|Year : 2000 | Volume
| Issue : 2 | Page : 69-72
An epidemiological study of sexually transmitted diseases
TV Gopalakrishnan Nair, LK Asha, PV Leelakumari
TV Gopalakrishnan Nair
Source of Support: None, Conflict of Interest: None
A retrospective data analysis of one thousand STD patients from 1994 to 1998 at Medical College, Trivandrum was carried out. Males constituted 61.1% and females 38.9% in the study. Most of the STD patients were married (68%). In this group, 44.9% of males and 15% of females had extra marital contact (EMC). Of the 155 male married patients who had EMC, 128 (82%) had history of pre marital contact (PMC) as well. Commercial sex workers (CSWs) were the partners for most of the patients for EMC and PMC. The commonest STD was syphilis, both in men and women followed by herpes genitalis and condylomata acuminata. Latent syphilis was the most common type (54%) followed by sec ondary. The prevalence of herpes genitalis and condylomata acuminata showed an increase with a def inite decline in the prevalence of gonorrhoea. HIV was detected in 3.2% of the patients.
Keywords: Epidemiology, STD
|How to cite this article:|
Nair TG, Asha L K, Leelakumari P V. An epidemiological study of sexually transmitted diseases. Indian J Dermatol Venereol Leprol 2000;66:69-72
|How to cite this URL:|
Nair TG, Asha L K, Leelakumari P V. An epidemiological study of sexually transmitted diseases. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jan 17];66:69-72. Available from: http://www.ijdvl.com/text.asp?2000/66/2/69/4872
| Introduction|| |
Sexually transmitted diseases (STDs) have long been recognised as a major public health problem all over the world and they are as common as malaria with more than 6,85000 people infected every day and 330 million new cases each year. In developing countries STDs are ranked among the top five diseases for which adults seek health care services. However, changes in social behaviour have altered the pattern of STDs with certain STDs getting stabilized and certain others showing downhill trend. The advent of HIV has escalated the interest in STDs and in India, thery still continue to be a major public health problem, though the data on epidemiological aspect of STDs are rather meagre in the country. The epidemiological pattern of one thousand STD patients is reported here.
| Materials and Methods|| |
Records of all the 1200 STD patients who attended the Department of Dermatology and Venereology from January 98 were analysed in this retrospective study. Two hundred cases were excluded due to improper recording, voluntary check up after exposure, incomplete investigation and follow up. All the patients were seen by a specialist and the diagnosis was established by appropriate investigations. The socioeconomic and epidemiological data were recorded by a specially trained social scientist.
| Results|| |
More than 54% of the patients belonged to the 20-29 age group and 7% were below 20 years of age. Males outnumbered females, constituting 61% of the total STD patients [Table - 1].
[Table - 2] shows that casual labourers and skilled workers were the majority with an almsot equal contingent of unemployed. Only 0.7% of the total patients were CSWs. Majority of the patients had atleast high school level education (43%) and 4% were graduates. Marital status of the patients showed that 68.4% were married and 28.7% unmarried while 3.2% were separated, divorced or widowed. Degree of marital harmony, among the married, was satisfactory in 93% of the patient and 60% of the patients were in the habit of taking alcohol.
Contraceptive measures were adopted by 34% of the married patients out of which the vast majority (91%) opted for permanent methods. But, of the 287 unmarried patients only four used condom as a protective measure [Table - 3].
History of pre-marital exposure (PMC) was present in 53% of the patients out of which 93% were males. The majority had their first sexual experience between 15 and 25 years of age whereas 3.6% were under 15 years at the time of their first experience. Of the 531 patients with history of PMC, 409 (77%) had CSWs as their partners. For others, the partners were casual contacts and relatives.
The most common provocative factor for PMC was sexual urge (89%). Other reasons were love affairs (3%), influence of friends (3%), curiosity (1.9%) and monetary gains (0.9%). Sexual assault was reported in nine patients (1.77%) [Table - 4].
Out of the 345 married male patients, 155(44.9%) gave history of extramarital contact (EMC) and out of the 339 married female patients 52 (15%) had a similar history of contact. An interesting factor noticed was that 82% of the male patients with EMC had history of PMC as well. CSWs were the partners for the majority of the patients who went for EMC [Table - 5]. The main reason attributed for EMC was separation of the spouse, ranking first for females and second for males [Table - 6]. Sexual urge was the most common cause for EMC in males (69%) and second common cause in females. Other reasons common for both the sexes were marital disharmony, disability of the spouse and for a change.
| Pattern of STDs|| |
Syphilis accounted for nearly 50% of the cases, followed by herpes genitalis [Table - 7]. Condylomata acuminata accounted for 11%. Among males, gonococcal and non-gonococcal urethritis had an almost equal prevalence of 5% and 4.4% respectively, but in females both together accounted for only 8 cases. HIV positivity was seen in 3.2% of cases and the most common STD associated with HIV was syphilis. Chancroid, Donovanosis and LGV constituted 3.9% of all the STD patients.
In the syphilis group majority of the patients had latent syphilis [Table - 8]. Secondary syphilis was the next common followed by primary chancre. Three cases of gummatous syphilis, one each on the nasal septum, hard palate and forearm (noduloulcerative) were noted. There were 2 cases of neurosyphilis and one each of cardiovascular and congenital syphilis.
| Discussion|| |
The prevalence of STD is declining when compared with that of previous years, because of the awareness and better STD care available after the emergence of HIV/AIDS. The males outnumbered the females (1.5:1), though the ratio has come down.  The level of education of the patients reflects the educational status in the state. Majority of the males (57%) and the females (93.57%) were married. Many studies have established that prevalence of STDs is more among married people ,, though there are isolated reports of a higher prevalence in unmarried males.  A higher percentage of married female STD patients indicates conjugal transmission as only 0.7% of female patients were CSWs and only another 15% had history of EMC. The finding that 45% of the married male patients had history of EMC inspite of a married life and 82% of them had the history of PMC as well indicates that the high risk variable acquired early in life persists inspite of marriage.
The study shows that the people are aware of STDs, but reluctant to adopt preventive measures as only 4 out of 287 unmarried patients used condom as protective measure. The married ones who adopted family planning methods preferred permanent methods which offer no protection against STDs, but may encourage clandestine sex.
The pattern of STDs vary in different places. Syphilis is still the commonest STD seen in our patients which is in conformity with the previous reports from the same centre,  in which secondary syphilis was the most common type. A higher prevalence of latent syphilis in this series is because of the use of antibiotics for various indications and without indications,  which can abort early manifestations of syphilis.  At the same time the occurrence of 6 cases of late syphilis (3 with gumma) and one case of congenital syphilis is because at times antibiotics do not reach the needy or the patients are not properly penicillinised.
A higher prevalence of herpes genitalis and a drop in the gonococcal infection (5%) in this study reflect the changing trends in the pattern of STDs in the country as similar findings are reported from other states also. ,,,,,, A rise in the prevalence of condylomata acuminata along with that of herpes genitalis shows that the trend is similar to that in the western countries.  A higher percentage of herpes genitalis in females in this study could be because of the better awareness and STD care provided. Out of the 32 HIV positive cases reported 17 were associated with other STDs, the most common being syphilis (52.9). STDs like chancroid, Donovanosis and LGV are not a major problem in the state probably because of better living conditions.
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[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8]