the practitioners in private sector. 2) To compare the results with the previous large scale studies and to provide suitable recommendations. Material and methods: This cross sectional study was carried out in urban Patiala in 2012-13 among 100 randomly selected private practioners by personal visiting and getting responses to a set questionnaire. Group A constitutes allopathic and group B constitutes non allopathic practioners. Results and observations: 60% in Group A and 38% in Group B admit to be aware of syndromic approach but only 16 in Group A and 4 in Group B had correctly replied about no. of kits available in syndromic approach. 70% in both the groups were of the opinion that it will generate better follow up while 35-40% believe there is a risk of over treatment with this approach. Discussion: Since, practice of syndromic case management of STIs is presumed to be dependent on the practioners individual opinion and attitude hence it is beneficial to know about their opinion. To raise the rates of treatment as per WHO advised strategy of Syndromic management, confidence building and appropriate knowledge to the health care providers is a must. Conclusion: Apparent need is there for regular educational activities for licensed private practioners as short trainings, CME, seminars on standard treatment protocols.

Genital inflammation, immune activation and risk of sexual HIV acquisition.

Women who have genital inflammation are at increased risk of sexual HIV infection. The purpose of this review is to evaluate the mechanisms for this relationship, causes of genital inflammation, and strategies to manage this condition. We have recently shown in a cohort of South African women that HIV seroconversion was associated with persistently raised genital inflammatory cytokines (including MIP-1α, MIP-1β, and IP-10). Elevated inflammatory cytokine concentrations may facilitate HIV infection by recruiting and activating HIV target cells and disrupting the mucosal epithelial barrier. Bacterial vaginosis and sexually transmitted infections (STIs), which are predominantly asymptomatic in women, cause lower genital tract inflammation and increased HIV acquisition risk. In Africa, where syndromic management of STIs and bacterial vaginosis is standard-of-care, the substantial burden of asymptomatic infections has likely contributed to high-HIV incidence rates. A genital inflammatory profile contributes to the high risk of HIV acquisition in African women. STIs and bacterial vaginosis are poorly managed in Africa and other developing nations and as such remain major drivers of persistent genital inflammation and HIV acquisition among these women.

Healthcare-seeking preferences of patients with sexually transmitted infection attending a tertiary care center in South Kerala

Background:Sexually transmitted infections (STIs) are a major public health problem in developing countries. These diseases are associated with increased risk of transmission of human immunodeficiency virus as well as adverse outcomes on pregnancy and reproductive health. Sexual behavior and healthcare-seeking behavior are identified as the true risk factors of STIs.Methods:Hospital-based cross-sectional study design was adopted. Eighty-five STI patients were studied regarding the inappropriate treatment-seeking behavior, the nature of the first point of contact with the health care, the appropriateness of treatment and the concerns of the patient regarding the services rendered by government health-care facilities.Results:Among the 85 patients studied, 55.3% were males and 44.7% were females. Inappropriate treatment-seeking behavior was seen in 29.8% of males and 36.8% of females. About 59.6% of males and 81.6% of females sought appropriate treatment from modern medicine practitioners before attending our institution. Only 7.1% of males and 3.2% of females received appropriate treatment. The government sector was the choice of treatment for 46.4% males and 93.5% females and this difference was statistically significant (P = 0.00081). Lack of free medicines, issues of confidentiality, and privacy were the major service-related issues in the public sector.Conclusion:Appropriate treatment at the first point of contact with the health system is an important measure to prevent further transmission and development of complications. Health providers from both private and public sector should be given frequent periodic training regarding syndromic management of STIs and the training should stress on the need for risk reduction and condom promotion messages along with medical management. Program planners should take necessary steps to ensure adequate and continuous supply of free drugs and tackle issues of confidentiality and privacy.

Healthcare-seeking preferences of patients with sexually transmitted infection attending a tertiary care center in South Kerala

Sexually transmitted infections (STIs) are a major public health problem in developing countries. These diseases are associated with increased risk of transmission of human immunodeficiency virus as well as adverse outcomes on pregnancy and reproductive health. Sexual behavior and healthcare-seeking behavior are identified as the true risk factors of STIs. Hospital-based cross-sectional study design was adopted. Eighty-five STI patients were studied regarding the inappropriate treatment-seeking behavior, the nature of the first point of contact with the health care, the appropriateness of treatment and the concerns of the patient regarding the services rendered by government health-care facilities. Among the 85 patients studied, 55.3% were males and 44.7% were females. Inappropriate treatment-seeking behavior was seen in 29.8% of males and 36.8% of females. About 59.6% of males and 81.6% of females sought appropriate treatment from modern medicine practitioners before attending our institution. Only 7.1% of males and 3.2% of females received appropriate treatment. The government sector was the choice of treatment for 46.4% males and 93.5% females and this difference was statistically significant (P = 0.00081). Lack of free medicines, issues of confidentiality, and privacy were the major service-related issues in the public sector. Appropriate treatment at the first point of contact with the health system is an important measure to prevent further transmission and development of complications. Health providers from both private and public sector should be given frequent periodic training regarding syndromic management of STIs and the training should stress on the need for risk reduction and condom promotion messages along with medical management. Program planners should take necessary steps to ensure adequate and continuous supply of free drugs and tackle issues of confidentiality and privacy.

Knowledge and Practice of Clinicians regarding Syndromic Management of Sexually Transmitted Infections in Public Health Facilities of Gamo Gofa Zone, South Ethiopia.

Background. Sexually Transmitted Infections (STIs) are the leading causes of morbidity among young adults. This study assessed the knowledge and practice of clinicians regarding syndromic management of STIs in public health facilities of Gamo Gofa Zone, Southern Ethiopia. Methods. Facility based cross-sectional study with mixed methods of data collection was conducted in public health facilities of Gamo Gofa Zone. The study included 250 clinicians and 12 health facilities, 26 mystery clients were hired, and 120 STI patient cards were reviewed. Data was entered in EPI info version 7.0.1 and analyzed by SPSS version 20. Results. Of the participated clinicians, 32 (12.8%) were trained on syndromic management of STIs. Highest knowledge of clinicians was for urethral discharge (27.2%). Professional category of clinicians and type of health facility (AOR = 0.194; 95% CI = 0.092, 0.412) were determinants of urethral discharge knowledge. Of the cards reviewed, only in 8.3% of cards and 19.23% of mystery clients did the clinicians correctly follow the guideline. Conclusion. Knowledge and practice of clinicians regarding syndromic management of STIs in study area were poor. Efforts should be made to increase the knowledge of clinicians by providing training on syndromic management of STIs and supportive supervision should be regular.

Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection

BackgroundUntreated sexually transmitted infections (STIs) and bacterial vaginosis (BV) cause genital inflammation and increase the risk of HIV infection. WHO-recommended syndromic STI and BV management is severely limited as many...

P06.13 Inflammatory cytokine biomarkers identify women with asymptomatic genital infections that increase the risk of hiv infection

Introduction Untreated sexually transmitted infections (STIs) and bacterial vaginosis (BV) cause genital inflammation and increased risk of HIV infection. WHO-recommended syndromic STI and BV management is limited as large numbers of women with asymptomatic infections go untreated. The purpose of this study was to evaluate genital cytokine profiles as a biomarker to identify women with asymptomatic, treatable infections. Methods Luminex was used to measure the concentrations of 42 cytokines in cervicovaginal lavages (CVL) from 227 HIV-uninfected women from Durban, South Africa, and nine cytokines in endocervical swabs from 264 women from Bondo, Kenya and Pretoria, South Africa. Women were screened for BV and treatable STIs ( Chlamydia trachomatis , Neisseria gonorrhoeae , Trichomonas vaginalis , Mycoplasma genitalium ) using microscopy and molecular assays. Nonparametric receiver operating characteristic curves and logistic regression were used to identify cytokine profiles associated with STIs/BV. Results In women from Durban, concomitant increased IL-1α and IL-1β and decreased IP-10 concentrations in CVLs predicted the presence of a treatable genital condition, correctly classifying 76% of women (sensitivity 72%, specificity 81%, PPV 86% and NPV 64%). In a separate validation cohort of women from Bondo and Pretoria, IL-1α, IL-1β and IP-10 concentrations in endocervical swabs correctly classified 72% of the participants according to STI/BV status. This approach performed substantially better than clinical signs in both cohorts from Durban (sensitivity 19%, specificity 92%, PPV 79% and NPV 40%) and Pretoria and Bondo (sensitivity 29%, specificity 78%, PPV 68%, NPV 39%). Conclusion Across two cohorts of women residing in different regions in sub-Saharan Africa, genital IL-1α, IL-1β and IP-10 together was the best immunological predictor of the presence of an STI or BV. Supplementing syndromic management with point-of-care assessment of biomarkers of genital inflammation may improve STI/BV management for women, enabling more effective treatment of asymptomatic infections and potentially reducing their risk of HIV infection. Disclosure of interest statement This work was supported by a Strategic Health Innovation Partnerships (SHIP) grant from the South African Medical Research Council and grants from the Poliomyelitis Research Foundation (PRF) of South Africa and European and Developing Countries Clinical Trials Partnership (EDCTP). The cohorts were supported by grants from the Comprehensive International Program of Research on AIDS (CIPRA) of the Division of AIDS (DAIDS); National Institute of Allergy and infectious Disease (NIAID); National Institutes of Health (NIH) and US Department of Health and Human Services (DHHS) [grant number U19 AI51794]. FEM-PrEP was conducted under two grants funded by the United States Agency for International Development (USAID): the Contraceptive and Reproductive Health Technologies and Research Utilisation Program (GPO-A-00–05–00022–00), and the Preventive Technologies Agreement (GHO-A-00–09–00016–00). Early support was also provided by the Bill and Melinda Gates Foundation. Gilead Sciences, Inc. donated Truvada® and placebo. LM was supported by the PRF; South African Medical Research Council (MRC); the Carnegie Corporation; the National Research Foundation (NRF) of South Africa and the UCT Clinical Infectious Diseases Research Initiative/Wellcome Trust. No pharmaceutical grants were received in the development of this study.

P09.22 The aetiology of genital discharge syndromes in zimbabwe

Background In many countries, sexually transmitted infections (STI) are treated syndromically. Thus, male and female patients with genital discharge syndromes (GDS) receive antimicrobials covering Chlamydia trachomatis (CT), Neisseria Gonorrhoeae (NG) and Trichomonas vaginalis (TV) infections and bacterial vaginosis (BV) among women. However, periodic surveys into the aetiology of GDS are necessary to inform treatment guidelines. Methods For this study, we enrolled 400 patients with GDS at 6 regionally diverse clinics in Zimbabwe. To date, test procedures have been completed for patients enrolled at the Harare study sites (N = 137). Sites were visited sequentially by a mobile unit of 3 trained nurses to enrol patients with STI syndromes, including GDS. STI history and risk data were collected by questionnaire and uploaded to a web-based database. Urine and vaginal specimens were taken for testing with a validated multiplex polymerase chain reaction assay (M-PCR, National Institute of Communicable Diseases, Johannesburg) for CT, NG, TV and Mycoplasma genitalium (MG). Smears for Gram stain and subsequent assessment using Nugent criteria for the diagnosis of BV were obtained from all women with vaginal discharge. Results M-PCR testing is complete for all GDS patients enrolled in Harare; 68 men and 69 women. Positivity rates were as follows. Men: NG = 60.3%, CT = 13.2%, TV = 4.4%, MG = 2.9%. Women: NG = 18.8%, CT = 8.7%, TV = 14.5%, MG = 7.3%. Among women, 31.9% met Nugent criteria for BV and 20.0% had yeast infection identified on Gram stain. Conclusions In this preliminary analysis, gonorrhoea was the most common cause of GDS among both men and women, but much more common among men. Chlamydia infections were substantially less common among both men and women and trichomoniasis was more common than chlamydia infections among women. Regardless of investigated microbiologic causes, many women met criteria for BV. M. genitalium infections were uncommon overall. These findings will inform development of future syndromic STI management guidelines.

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India

Background:Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis.Aims and Objectives:To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach.Materials and Methods:A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence.Results:The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive.Conclusion:Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Study of patterns of sexually transmitted diseases using a syndromic approach in the era of human immunodeficiency virus from a tertiary care hospital of the Northern India

Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice.

ObjectivesPoint-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings.MethodsIn-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise.ResultsParticipants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection.ConclusionsThe introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

Performance and comparison of self-reported STI symptoms among high-risk populations – MSM, sex workers, persons living with HIV/AIDS – in El Salvador

Resource-limited countries have limited laboratory capability and rely on syndromic management to diagnose sexually transmitted infections (STIs). We aimed to estimate the sensitivity, specificity and positive predictive value (PPV) of STI syndromic management when used as a screening method within a study setting. Men who have sex with men (MSM), female sex workers (FSWs) and people living with HIV/AIDS (PLWHA) participated in a behavioural surveillance study. Data were obtained on demographics, sexual behaviours, STI history and service utilisation. Biological specimens were tested for genital inflammatory infections (Neisseria gonorrhoeae [GC], Chlamydia trachomatis [CT], Mycoplasma genitalium [MG], Trichomonas vaginalis [TV]) and genital ulcerative infection (syphilis and Herpes simplex virus-2). There was a high prevalence of Herpes simplex virus-2 (MSM 48.1%, FSW 82.0% and PLWHA 84.4%). Most participants reported no ulcerative symptoms and the majority of men reported no inflammatory symptoms. Sensitivity and PPV were poor for inflammatory infections among PLWHA and MSM. Sensitivity in FSWs for inflammatory infections was 75%. For ulcerative infections, sensitivity was poor, but specificity and PPV were high. Reliance on self-reported symptoms may not be an effective screening strategy for these populations. STI prevention studies should focus on symptom recognition and consider routine screening and referral for high-risk populations.

Evaluation of syndromic management of sexually transmitted infections within the Kisumu Incidence Cohort Study

While laboratory aetiological diagnosis is considered the gold standard for diagnosis and management of sexually transmitted infections (STIs), syndromic management has been presented as a simplified and affordable approach for STI management in limited resource settings. STI signs and symptoms were collected using staff-administered computer-assisted personal interview and audio computer-assisted self-interview. Participants underwent a medical examination and laboratory testing for common STIs. The performance of syndromic management was assessed on the agreement between interviewing methods as well as accurate diagnosis. We screened 846 participants, of whom 88 (10.4%) received syndromic STI diagnosis while 272 (32.2%) received an aetiological diagnosis. Agreement between syndromic and aetiological diagnoses was very poor (overall kappa = 0.09). The most prevalent STI was herpes simplex virus type 2 and the percentage of persons with any STI was higher among women (48.6%) than men (15.6%, p < 0.0001). Agreement between audio computer-assisted self-interview and computer-assisted personal interview interviewing methods for syndromic diagnosis of STIs ranged from poor to good. Our findings suggest that syndromic management of STIs is not a sufficient tool for STI diagnosis in this setting; development and improvement of STI diagnostic capabilities through laboratory confirmation is needed in resource-limited settings.

Changing trends in sexually transmitted infection (STI) clinic attendees - Current scenario

Background: Currently, sexually transmitted infections (STIs) form a huge public health issue in the global scenario. STIs are commonly more active than other prevailing infections in the community amongst the sexually active population and the epidemiological profile is very distinct and more dynamic than other diseases. Aims & Objectives: To understand the changing scenario of STIs and also the non-STIs among patients attending the STI clinic at the tertiary care centre. Materials and Methods: This is a tertiary care based retrospective study of all the patients attending the STI clinic at the department of Dermatology, Venereology and leprology (DVL), Gandhi Hospital, Secunderabad, for 3 years (from January 2011 to December 2013). STIs were categorized into different syndromes as per the syndromic management of STIs, as depicted by National AIDS Control Organization (NACO). Results: A total of 7,859 patients, with complaints of genital lesions, attending the STI clinic, were included in this study. Our study, from 2011 to 2013, showed a declining trend in bacterial STIs and increasing trend of fungal and viral STIs as seen in developing nations. The most common STI in males was candidial balanoposthitis, and females is vaginal/cervical discharge (candidial) followed by viral infections like genital herpes and condyloma acuminata. Conclusion: A comprehensive study of the epidemiological data is very important in order to decrease the incidence and prevalence of STIs and HIV. In order to decrease the incidence and prevalence of STIs and HIV, we need to further impart health education, counselling and improve the standards of health care facilities.

P3.146 Rising STI Prevalence Among MSM Clients in Calabar, Nigeria: A Call For Action

IntroductionEvidence has shown that there are increasing rates of new HIV and other STI infections occurring among Men who have Sex with Men (MSM) in Nigeria, with the prevalence 3...

Pattern of sexually transmitted infections: a profile from a sexually transmitted infections clinic of a tertiary care hospital of eastern India.

Background:Sexually transmitted infections (STIs) are public health problems, which significantly increase the risk of HIV transmission. A proper understanding of the pattern of STIs in different geographical regions is important for proper planning of STI control.Aims:To determine the pattern of sexually transmitted diseases in a tertiary care hospital in Eastern India.Subjects and Methods:This is a hospital-based, cross-sectional study done in a tertiary care hospital of Eastern India. All the consecutive patients attending the STI clinic of a tertiary care hospital from January 2011 to December 2011 were included in the study, irrespective of age and sex. Thorough history was taken; proper clinical examination and relevant laboratory investigations were done. STIs were categorized in different syndromes as depicted by National AIDS Control Organization(NACO) in the syndromic management of STIs. The STIs, which were not included in the syndromic management, were also identified by clinical features and investigations. Partner notification and condom promotion was done. The statistical analysis used was Chi-square test using MedcalcR statistical software Version 9.3 (Belgium).Results:The commonest STI was genital herpes. Viral STIs like genital herpes, condyloma acuminata, molluscum contagiosum were more prevalent than the non-viral ones like genital ulcer disease non-herpetic, syphilis. STIs which were not included in the syndromic management like molluscum contagiosum, condyloma acuminata, genital scabies were common. HIV seropositivity in the study population (4.2%) was more than the NACO estimate. Condom promotion, partner notification, and partner management was not adequate. Occurrence of venereophobia was found to be significantly higher in male than in female attendees of STI clinic.Conclusions:The trend for viral STIs is increasing while that for bacterial STIs is decreasing. Proper training of the health care providers regarding minor STIs, condom promotion, partner notification and partner management, counseling regarding venereophobia should be undertaken to make STI control programs successful.