|Year : 2007 | Volume
| Issue : 1 | Page : 6-9
Changing trends of sexually transmitted diseases at Kakinada
TS Chandragupta, Sudha Rani Badri, Srinivasa V Murty, G Swarnakumari, B.V.S Prakash
Department of STD, Rangaraya Medical College, Government General Hospital, Kakinada, Andhra Pradesh, India
T S Chandragupta
Department of STD, Govt. General Hospital, Kakinada - 533 001, AP
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Trends of sexually transmitted diseases (STD) vary from place to place depending on various epidemiological factors prevailing in that respective geographic area. To understand the pattern and trends of STDs, a study was conducted at the STD Dept., Govt. General Hospital, Kakinada, for a period of 6 years, i.e., from Jan. 2000 to Dec. 2005, which was further divided into two spells of 3 years each to understand the behavior of STDs. During the entire study period, a total of 12,071 patients were enrolled. All the patients were thoroughly examined and investigated. On analysis, it was found that 5,004 patients attended in the 1 st spell and 7,067 in the 2 nd spell. Majority of them were male, married and in the third decade of their life. At the same time, the number of female patients attending STD clinic increased significantly in the 2 nd spell.
All the diseases were broadly categorized into four groups, viz., bacterial, viral, protozoal, parasitic and fungal (PPF) and miscellaneous. The trend of STDs was changing from bacterial to viral diseases during the period of 6 years, with a definite decline of bacterial STDs. Among the viral diseases, HIV stood first in both the spells. In the PPF group, majority of the cases were contributed by fungal diseases. Unlike other studies, miscellaneous diseases included in this study dominated the picture and significantly influenced the percentage of incidence of individual diseases, which made it uncomparable with other studies.
Similar continuous ongoing studies at every level are essential to understand the pattern and behavior of STDs, which may influence the already existing strategies and interventions for control of STDs.
Keywords: Protozoal, parasitic and fungal, spells, sexually transmitted disease, trend
|How to cite this article:|
Chandragupta T S, Badri SR, Murty SV, Swarnakumari G, Prakash B. Changing trends of sexually transmitted diseases at Kakinada. Indian J Sex Transm Dis 2007;28:6-9
|How to cite this URL:|
Chandragupta T S, Badri SR, Murty SV, Swarnakumari G, Prakash B. Changing trends of sexually transmitted diseases at Kakinada. Indian J Sex Transm Dis [serial online] 2007 [cited 2020 Jan 26];28:6-9. Available from: http://www.ijstd.org/text.asp?2007/28/1/6/35703
| Introduction|| |
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.
| Results|| |
During the period of 6 years, total new clinic attendees were 12,071, of which 5,004 patients attended in the 1 st spell and 7,067 patients in the 2 nd spell of 3 years [Figure - 1].
Majority of the patients in both the spells were in the third decade of their life, followed by fourth decade [Table - 1]. The adolescent attendees decreased from 9.71% (486) in the 1 st spell to 5.94% (420) in the 2 nd spell. Surprisingly, the number of elderly clinic attendees was significant compared to the number of adolescents in the 2 nd spell. The number of patients belonging to the 'more than 50 years' age group increased from 285 (5.7%) in the 1 st spell to 474 (6.7%) in the 2 nd spell [Table - 1]. Male-to-female ratio was 1.66:1 and 1.44:1 in the 1 st and 2 nd spells respectively. In other words, there was a significant increase in female patients - from 1,882 (38%) in the 1 st spell to 2,896 (41%) in the 2 nd spell, with a net increase of 1,000 [Table - 1]. The number of married persons was 4,306 (86.05%) and 6,072 (87.92%) in the 1 st and 2 nd spell respectively [Figure - 2].
On analysis of individual diseases, the standard bacterial diseases, which ranged between 2.8% and 0.22% in the 1 st spell, decreased significantly and ranged between 0.89% and 0.01% in the 2 nd spell [Table - 2]. There was not even a single case of congenital syphilis or chancroid in the 2 nd spell [Table - 2]. Herpes genitalis had decreased from 6.78% (339) in the 1 st spell to 3.47% (245) cases in the 2 nd spell. The number of molluscum contagiosum cases had increased from 11 (0.22%) in the 1 st spell to 22 (0.31%) in the 2 nd spell. HIV cases had increased significantly from 804 (16.08%) in 1 st spell to 1,983 (28.06%) in the 2 nd spell [Table - 2].
The number of fungal diseases was 332 (63.23%) and 638 (89.35%) in the 1 st and 2 nd spell respectively out of the entire PPF group of diseases (protozoal, parasitic and fungal - [Table - 3]). Out of these, balanoposthitis in the male and candidial vaginosis in the female were 209 (4.18%) and 453 (6.41%) and 123 (2.46%) and 185 (2.61%) in the 1 st and 2 nd spell respectively [Table - 2].
Miscellaneous diseases (which were not considered in the studies conducted elsewhere) like erectile dysfunction, prostatorrhea, spermatorrhea, phimosis, paraphimosis, white discharge of unknown etiology, erosion cervix and persons coming for checkups like VDRL and HIV test accounted for 2,888 (57.76%) and 3,899 (55.17%) in the 1 st and 2 nd spell respec-tively, with a net increase of 1,000 in the 2 nd spell [Table - 2].
Thus, all the diseases were broadly categorized into four groups [Table - 3] - bacterial, viral, PPF and miscellaneous. On analysis of these broad categories of diseases, the bacterial diseases significantly decreased and were 5.87% (294) and 1.07% (76), and the viral diseases increased and were 25.91% (1,297) and 33.64% (2,378) in 1 st and 2 nd spell respectively. The number of cases in PPF group was 525 (10.49%) and 714 (10.10%) in the 1 st and 2 nd spell respectively, thus contributing significantly to the total number of cases [Table - 3].
The present study was compared with other studies done elsewhere. It was observed that the percentage of incidences of various STDs in the present study was very low [Table - 4].
| 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 [Figure - 2], 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 [Table - 3], 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 [Table - 4]. 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 [Table - 2].
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 [Table - 4].
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.
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[Figure - 1], [Figure - 2]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]