Sexually transmitted diseases (STDs) is a global health problem. In the past, tropical infections like chancroid, gonorrhea and syphilis were considered as most important STDs in developing countries. Donovanosis has been largely prevalent in only some tropical countries. Now scenario is changing very rapidly with effective management of bacterial STDs.

Epidemiological factors influencing STDs - like social, cultural and environmental factors; sexual practices; moral outlook; sex education; incidence of human immunodeficiency virus (HIV) infection; facilities for early diagnosis and treatment - vary from region to region.  The available data in India is limited due to lack of compulsory ‘reporting system and registry’ and presence of asymptomatic persons with STDs in society.

The present study was conducted to understand the pattern and any change in the trend of STDs, epidemiological factors and behavior of individual diseases.

Materials and Methods

All new clinic attendees of the exclusive STD Department constituted the material of this study. This study was conducted at the STD Department, Government General Hospital attached to Rangaraya Medical College, Kakinada, Andhra Pradesh. The period of study was 6 years (Jan. 2000-Dec. 2005), which was further divided into two spells of 3 years each, viz., 1 st spell from Jan. 2000 to Dec. 2002 and the 2 nd spell from Jan. 2003 to Dec. 2005 respectively.

A thorough history and clinical examination was done on every patient, supported with relevant laboratory investigations like Venereal Disease Research Laboratory (VDRL), Dark Ground Illumination (DGI), enzyme-linked immunosorbent assay for HIV, urethral smear, tissue smear, serology, X-ray chest, Fine Needle Aspiration Cytology (FNAC), biopsy, potassium hydroxide and normal saline mount, depending on the case. Pre- and post-test counseling was done for patients who needed HIV test. All the data were recorded. Every patient was treated accordingly and kept under follow-up.

Discussion

When the pattern and behavior of STDs were analyzed over a 6-year period in two equally divided spells, out of a total of 12,071 patients, the significant increase in the number of clinic attendees by 1.5 times in the 2 nd spell was due to increased awareness, decreased stigma in the public and efficient services and facilities provided by the department.

Majority of people were male patients, married and in the third decade of their life, which is consistent with the studies done by Agarwal et al . at Rohtak, Chopra et al .  at Patiala, Parmar et al .  at Ahmedabad. Since the majority of the patients belong to the married group, it can reasonably be deduced that extramarital relations were more prevalent, under the guise of marriage. Thus, marriage conferred unauthorized license to such people.

The number of cases of adolescent attendees decreased whereas the number of patients above 50 years of age increased in the 2 nd spell. The significant increase in the female patients from 1,882 to 2,896 in the 2 nd spell of 3 years reflects better counseling services and contact tracing by the department.

Out of the various categories of diseases, there was a significant decline in standard bacterial diseases over the period of 6 years, which is probably because of free availability of medicines across the medical shop counters, self medications and syndromic approach adopted by general physicians and Primary Health Centre doctors. Also, the trend of STDs is changing from bacterial to viral diseases. This is because all the bacterial diseases are almost curable with either one or the other antibiotic or through national control program. On the contrary, the viral diseases are known to persist or recur in spite of treatment and are widely spreading in the community, thus contributing to more number of viral infection cases.

Of all the categories of infections, viral diseases dominated the total number of cases. HIV dominated within the viral disease category in both the spells. The twofold increase in the number of HIV-positive cases in the 2 nd spell of 3 years was due to increased awareness, easy availability of testing facilities and drift of patients from asymptomatic stage to symptomatic stage. The percentage of incidence of Herpes genitalis was halved in the 2 nd spell compared to the 1 st , which is consistent with the study conducted by Chopra et al .  at Patiala. On the contrary, the number of molluscum contagiosum cases doubled in the 2 nd spell when compared to the 1 st . There was no significant change in the behavior of condyloma acuminata in both the spells.

Out of the PPF group, the fungal diseases occupied the major portion. The same fungal diseases also significantly contributed to the total number of cases in their respective spells.

Regarding miscellaneous diseases, it is to be commented that though not strictly STDs, the dominating number of miscellaneous cases has significantly influenced the percentage of incidence of various diseases in the present study.

The percentage of incidence of various diseases in the present study was very low when compared to the other studies done elsewhere, which is due to inclusion of all clinic attendees of the STD department, like cases of HIV and miscellaneous, for calculation of exact incidences, whereas majority of the other studies have drawn conclusion by considering only STDs. Thus there is more of a contrast than comparison between the present study and the other studies.

Similar continuous ongoing studies at different levels to detect changing trends are very much essential as such studies may influence the already existing strategies and interventions for the control of sexually transmitted diseases.

Chandragupta TS, Badri Sudha Rani, Murty Srinivasa V, Swarnakumari G, Prakash B.V.S
Department of STD, Rangaraya Medical College, Government General Hospital, Kakinada, Andhra Pradesh, India

Correspondence Address:
Chandragupta T S
Department of STD, Govt. General Hospital, Kakinada - 533 001, AP
India

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