Changing trends in sexually transmitted diseases in North Eastern India

Introduction

Sexually transmitted diseases (STDs) are a major health problem throughout the world and their importance has been magnified with the advent of Human Immunodeficiency Virus (HIV) infection. Study of prevalence of STDs is important to know about their incidence at a particular place and to devise appropriate control measures. The pattern of STDs in different parts of the world including India has shown a change in the various STDs over last ten years in North Eastern (N-E) part of our country.

Materials and Methods

The material of this study comprised of well maintained records of 551 cases of STDs admitted at Military Hospital (MH) Guwahati, M H Tejpur, and Air Force Hospital Hospital Jorhat from Jan 1995 to Dec 1999. Only those STD patients who gave history of sexual contact in N-E region were included in our study. Diagnosis was based on history, clinical examination and relevant laboratory investigations. Competitive Elisa tests were done on all cases for HIV infection. The results were compiled and data analysed.

Results

A total of 551 cases were diagnosed to have different STDs from Jan 1995 to Dec 1999 and all of them were males. Majority of cases were in the age group of 19 - 35 years (90.2%) and were married. Out of 551 cases, 53 (9.62%) were found to have infection and HIV. The year wise distribution [Table - 1] shows an increasing trend of HIV infection among STD cases, contrary to the decreasing trend of STD from 145 cases in 1995 to 71 cases in 1999. Out of total cases of STDs 142 (25.77%) were of chancroid, 108 (19.6%) were of CA, 77 cases (13.97%) NGU, 55 (9.98%) cases LGV, 51 (9.26%) cases syphilis and remaining 118 (21.42%) were of GONO, HG, BP and MI. The history of extramarital sexual exposure was present in all cases of which 82% gave history of exposure to commercial sex workers and remaining 18% with amateurs. Among the seven States of NE region, Nagaland and Assam were the main pockets of source of infection (52%).

Discussion

In the present study majority of the 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],[7],[8] All our study subjects were males. This is due to the fact that the study was conducted on defence personnel. In the Armed Forces soliders 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 our study. The decreasing trends in STDs is in accordance with most of the recent reports.[1],[2],[3],[4],[5] The reason for this much - desired effect may be due to better living standards, improvement in medical and educational facilities and also advent of several effective treatment regimens for various STDs in recent years. Another important reason for this may be the fear of AIDS, forcing people to practice of safe sex and seek early treatment. In our study we found increasing trend of HIV positivity among STD cases. It was just 2.07% in 1995 which rose to 21.12% in 1999 and this is inspite of decrease in STD cases from 145 cases in 1995 to 71 cases in 1999. This is in accordance with the findings of other studies.[5],[6]

A comparison of the present data with that seen a decade back (1986 - 1990) in the same region [Table - 2] revealed a sharp decline from 14. 6% to 9.26% in syphilis, 35% to 25.7% in chancroid and 17.08% to 4.72% in GONO whereas a conspicuous upward trend was seen in the incidence of CA (9.17% to 19.6%) and NGU (3.33% to 13.97%). The pattern of other STDs has by and large remained same.

The findings noted in our analysis point out a striking decrease in the incidence of bacterial and treponemal STDs over a period of ten years. This is probably due to the fact that most of the bacterial and treponemal STDs are treated at the primary level by virtue of large number of currently available antibiotics.

The reason for the upward trend noted in relation to CA as attributed by Bhusan Kumar[7] could be due to the increasing antibiotic use to treat bacterial STDs, thereby increasing the reference rate of this disease. Moreover increased rate of self - reporting by patients in the propaganda era could have also played a role in the observed trend.

Rise in NGU has also been observed by Ranganayakulu et al.[8] This could be attributed to the fact that the cases of urethritis are more often first treated by private practitioners as a case of gonorrhoea with powerful and unrelated antibiotics and when the discharge persists due to concomitant mixed infection like C. trachomatis they report to the STD clinic.