STD trends in regional institute of medical sciences, Manipur

Introduction

Sexual promiscuity and unsafe sexual practices increase the risk of acquiring STDs, a major high risk for transmission of HIV infection all over the world including India.′ Sexual intercourse was the dominant mode by which HIV was spreading in India with infection already prevalent in 1986 among the sex workers and their clients who were sexually promiscuous men. There is a strong association between HIV infection and STDs, especially those causing genital ulcers such as chancroid, syphilis and genital herpes.′ High prevalence of STDs led to increased susceptibility to HIV which in turn led to a high prevalence of HIV because of interaction between the two diseases.[3] There is a need for study of the trends in STDs and their correlation with HIV to develop effective preventive measures.

Materials and Methods

STD patients attending the STD clinic at Regional Institute of Medical Sciences (RIMS) hospital, Imphal during January, 1996 to December, 2000 were recorded in a proforma which basically consists of the details of the age, sex, history of contact and typical findings of the patients. Relevant laboratory tests were carried out whenever possible. The HIV test was done after pretest counselling and obtaining the consent of the patient. Tests for VDRL and HIV antibody were carried out in the Microbiology department and HIV/AIDS National Reference Laboratory (NRL) at RIMS hospital respectively.

Results

[Table - 1] shows the total attendance of the patients in the skin OPD during the period of study. Out of the total 67,433 patients, 36,942 were males and the rest females. The percentage of STDs among the cases was 3.30%.

[Table - 2] shows the sex distribution of the STD cases.

There were 1993 males and 237 females. In [Table - 3], the types of STD have beer classified as ulcerative, discharge and miscella neous groups. In the ulcerative group, the commonest STD was balanoposthitis (22%), follower by chancroid (10.8%), genital warts(9.6%), syphilis(6.2%), genital herpes (5.2%), molluscum (0.9%), granuloma inguinale (0.6%) and lymphogranuloma venereum (0.1%). Sec-ondary syphilis (52.2%) and primary syphilis (38.8%) were the common presentations of syphilis.

Gon-orrhoea (11.8%) was followed by NGU (11.2%), vaginal candidi-asis(2.6%), trichomoniasis (2.3%) and bac-terial vaginosis (0.6%) in the dis-charge group. STD related scabies and fungal infections ac-counted for 9.7% and psychosexual disorders were observed in 6.4% in the miscellaneous group. The maximum number of males (46.1%) and fe-males(45.1 %) were between 25-34 years of age [Table - 3] ).

Discussion

STDs accounted for 3.30% of the skin OPD attendance. The maximum number of patients (72.5%) were between 15 and 34 years of age which is a sexually active age group. Male and female ratio was 8.4:1. STD symptoms in females are usually not pronounced as in case of males. Moreover, most of the female patients attended Gynaecology clinic first.[4] This might explain the low attendance in STD clinics. The upward trend in cases of balanoposthitis in males and candidal vaginitis in females in comparision with a steady trend of syphilis and chancroid has been depicted in [Table - 4]. Irritants (49.18%) and candidal infections (42.24%) were found to be the main causes of balanoposthitis in this study. Increasing misuse of antiseptic soap and household remedies by those who were at risk might partly be responsible for causing balanoposthitis. Increasing mass awareness about STD/ HIV infections could explain the increasing occurrence of psychosexual disorders observed in the study.

Since RIMS hospital is the largest referral hospital in Manipur, our findings may give a rough indication of the pattern of STDs in this State. There is a broad concordance between our findings and the findings of other workers in other parts of the country. Bhusan et al found genital warts (12.4%), gonorrhoea (16.9%), chancroid (12.2%%), genital herpes (11.4%) and syphilis(10.4%) in a study in Chandigarh.[5] Another study in Chengalpattu, Madras has shown that the commonest STD was chancroid (24.4%) in men and syphilis (29%) in women while balanoposthitis (11.4%) ranked third in men.[4] An earlier study in RIMS hospital has also shown balanoposthitis (27.4%) to be the commonest STD, followed by NGU(I 4.5%) and genital warts(13.5%).[6] Other workers have also reported increase in the incidence of genital warts and herpes genitalis and a low occurrence of lymphogranuloma venereum and granuloma inguinale cases.[4],[7] The upward trend in genital warts might be due to increasing antibiotic use to treat bacterial STDs.[5] VDRL reactivity and HIV infection among STD patients.

The study shows that the VDRL reactivity showed a median percentage of 8.49% while the HIV prevalence among the STD patients showed a median percentage of 8.12%(Table V). Both STD and HIV infections are associated with the some high risk behaviour, that is, sexual intercourse with multiple partners. India has a high incidence of STDs, estimated at 40 million new cases a year or approximately 5%.[8] There is a good evidence that concomitant infection with STDs particularly those characterised by genital ulcers, facilitates HIV infection.[9]

Some of the important points for the prevention and control of the STD are (1) to delay sex till marriage (2) to avoid extramarital sex (3) to have only one non-infected monogamous sexual partner (4) early diagnosis and treatment of STD cases and contacts (5) routine blood testing of patients attending STD clinics (6) condom use while having sex with unknown sexual partner (7) strengthening of STD clinics and Family Health Awareness Programme and (8) to give health education and awareness regarding STD/ HIV among the masses.