A study on the present scenario of STD management in an urban clinic in Kolkata

Introduction

Sexually transmitted diseases (STD) remain a public health problem of major significance in most parts of the world[1] and India is no exception. The epidemic of the human immunodeficiency virus (HIV) has boosted the importance of the control of STD, because it is now well established that STD especially those which cause ulcers, greatly increase the risk of HIV transmission. Sexually transmitted diseases are responsible for much worldwide morbidity.[2] Different studies report a high prevalence of HIV positivity among patients who have had chancroid, syphilis or herpes genitalis.[3],[4] In this context treatment of STD promoted through the syndromic management provides health education about safe sex, partner management and condom programming. This study has been done to find out the present scenario of STD management in an urban clinic in Calcutta.

Materials and Methods

The study was conducted at the department of Dermatology, leprology and STD of R.G. Kar Medical College and Hospital, Calcutta. The material of this study comprised of all patients who attended the STD clinic from January 1996 to December 1999. Medical record sheet of patients were analyzed for the study. Trends among the various STD were understood. All relevant investigations, i.e. VDRL test and gram staining that were done to confirm were noted.

Safer sex education and condom promotion were data evaluated. The results were compiled and data analyzed.

Results

The results of the study are given in [Table - 1], [Table - 2], [Table - 3] and [Table - 4].

Discussion

Total number of patients attending the STD clinic in the years from 1996 to 1999 was 4129. Out of this 25.75% were STD cases. Others attended the clinic for check up and investigation, and sex disorders like premature ejaculation, poor erection, loss of libido and also misconception about sex organ as complained of small penis. 86% of STD cases were males and 14% were females (ratio M:F = 6:1). This may be due to conservative behavior of the female, fear of social stigma and lack of typical clinical lesions in females. Prostitutes and promiscuous individuals formed reservoir.[5],[6],[7] The spectrum of age among STD attendants were from new born to sixty, while majority were in the age group 18 to 38 years. This is the period of sex fantasy and increased sex vigor. The incidence of NGU is more than gonorrhoea in this study. This is because patients with acute gonorrhoea less frequently attend hospital clinic due to over the counter availability of highly effective antibiotics and easily accessible private practitioners. NGU is caused by Chlamydia trachomatis in about 30-50% of cases and by Ureaplasma urealyticum in a smaller percentage.′ Some studies suggest that chlamydia - negative NGU responds less well to conventional antimicrobial therapy than does chlamydia positive NGU.[9]

The lower prevalence of genital herpes and LGV in contrast to other studies[2],[10] was noteworthy. The low prevalence of genital herpes might be due to self-resolving short course of the disease and overlooking of the disease during diagnosis. The low incidence of LGV is comparable with other studies where it range from 0.1 % to 0.6% STD,[7] in contrast to higher incidence of LGV in some studies.[9],[10]

13.7% of STD cases were reactive for VDRL test and 8% of the antenatal attendents were VDRL test strongly reactive. These observations stress for continuous examination of all STD attendents and antenatal mothers for VDRL test routinely.[7],[8],[9],[10],[11]

The urethral discharge tested for gram stain was positive for gonococcus was in 29%. In another study by Ghosh et al the positivity was 26.5%.[12]

It can be concluded from this study that though some of the STDs showed a downward trend, nearly a constant management properly implimented at all level of health care system is essential for effective control of STD.