Geeta Kiran Arakkal, et al. Changing trends in STI
RESEARCH ARTICLE
CHANGING TRENDS IN SEXUALLY TRANSMITTED INFECTION (STI) CLINIC
ATTENDEES – CURRENT SCENARIO
Geeta Kiran Arakkal, Sudha Vani Damarla, Harish Kumar Kasetty, Sudha Rani Chintagunta
Department of Dermatology, Venereology & Leprosy, Gandhi Medical College, Secunderabad, Telangana, India
Correspondence to: Geeta Kiran Arakkal ([email protected])
DOI: 10.5455/ijmsph.2014.260620141
Received Date: 07.06.2014
Accepted Date: 26.06.2014
ABSTRACT
Background: Currently, sexually transmitted infections (STIs) form a huge public health issue in the global scenario. STIs are
commonly more active than other prevailing infections in the community amongst the sexually active population and the
epidemiological profile is very distinct and more dynamic than other diseases.
Aims & Objectives: To understand the changing scenario of STIs and also the non-STIs among patients attending the STI clinic at the
tertiary care centre.
Materials and Methods: This is a tertiary care based retrospective study of all the patients attending the STI clinic at the
department of Dermatology, Venereology and leprology (DVL), Gandhi Hospital, Secunderabad, for 3 years (from January 2011 to
December 2013). STIs were categorized into different syndromes as per the syndromic management of STIs, as depicted by National
AIDS Control Organization (NACO).
Results: A total of 7,859 patients, with complaints of genital lesions, attending the STI clinic, were included in this study. Our study,
from 2011 to 2013, showed a declining trend in bacterial STIs and increasing trend of fungal and viral STIs as seen in developing
nations. The most common STI in males was candidial balanoposthitis, and females is vaginal/cervical discharge (candidial) followed
by viral infections like genital herpes and condyloma acuminata.
Conclusion: A comprehensive study of the epidemiological data is very important in order to decrease the incidence and prevalence
of STIs and HIV. In order to decrease the incidence and prevalence of STIs and HIV, we need to further impart health education,
counselling and improve the standards of health care facilities.
Key Words: Epidemiology; Sexually Transmitted Infections; HIV Infection; Trends
Introduction
The term venereal disease is obsolete and has been
replaced by sexually transmitted diseases (STDs) and
more recently as sexually transmitted infections (STIs). [1]
Currently, STIs form a huge public health issue in the
global scenario. High-risk factor for STIs, which is of
utmost importance, is unprotected sex with an infected
partner, either active or asymptomatic.[2,3]
The epidemiology of STIs is the result of interaction
between the pathogens, behaviour of the patient as well
as the prevention and control measures which lead to
significant proportion of infertility, ectopic pregnancy,
infant deaths, maternal mortality, malignancies and
increased susceptibility to HIV infection.[4] STIs are
commonly more active than other prevailing infections in
the community amongst the sexually active population
and the epidemiological profile is very distinct and more
dynamic than other diseases.[5]
The variation in social, cultural and environmental
factors, sex education and sexual practices influence the
incidence of STI and HIV in different communities and
regions, and is responsible for the diverse
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epidemiological profile.[6] The changing epidemiology
from 1970s to 2000 in different regions of the country
has been shown in various studies.[7-11] The bacterial
STIs are rapidly and effectively managed, which shows
that there is a change in present scenario of STIs.[9]
Our study showed that there is a noted increase in
balanoposthitis, genital herpes and condyloma
acuminatum while there is a decreasing trend in the
frequency of syphilis, LGV and Chancroid. Presence of
high number of asymptomatic STI patients and absence
of a mandatory reporting system and registry are the
limiting factors responsible for the lack of accurate data
in India. There is a need to understand the current
scenario of prevailing STIs in the region for the
successful implementation of STI control strategies to
reduce the incidence of STIs in view of HIV era.
The aim of present study is to understand the changing
scenario of STIs and also the non-STI patients attending
the STI clinic at the tertiary care centre.
Materials and Methods
This is a tertiary care based retrospective study of all the
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 10
Geeta Kiran Arakkal, et al. Changing trends in STI
patients attending the STI clinic at the department of
DVL, Gandhi Hospital, Secunderabad. The study period
was for 3years – from January 2011 to December 2013.
Data consisting of demographic information of patient’s
age, gender, marital status and sexual history was
recorded. Clinical Profile containing the chief complaints
at the time of presentation, duration, history of any
treatment and clinical diagnosis was noted.
Investigational reports like Grams stain and culture,
FNAC, tissue smear, urethral smear, Tzanck smear, KOH,
wet mount preparations, chest X-ray along with
serological tests like ELISA, Rapid tests for HIV, RPR,
VDRL and TPHA for syphilis were noted.
STIs were categorized into different syndromes as per
the syndromic management of STIs as depicted by
National AIDS Control Organization (NACO).[12] These
syndromes were urethral discharge, vaginal discharge,
genital ulcer disease, inguinal bubo, lower abdominal
pain and scrotal swelling etc.
Counselling regarding the risk involved in unprotected
sexual contact, vulnerability to acquire HIV infection in
presence of other STIs, need for partner treatment and
use of condoms was being done by STI counsellor in all
the patients.
Results
A total of 7,859 patients with complaints of genital
lesions attending the STI clinic were included in this
study. Out of these 5288 (67.28%) were males and
2631(33.47%) were females with a ratio of 2:1. The age
group of patients were between 15 to 70 years, of which,
majority 5517 (70.19%) belonged to 21 to 40 years.
Our study showed an increasing number of patients
attending the STI clinic over a period of 3 years. 2,084
(26.51%) patients attended the STI clinic in the year
2011, and the number increased to 2,561 (32.58%) in
2012 and 3,214 (40.89%) in 2013.
In our study we observed that most common STI in
males was balanoposthitis (candidial) followed by
genital herpes and the least common was chancroid. In
females, commonest was Vaginal/cervical discharge
(candidial) followed by genital herpes and the least
common being Lymphogranuloma venereum (LGV)
(Table 1). A large no. of male and female patients also
attended with Non-STI and sexual problems (Table 2).
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Table-1: STI in males and females
STI
Male
Female
Candidial Balanoposthitis
691 (8.79%)
0
Vaginal/cervical discharge (candidial)
0
556 (7.07%)
Herpes genitalis
394 (5.01%)
177 (2.25%)
Condyloma acuminata
382 (4.86%)
147 (1.87%)
Genital scabies
308 (3.91%)
137 (1.74%)
Non-Gonococcal Urethritis
245 (3.11%)
116 (1.47%)
Genital Molluscum Contagiosum
242 (3.07%)
60 (0.76%)
Gonococcal Urethritis
87 (1.10%)
43 (0.54%)
Syphilis
38 (0.48%)
20 0.25%)
LGV
26 (0.33%)
14 (0.17%)
Chancroid
20 (0.25%)
0
Total
2433 (30.95%) 1270 (16.15%)
Table-2: Patients with Non-STI
NON-STI
Male
Tinea cruris
346 (4.40%)
Premature Ejaculation
219 (2.79%)
Pearly Penile Papules
187 (2.37%)
Intertrigo
177 (2.25%)
Sebaceous cyst
171 (2.17%)
Vulval pruritis
0
Scrotal dermatitis
167 (2.12%)
Infertility
155 (1.97%)
LSA
0
Erectile dysfunction
123 (1.56%)
Total
1545 (19.65%)
Table-3: HIV patients with associated STIs
HIV
Male
Genital Herpes
119 (1.51%)
Condyloma acuminata
90 (1.14%)
Genital MC
77 (0.97%)
Balanoposthitis
42 (0.53%)
Syphilis
28 (0.35%)
Vaginal/Cervical Discharge
0
LGV
13 (0.16%)
Total
369 (4.69%)
Table-4: MSM and CSWs attending the STI clinic
Attending the STI clinic
2011
2012
2013
MSM
70
152
212
CSW
114
237
349
Female
139 (1.76%)
68 (0.86%)
0
56 (0.71%)
0
139 (1.76%)
68 (0.86%)
41 (0.52%)
13 (0.16%)
0
317 (4.03%)
Female
57 (0.72%)
43 (0.54%)
31 (0.39%)
0
14 (0.17%)
25 (0.31%)
8 (0.10%)
178 (2.26%)
Total
434 (5.52%)
700 (8.90%)
The most common STI seen in HIV patients was herpes
genitalis followed by condyloma acuminatum – in both
males and females (Table 3). Our study showed that
there is an increase in number of commercial sex
workers (CSW) and men who have sex with men (MSM)
attending the STI clinic, probably due to the active role
played by the NGOs under the guidance of NACO (Table
4). A significant number of patients also attended STI
clinic with Venereophobia (morbid fear of venereal
disease), which was more common among the males 447
(5.68%) than the females 166 (2.11%).
Discussion
A total of 7,859 patients, with complaints of genital
lesions, attended the STI clinic from January 2011 to
December 2013. Out of these, 5,288 (67.28%) were
males and 2,631(33.47%) were females with a ratio of
International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 10
Geeta Kiran Arakkal, et al. Changing trends in STI
2:1, which is similar to Nair TG et al.[13] study in which,
males constituted 61.1% and females 38.9% and
contrary to Neela patil et al.[14] study, with a male to
female ratio of 1:2.4 in 2012.
Our study showed that there is an increase in number of
commercial sex workers (CSW) and MSM attending the
STI clinic, probably due to the active role played by the
NGOs under the guidance of NACO.
Most common STI in males was candidial
balanoposthitis, and in females was vaginal/cervical
discharge (candidial) followed by viral infections like
genital herpes and genital warts.
in bacterial STIs like and increasing trend of fungal and
viral STIs as seen in developing nations. A
comprehensive study of the epidemiological data is very
important to identify the pattern of STIs for preventive
and control measures to curb these infections by the
government and non- government organizations. In
order to decrease the incidence and prevalence of STIs
and HIV we need to further impart health education,
counseling and ensure regular follow up of the patients
and their partners and improve the standards of health
care facilities.
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Increase in the number of patients with fungal infections
may be due to indiscriminate use of antibiotics, younger
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Our study showed that the prevalence of bacterial STIs
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Cite this article as: Arakkal GK, Damarla SV, Kasetty HK, Chintagunta SR. Changing trends in sexually transmitted infection (STI) clinic attendees –
Current scenario. Int J Med Sci Public Health 2014;3:1215-1218.
Source of Support: Nil
Conflict of interest: None declared
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International Journal of Medical Science and Public Health | 2014 | Vol 3 | Issue 10