RESUMO
The pattern of sexually transmitted disease (STD) is the basis for designing surveillance of specific STD, their trends and syndromic management protocols. Two hundred and fifteen consecutive first-time STD clinic attenders at a teaching hospital in Bombay were recruited for the study in October 1995. Thorough clinical examination and the following investigations were done: wet mount, Gram stain, Giemsa stain, modified Thayer-Martin (MTM) medium culture, Fontana stain, Venereal Disease Research Laboratory (VDRL), Treponema pallidium haemagglutination test (TPHA), HBsAg and HIV. Ulcerative STD constituted 73.5% of total STD while 15.8% were discharges and 10.2% were genital growths. Ulcers in decreasing order of frequency were chancroid (51.9%), genital herpes (29.1%) and syphilis (14.5). 76.5% of genital discharges were due to gonococcal infection. The high rate of ulcerative STD is possibly an important co-factor for the high HIV prevalence of 31.2% in Bombay. Of 182 patients tested for HBV, 16 (8.8%) were reactive for HBsAg, revealing a high prevalence among STD attenders. A high co-relation of HBsAg positive with either HIV or VDRL requires urgent attention for HBV intervention strategies in this population.
PIP: Analysis of the pattern of various sexually transmitted diseases (STDs) in a given region is essential to the design of surveillance programs and syndromic management protocols since the pattern varies from area to area. Enrolled in the present study were 215 consecutive, first-time STD clinic attenders at a teaching hospital in Bombay, India, in October 1995. Patients were grouped into 5 categories--genital ulcer disease, genital discharges, buboes, genital growths, and others--and tested accordingly. The mean age of the 193 male STD patients was 26.6 years, while that of the 22 female patients was 22.9 years. Genital ulcer disease constituted 73.5% of all STDs in this series, while 15.8% were discharges and 10.2% were genital growths. Ulcers were chancroid (51.9%), genital herpes (29.1%), and syphilis (14.5%). 76.5% of genital discharges were due to gonococcal infection. HIV was detected in 60 men (31.1%) and 7 women (31.8%), for an overall prevalence of 31.2%. 70.1% were infected with HIV-1, 8.9% with HIV-2, and 21% were positive for both HIV-1 and HIV-2. The high rate of ulcerative STD in this sample is a likely co-factor in the high HIV prevalence. Hepatitis B surface antigen prevalence was 8.8%, and one-quarter of these patients were also HIV-infected. This finding indicates a need for more widespread hepatitis B vaccination in India.