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Indian Journal of Community Medicine

Study of STD Pattern in Hamidia Hospital, Bhopal and its Associated Risk Factors

Author(s): M. Toppo, S.C. Tiwari, GC. Dixit, Nandeshwar

Vol. 29, No. 2 (2004-04 - 2004-06)

Abstract

Research Question: What is the STD pattern in Hamidia Hospital and its associated risk factor?

Objectives: To find out the pattern of STD patients angst those attending Hamidia Hospital, Bhopal and to find out associated risk factors for Sexually Transmitted Diseases.

Study Design: Cross Sectional

Setting: Hamidia Hospital

Sample Size: 480 cases who visited skin and V.D. clinic in the period May 1996 to April 1997.

Results:

STD pattern in Hamidia Hospital is slightly different in males and females. In male syphilis is more common followed by gonorrhoea, Chancroid ± herpes infection. In female, syphilis was common followed by PID and gonorrhoea infection.

Introduction

Sexually transmitted diseases are a group of communicable diseases that are transferred predominantly by sexual contact. As the name suggests STD are transmitted from an infected person to healthy person by sexual intercourse.

Despite the tremendous progress brought about by investments in maternity :e. family planning, child immunization and better nutrition, one crucial dement of maternal and child health has been sorely neglected; the prevention and treatment of sexually transmitted diseases (STDs). Historically, STDs have also been overlooked in the global fight against infectious diseases; as a result, they continue to drain the lives of young and old throughout the developing world.

Sexually transmitted diseases are a major public health problem in developed and developing countries but prevalence rates are apparently far higher in developing countries where STD treatment is less accessible. Among women syphilis prevalence rates may be 10 to 100 times higher in developing countries Gonorrhoea rates may be 10 to 15 times higher and chalmydia rates may be 2 to 3 times, higher.

Despite greater emphasis on the treatment and prevention of STDs, there has been a significant increase in their incidence in India. There has been 3 fold increase in the number of cases from 1984 to 1986. The data obtained from STD clinics of the country shows that during 1981-82 about 5,57,994 cases had been reported whereas in 1986-87 there were about 13,14,723 reported cases.

Attempt has been made to find out the pattern of sexually transmitted disease and associated risk factors of the patient attending Skin and VD. clinic of Hamidia Hospital, Bhopal.

Objectives

(a) To find out pattern of STD patients amongst the patients attending Hamidia Hospital, Bhopal. (b) To find out associated risk factors for sexually transmitted diseases.

Material and Methods

The present study was carried out for a period of 1 yr. from May 96 to April 97. A total of 480 cases visited Skin and V.D. clinic in the period May 1996 to April 1997 for treatment out of which 250 patients were studied. Out of these 183 cases were male and 69 were female.

Consultants (venerologist and dermatologist) screened STD cases. Cases were interviewed using pretested and predesigned proforma followed by clinical examination. Blood sample and smear was collected in laboratory attached to Skin and VD. Clinic and appropriate tests were done to confirmed diagnose of STD.

Observation and Results

The diagnosis of STD cases amongst females showed that maximum cases were found to be suffering from Syphilis i.e. 18 (26%). The next common disease which was prevalent among females was PID 14 (20.4%). Third common finding was trichomomiasis 12(17.3%) followed by gonorrhoea 8 (11.5%) and candidiasis 8 (11.6%). Lympho Granuloma Venereaum and Herpes genitalia were the minimum cases diagnosed i.e. 2 (3%) cases each.

In a total of 181 cases amongst males, majority of the cases were suffering from syphilis 29 (32.6%) cases followed by gonorrhoea 40 (22.1%) cases. Third common disease was Herpes genitals which constituted 31(18.2%) cases and Chancroid 18 (9.9%) cases. The next common pattern among males was of NGU 10 (5.5%) and C. Accuminata consisting of 7 (3.8%) cases and 4 (2.3%) cases were suffering from molluscum contagiosum. Other common cases constituted of 3 (1.6%) cases were of Genital Scabies and condyloma lala respectively 3 (1.7%). Finally 2 (1.1 %) cases each were of AIDS and Donovanosis respectively which were the minimum cases found in the study.

Table 1 : Sexwise distribution of sexually transmitted diseases.

Diagnosis Females (N=69) Males (N=181)
n (%) n (%)
Syphilis 18 (26) 59 (32.6)
Gonorrhoea 08 (11.5) 40 (22.1)
Herpes Genitalia 02 (03) 31 (18.2)
Chancroid - - 18 (9.9)
PID 14 (20.4) - -
PID with secondary 05 (7.2) - -
Syphilis

Trichomoniasis

12 (17.3) - -
Candidasis 08 (11.6) - -
L.G.V. 02 (03) 2 (1.1)
Non Gonococci) Urethritis - - 10 (5.5)
Warts - - 2 (1.1)
C. accuminata - - 7 (3.8)
C. lata - - 3 (1.7)
AIDS - - 2 (1.1)
Molluscum contagiosum - - 4 (2.3)
Genital Scabies - - 3 (1.6)

Table II : Risk Factors for STDs among men and Women

  Males Females Total
n=181 n=69 n=250
n (%) n (%) n (%)
Multiple Sexual 170 (93.9) 25 (36.2) 195 (78)
Partner Visit to prostitute 121 (66.3) 121 (48.4)
N.A.
Touring Work 49 (27.1) 0 (0.0) 49 (19.6)
Spouse has STD 13 (54.3) 14 (73.6) 27 (10.8)
Sexual relations out of Wedlock 137 (75.6) 20 (28.9) 157 (62.8)

Out of 250 cases 195 (78w) cases had multiple sexual partners Of these 93.9% men (1701181) had history of multiple sexual partners compared to 36.2 % (25/69) females. Of 181 cases, 121 (66.8%) cases had contact with prostitutes.

Twenty-seven percent (49/181) male cases and none of the females had touring job. Majority of the stationed workers were labourers, daily wage workers, students, shopkeepers and servants. Persons whose job involved touring were mostly truck drivers, auto drivers and businessmen. Among 49 cases 82% were those who had frequent touring in a week and rest 18% had tour once in fifteen days and once in a month. These observations indicate that those who had to tour frequently run a higher risks of getting STDs. Of 24 male cases 13 (54.3%) and of 19 female cases 14(73.6%) reported history of STDs among their spouses. In 250 STD Cases 157 (62.8%) cases had relations out of wedlock. Amongst them 137 (75.6%) cases were male, showing the promiscous nature of men. Only 28.9% female had relations out of wedlock.

Discussion

Above study was done with the objective to find out the pattern of STD patients and to elicit associated risk, factors. The study shows that Syphillis and gonorrhoea are still the major prevalent STDs amongst males. The third group was constituted by herpes genitalia followed by Chancroid. Cases which formed a small number were Molluscum Contagiosum, genital scabies, LGV. There were two AIDS cases. Amongst females pattern was same with syphillis ranking first followed by PID and gonorrhoea. Thus PID, syphillis and gonorrhoea still seem to be ranking high amongst women.

Multiple sexual partners is one of the major risk factors for contracting the disease. In a total of 250 cases 195 (78%) cases had more than one sexual partner. More males i.e. 1.70 (93.9%) than females 25 (36.2%) were sexually promiscuous.

Of 181 male cases 121(66.8%) had regular to irregular visits to prostitutes and 60 (33.2%) cases had got STD from other sources. It was thus quite evident that prostitutes are undoubtedly biggest reservoir of infection in the spread of STDs.

About 49 (19.6%) male cases had touring jobs and rest of cases had stationary work. The pattern of touring amongst the 49 male cases showed that 40 (81.6%) cases were those who had weekly frequent training. Next group of cases were those who had touring once in fifteen days i.e. 7 (14.3%) and 2 (4.1%) cases were those who had touring once in a month.

These observations indicate that those who had to tour frequently run a high risk of getting STDs

Sexual transmission therefore is the main route of transmission from an infected partner to another partner. Of 43 couples 14 (73.7%) wives had problem as related by their husband and 13 (54.2%) husbands had problem as told by their wives.

About 157 (62.8%) cases had relations out of wedlock. Amongst them 137 (75.6%) cases were males and only 20 (28.9%) of them were females thus showing the promiscuous nature of men.

Conclusion

It can be concluded from the above study that STD is a public health problem in the community as the disease is more of a social disease than a medical disease. Amongst male syphillis, gonorrhoea, herpes and chancroid were prevalent. Amongst female syphillis, gonorrhoea and PID and other STI like trichomoniasis and candidiases were prevalent.

STD was more common amongst those who were in the mobile section of the community and thus showed more prevalence of contracting the disease. STD was highest in men who had association with prostitutes and men who had premarital and extramarital relations or were having multiple sexual partners. Most of the cases contracted the disease either from their spouses, or from prostitutes.

Married and polygamous men and women are often at higher risk of contracting STDs than might be expected, because of the high risk behaviour that is relatively common among men and women in our country : intercourse with multiple partners and with commercial sex workers. Thus STD prevention efforts are critical and should be a high priority for policy makers.

References

  1. WHO - 1985 Control of STD's Geneva WHO.
  2. Infertility and STD - A public Health Challenge Population Report Vol - X I No. 3 P 1983,121.
  3. HAJNI -1975 VD in Kashmir, Indian Journal of Dermatology and Venerology 41,121-25.
  4. Nath LM - Marital status and VD, 1973, 95-98.
  5. David H. Martin - Medical clinics of North America-STD-Nov90.
  6. Swasth Hind - STD-May 1988.
  7. Vijay Narayan, Lucknow-1984-A Social dilemma.
  8. WHO - Chronicle - Venereal Diseases and Treponematoses-1973.
  9. Population Report - Controlling STD's June 1993 No. 9.
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