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PubMed1996

Ciprofloxacin. An updated review of its pharmacology, therapeutic efficacy and tolerability.

Ciprofloxacin is a broad spectrum fluoroquinolone antibacterial agent. Since its introduction in the 1980s, most Gram-negative bacteria have remained highly susceptible to this agent in vitro; Gram-positive bacteria are generally susceptible or moderately susceptible. Ciprofloxacin attains therapeutic concentrations in most tissues and body fluids. The results of clinical trials with ciprofloxacin have confirmed its clinical efficacy and low potential for adverse effects. Ciprofloxacin is effective in the treatment of a wide variety of infections, particularly those caused by Gram-negative pathogens. These include complicated urinary tract infections, sexually transmitted diseases (gonorrhoea and chancroid), skin and bone infections, gastrointestinal infections caused by multiresistant organisms, lower respiratory tract infections (including those in patients with cystic fibrosis), febrile neutropenia (combined with an agent which possesses good activity against Gram-positive bacteria), intra-abdominal infections (combined with an antianaerobic agent) and malignant external otitis. Ciprofloxacin should not be considered a first-line empirical therapy for respiratory tract infections if penicillin-susceptible Streptococcus pneumoniae is the primary pathogen; however, it is an appropriate treatment option in patients with mixed infections (where S. pneumoniae may or may not be present) or in patients with predisposing factors for Gram-negative infections. Clinically important drug interactions involving ciprofloxacin are well documented and avoidable with conscientious prescribing. Recommended dosage adjustments in patients with impaired renal function vary between countries; major adjustments are not required until the estimated creatinine clearance is < 30 ml/min/1.73m2 (or when the serum creatinine level is > or = 2 mg/dl). Ciprofloxacin is one of the few broad spectrum antibacterials available in both intravenous and oral formulations. In this respect, it offers the potential for cost savings with sequential intravenous and oral therapy in appropriately selected patients and may allow early discharge from hospital in some instances. In conclusion, ciprofloxacin has retained its excellent activity against most Gram-negative bacteria, and fulfilled its potential as an important antibacterial drug in the treatment of a wide range of infections. Rational prescribing will help to ensure the continued clinical usefulness of this valuable antimicrobial drug.

Anti-Infective Agents↗
PubMed2000

Treatment of sexually transmitted bacterial diseases in pregnant women.

Testing for and treating sexually transmitted diseases (STDs) in pregnant women deserves special attention. Treatment possibilities are limited because of potential risks for the developing fetus, and because effects can differ in pregnant compared with non-pregnant women, re-infection may be missed because of the intrinsic delicacy of contact-tracing during pregnancy and because pregnant women are more reluctant to take the prescribed medication in its full dose, if at all. However, the devastating effects of some of these genital infections far outweigh any potential adverse effects of treatment. Although active syphilis has become a rarity in most Western countries, it is still prevalent in South America, Africa and South-East Asia. Benzathine benzylpenicillin (2.4 million units once or, safer, twice 7 days apart) is the treatment of choice, although patients with syphilis of longer standing require 3 weekly injections as well as extensive investigation into whether there has been any damage due to tertiary syphilis. Despite declining rates of gonorrhea, the relative rate of penicillinase-producing strains is increasing, especially in South-East Asia. The recommended treatment is intramuscular ceftriaxone (125 or 250 mg) or oral cefixime 400 mg. Despite good safety records after accidental use, fluoroquinolones are contraindicated during pregnancy. An alternative to a fluoroquinolone in pregnant women with combined gonorrhea and chlamydial infection is oral azithromycin 1 or 2 g. Azithromycin as a single 1 g dose is also preferable to a 7 day course of erythromycin 500 mg 4 times a day for patients with chlamydial infection. Eradication of Haemophilus ducreyi in patients with chancroid can also be achieved with these regimens or intramuscular ceftriaxone 250 mg. Trichomonas vaginalis, which is often seen as a co-infection, has been linked to an increased risk of preterm birth. Patients infected with this parasite should therefore received metronidazole 500 mg twice daily for 7 days as earlier fears of teratogenesis in humans have not been confirmed by recent data. Bacterial vaginosis is also associated with preterm delivery in certain risk groups, such as women with a history of preterm birth or of low maternal weight. Such an association is yet to be convincingly proven in other women. The current advice is to treat only women diagnosed with bacterial vaginosis who also present other risk factors for preterm delivery. The treatment of choice is oral metronidazole 1 g/day for 5 days. The possible reduction of preterm birth by vaginally applied metronidazole or clindamycin is still under investigation. In general, both test of cure and re-testing after several weeks are advisable in most pregnant patients with STDs, because partner notification and treatment are likely to be less efficient than outside pregnancy and the impact of inadequately treated or recurrent disease is greater because of the added risk to the fetus. Every diagnosis of an STD warrants a full screen for concomitant genital disease. Most ulcerative genital infections, as well as abnormal vaginal flora and bacterial vaginosis, increase the sexual transmission efficiency of HIV, necessitating even more stringent screening for and treating of STD during pregnancy.

Anti-Bacterial Agents↗
PubMed2002

Treatment of sexually transmitted infections with single-dose therapy: a double-edged sword.

Since the advent of the antimicrobial era, single-dose therapy has been a valuable tool in the management of genital infection. Most of the common sexually transmitted infections (STIs) such as gonorrhoea, syphilis, trichomoniasis and chancroid can be treated in this way, as can genital infections which are not sexually transmitted such as bacterial vaginosis and genital tract candidiasis. Until recently, treatment for Chlamydia trachomatis infection required a multi-dose regimen, but single-dose azithromycin has now been shown to be an effective and acceptable alternative to this. Unfortunately, eradicative therapy has proven to be elusive for the viral STIs such as genital herpes simplex infection, human papilloma virus infection and human immunodeficiency virus (HIV) infection. The main advantage of single-dose therapy lies in its convenience and in its ability to ensure virtually 100% compliance. This addresses the problems of reduced clinical efficacy and the difficulties in assessing the response to therapy which complicates poor treatment compliance. However, some single-dose regimens for STIs do have drawbacks, particularly in certain situations. This may be with respect to efficacy, for example in syphilis with single-dose benzathine penicillin therapy, particularly for pregnant women and individuals infected with HI. Alternatively, it may involve toxicity, for example with single-dose metronidazole therapy for trichomoniasis or bacterial vaginosis where a higher rate of gastrointestinal adverse effects may be expected than if a lower multi-dose regimen is used. In addition, single-dose therapy, for example with nevirapine, given to the mother in labour and to the baby after delivery significantly reduces the risk of mother to child HIV transmission, but resistance mutations are frequently detected in the viral genome after the brief exposure to the drug, which could jeopardise its future use. Single-dose therapy clearly has both advantages and disadvantages. We have reviewed a range of these in a variety of situations, focussing on their applications, effectiveness, compliance and toxicity, highlighting how single-dose therapy may be a double-edged sword.

Anti-Bacterial Agents↗
PubMed1998

Drugs for STD management in developing countries: choice, procurement, cost, and financing.

OBJECTIVES: (i) To compare acquisition costs of drugs between countries to treat one standardised STD episode. (ii) To explain variations, treatment protocols, purchasing policies, procurement systems, and sources of financing. METHODS: National STD guidelines, purchasing mechanisms, and drug acquisition costs from 15 countries were compiled, using information from ministries of health and European Commissions headquarters. Prices were converted in European currency unit (ecu). Acquisition costs per episode were calculated for the four main STD syndromes--urethral discharge, vaginal discharge, lower abdominal pain in women, and genital ulcer disease (GUD). To compare costs in different countries the relative distribution of the four main STD syndromes was calculated. RESULTS: Treatment protocols. All 15 countries recommended treatment for urethral discharge with drugs effective against Neisseria gonorrhoeae and Chlamydia trachomatis. For vaginal discharge two patterns emerged. In 11 countries women with vaginal discharge were divided into high risk of STDs and low risk of STDs. Women at low risk were treated for candidiasis, trichomoniasis, and bacterial vaginosis and those at high risk were also treated for N gonorrhoeae and C trachomatis. Guidelines for abdominal pain all included treatment for N gonorrhoeae, C trachomatis, and anaerobic infections. All countries except the Philippines recommended treating GUD with drugs effective against chancroid and syphilis. Costs per episode. Acquisition costs per episode varied from 0.40 ecu to 7.89 ecu with wide variations. The standardised acquisition cost of STD drugs for the public sector varied between 0.54 ecu in Tanzania and 5.80 ecu in Swaziland. The choice of drugs was the main factor explaining this difference. In countries which only use generic drugs, acquisition costs were lower (between 0.54 ecu and 1.07 ecu). However, important variations exist between countries which use similar treatment protocols (for example, 2.54 ecu in Namibia, 5.80 ecu in Swaziland). These variations are mainly explained by differences in procurement methods. Acquisition costs for peripheral public services are higher than at central level (for example, 0.89 ecu versus 0.54 ecu in Tanzania) as a result of mark ups for transport, handling, and inflation. Acquisition cost of drugs per standardised STD episode for patients through private pharmacies may be as high as 11.93 ecu in Senegal. This is more than 10 times the acquisition cost for public sector at central level in this country (of 1.04 ecu) and is mainly due to the fact that drugs in private pharmacies are branded drugs, which are imported at a high price, taxes, and mark ups in the distribution chain. In 11 of the 15 countries studied, effective STD drugs are now available through public services, in at least in a part of the country. In Botswana, Ghana, Ivory Coast, Mauritania, Lesotho, Namibia, Senegal, Seychelles, and Swaziland these drugs are supplied throughout the country within the existing essential drug programme and financed by the government budget or through a revolving fund for drugs. In Tanzania and Mozambique, all STD drugs in the public sector are funded through donor support. In Nepal recommended STD drugs are widely available at low cost through private outlets. CONCLUSIONS: Reducing antimicrobial susceptibility of N gonorrhoeae and Haemophilus ducreyi is a continuous threat for sustainable STD drug supply as alternative patented drugs are more expensive. If patented STD drugs are required drug cost may be minimised by selecting the most appropriate management protocols and by improving procurement. Moreover, recent studies have confirmed the continued susceptibility of N gonorrhoeae to low cost generic drugs in some countries (Mozambique, Tanzania, and Senegal). Even under these circumstances, continued donor support will be needed for the poorest countries to ensure the availability of effective STD management as an esse

Anti-Infective Agents↗
PubMed1997

Health-seeking behaviour of STD patients in an urban area of southwest Nigeria: an exploratory study.

Sexually transmitted disease patients of health institutions in Ado-Ekiti responded to questionnaires on the quality of STDs treatment; four-fifths of the institutions are privately owned. Gonorrhoea and syphilis are the major STDs reported by the respondents and treated by the health-care providers. Other types are candida, dysuria, lymphogranuloma venereum, chancroid, trichomoniasis and STD-related problems. The symptoms noticed by the respondents are pain, burning sensation, discharges, itching and open sores. Most sought treatment within seven days of noticing the symptoms. Most sought treatment from other health providers before coming to the health institutions where they were interviewed. Respondents were attended by modern doctors during their search for a cure, but in most cases, only by physical examination because laboratory facilities were non-existent or inadequate. Treatment was mainly chemotherapy, involving antibiotics and analgesics. In addition to chemotherapy, the health providers counselled the patients. Most respondents reported that they were satisfied with the quality of treatment. Results are discussed and recommendations are made.

Adolescent↗
PubMed1990

Office and Laboratory Testing for STDs: Present and Future.

This chapter is aimed at the clinician in private practice or in a small clinic setting dealing with sexually transmitted diseases (STDs) but lacking immediate access to larger laboratories. Tests that should be routinely available for patients with STDs are described. Some of these tests may be performed on site, whereas others must be sent out to appropriate laboratories. Among the tests described are Gram stain testing, culture of Neisseria gonorrhoeae, darkfield examination, as well as testing for Chlamydia trachomatis, herpes simplex virus, chancroid, and syphilis.

Journal Article↗
PubMed1996

Herpes, Syphilis, and Other Ulcerogenital Conditions.

This well-illustrated overview of herpes simplex virus infection, syphilis, and chancroid focuses on history, biology, pathophysiology, epidemiology, natural history, signs and symptoms, laboratory tests, and diagnostic problems. Clinicians are reminded of the high correlation between genital ulcer disease and infection with the human immunodeficiency virus.

Journal Article↗
PubMed1975

Pathogenesis of Trypanosoma equiperdum in rabbits.

Seventeen rabbits experimentally infected with Trypanosoma equiperdum were examined for lesions at different times during a 5-month period. A chancroid developed at the inoculation site in the skin, and later, similar lesions appeared in skin of the ears, eyelids, and nose. The inflammatory reaction was primarily granulomatous, and viable trypanosomes were present in all skin lesions. The rabbits had reticuloendothelial hyperplasia of spleen and lymph nodes. In 3 rabbits, there was amyloid deposition in splenic lymph nodules and renal glomeruli. Amyloid had typical fibrillar appearance by electron microscopy (EM) and was reactive for immunoglobulin M (IgM) and immunoglobulin G (IgG) with fluorescent antibody (FA). With time, there was lessening capability of T equiperdum to agglutinate in antiserums of infected rabbits, suggesting that antigenic variation occurred during infection. The serum concentrations of IgM and IgG increased significantly in the infected rabbits and then remained elevated or they decreased, though fluctuating widely. Three of 5 infected rabbits demonstrated depressed antibody response to injected ovine erythrocytes.

Agglutination Tests↗
PubMed2000

Episome profiles and mobilizable beta-lactamase plasmid in Haemophilus ducreyi.

Chancroid caused by Haemophilus ducreyi has been described as a significantly predisposing factor of HIV heterosexual transmission in an endemic region of both diseases. The fastidious, H. ducreyi has been reported world wide with various antimicrobial susceptibility patterns. A high tendency of drug resistances has generally been found among isolates derived in Thailand. In this study, the plasmids of H. ducreyi were isolated and analysed from 63 clinically derived organisms. Twenty-nine out of 63 isolates (46%) revealed the same plasmid profiles. Plasmid DNA was further cloned into Escherichia coli and transformants were selected. A 3.6 kb plasmid (pCb) carrying ampicillin resistance was subsequently identified. The pCb conferred resistance to various beta-lactam antibiotics including penicillin G, carbenicillin, piperacillin, cefazolin, cefoperazone, ampicillin-sulbactam, and amoxicillin-clavulanate but not to cefoxitin. Co-resistance to streptomycin, chloramphenicol and tetracycline was not detected. Beta-lactamase gene was located on the major pCb fragment of EcoRI and AatII cutting.

Cloning, Molecular↗
PubMedDate not supplied

STD update: screening and therapeutic options.

Sexually transmitted diseases (STDs) are some of the most common causes of illness worldwide. Prevention and educational programs have helped to curb the rise of syphilis, gonorrhea, non-gonococcal urethritis, chancroid, granuloma inguinale and lymphogranuloma venereum within most of the United States. However, there are still "hot spots" in the southern U.S. and in non-Caucasian and urban populations, and these diseases continue to be prevalent in underdeveloped countries. Molluscum contagiosum and condyloma acuminata are increasing throughout the world. Herpes simplex is in the midst of an epidemic, having increased in the United States by 30% in the last 15 years. The failure of preventive programs to halt or reverse these epidemics stems from a combination of factors involving both patients and the medical profession. Patient and sexual partner ignorance, denial and deliberate deception play an important role. However, healthcare professional ignorance and failure to keep a high index of suspicion are also crucial. These issues are compounded by the quick-visit concept propagated by managed care, which dilutes most educational efforts. Teens particularly suffer from the lack of an unhurried discussion of sexual practices, and the sharp rise in STDs in this population reflects failure in the medical system. This paper will review the classical presentations of the various STDs, and will detail in what ways the coexistence of HIV disease alters clinical appearance and disease progress. Subtle variations in presentations that often lead to misdiagnosis are discussed. Diagnosis and treatment of STDs change rapidly as new developments occur, and the latest recommendations are examined. The ways in which these therapies differ in special need groups such as HIV and pregnancy are specifically detailed. The goal of this review is to arm the clinician with all of the necessary ingredients for timely and accurate diagnosis and treatment, as well as ways to assist the patient in dealing with these difficult topics. Patient education is highlighted, as it, along with practitioner expertise, is the key to disease eradication. We are the missing link in STD eradication.

Female↗
PubMed2002

Sexually transmitted diseases in the older population in Singapore.

BACKGROUND: Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. AIM: To study the distribution and types of STDs in older persons, defined in our study as individuals aged 50 years or older. METHOD: Retrospective analysis of surveillance data for diseases notified under the Infectious Disease Act, which include syphilis, gonorrhoea, non-gonococcal urethritis (NGU), vaginal discharge and chancroid. Human immunodeficiency virus (HIV) infections were not included. Data from notifications of diseases, such as genital herpes and genital warts, which are not compulsory, were also analysed. Period of study was from January 1996 to December 2000. RESULTS: During the study period, STD notifications for persons aged 50 years and older accounted for 7.6% of all notifications. Among these older persons, males were predominantly affected. The most common disease notified in older persons was gonorrhoea (600 cases), followed by non-infectious syphilis (578 cases) and NGU (339 cases). There were 76 cases of infectious syphilis. The age-specific disease rates for this group of older patients were as follows (number of cases per 100,000 patients per year): gonorrhoea-17.61, non-infectious syphilis-16.96, infectious syphilis-2.23, NGU-20.66, genital warts-6.92 and genital herpes-7.33. CONCLUSION: Although STDs occur mainly in the young, it affects a small but significant proportion of persons aged 50 years and older. A better understanding of the epidemiology of STDs in these population is important for reducing STD morbidity and improving STD care.

Adult↗
PubMed2002

AIDS in Papua New Guinea: situation in the Pacific.

There has long been reason to anticipate a major heterosexual epidemic of acquired immunodeficiency syndrome (AIDS) in Papua New Guinea (PNG) and probably in the rest of Melanesia. From the social and behavioural perspectives, Melanesia is strikingly similar to other areas of the world with serious epidemics of AIDS. High levels of other sexually transmitted infections indicate behaviour patterns that would also facilitate transmission of human immunodeficiency virus (HIV) and presence of cofactors for HIV infection. Low levels of male circumcision parallel the situation in other epidemic areas. Near-parity by sex in cases reported so far in PNG is evidence that primary infection is largely heterosexual. The late start of a major epidemic in PNG can probably be attributed to: (a) the relatively small aggregation of people in urban centres (even Port Moresby has only one-quarter of a million people); (b) a highway system that does not network across the whole country; (c) limited size of the organized commercial sex sector; and (d) possibly low level of chancroid to act as a cofactor. The situation is now changing. Over the last seven years, HIV infection, probably the highest in Port Moresby and mostly measured there, has been rising by about 60% per annum. This rise is genuine and, if sustained, would infect 10% of the adult population of PNG in little more than 12 years. Some countries of sub-Saharan Africa have witnessed such exponential rises.

Acquired Immunodeficiency Syndrome↗
PubMed1995

HIV and STDs: how are they linked?

I write in response to Dr. Gina Dallabeta's article with this title (HIV and STDs: How Are They Linked?). Prospective studies in sub-Saharan Africa have established the following: 1. Seropositive commercial sex workers have a higher prevalence of genital ulcer disease (GUD) and positive serology for syphilis. 2. Seropositive men with chancroid more frequently have a history of prior GUD. 3. Seronegative men with a history of recent contact with a commercial sex worker are more likely to seroconvert if they have GUD than urethritis. GUD increases the infectiousness of HIV. Similarly, there is increased susceptibility to the virus in cases of genital chlamydial infection and Trichomonas vaginalis. The mechanisms are basically two--mechanical and biological. Mechanically, the raw area resulting from the STD provides a portal of entry for the virus. Biologically, activated lymphocytes and macrophages enhance HIV shedding and increase the susceptibility of the individual to HIV.

Africa↗
PubMed1994

Circumcision in the control of HIV?

Ken Rankin (AH, Jan '94, p 34) rightly points out that more circumcisions are carried out than are justified on clinical grounds alone. However, the advent of AIDS raises a number of interesting points about the possible role of circumcision as an epidemiological tool for the control of HIV transmission. It has been reported that an absence of circumcision increases susceptibility to acquiring STDs. STDs, especially those that cause genital ulcer disease (such as syphilis, chancroid and genital herpes), are recognized major risk factors for the transmission of HIV. Furthermore, some studies have shown that the distribution of HIV seroprevalence in Africa is closely associated with the geographical pattern of circumcision practices, whilst other workers have shown an association between absence of circumcision and HIV seropositivity. In some societies where circumcision was formerly practiced on religious/cultural grounds, it has now largely been abandoned as a consequence of urbanization and the adoption of Western lifestyles. In such situations, a revival of this ancient custom might supplement other control measures against HIV transmission. The only proviso would be an insistence on sterile procedures. The devastating impact of AIDS, especially in sub-Saharan Africa, necessitates a consideration of all possible interventions.

Circumcision, Male↗
PubMed2002

Spectrum of dermatopathologic lesions associated with HIV/AIDS in India.

Histopatholgoical analysis of cutaneous lesions in 195 patients with HIV/AIDS was carried out between 1989 to 1997 at tertiary level public hospital in Mumbai. 104/195 (53%) cases showed infectious diseases which comprised of molluscum contagiosum (28), condyloma accuminata (18), verruca vulgaris (7), varicella zoster (5), syphilis (14), tuberculosis (13), donovanosis (4), leprosy (2), chancroid (2), bacillary angiomatosis (2), lymphogranuloma venercum (1), Norwegian scabies (3), leishmaniasis (2), demodicidosis (1), crytococcosis (1), tinea versicolor (1). In 12 (6%) cases neoplasms were observed which included squamous cell carcinoma (9), basal cell carcinoma (2) and kaposi's sarcoma (1) case. The miscellaneous conditions were observed in 66(33.5%) cases which comprised of psoriasis (21), papular urticaria (13), Reiter's disease (7) and eosinophilic folliculitis (6). The prevalence of cutaneous tuberculosis observed in this study is high as compared with western literature while the prevalence of kaposis's sarcoma is quite low as compared with reports from Africa, USA and United Kingdom.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Profile of men suffering from sexually transmitted infections in Pakistan.

BACKGROUND: To evolve effective prevention and efficient treatment strategies for sexually transmitted infections (STIs) in a country, comprehensive understanding of the prevalent STI and their modes of transmission is needed. The aim of this present study was to generate such data for Pakistan. METHOD: The study was conducted between June 1999 and September 1999 in four provincial capitals. In each city, data were collected from one or more teaching hospitals and a number of general practitioners. During this period, 465 men suffering from STIs were interviewed. RESULTS: The mean age of study population was 31.9 +/- 8.6 years, 60% were married, 58.3% urbanites, 81.7% living with their families and 83.3% smokers. Only 10.5% were drug addicts. Out of 465 cases, 27.5% cases had gonorrhoea, 31.6% syphilis, 17.2% chancroid, 18.3% herpes, 5.2% chlamydial infections while only one case (0.2%) was HIV positive. Most men (55%) acquired the infection heterosexually, 11.6% through homosexuality, 18.4% through bisexual relations and 2 men (0.5%) reported bestiality. Among 78.1% of those contracting the infection heterosexually, the source of infection was a sex worker. None acquired infection through his wife. The knowledge about STIs was very poor. Wrong notions were prevalent. CONCLUSIONS: The pattern of STIs is different from developed countries. Those acquiring STIs in Pakistan were older, married and living with their families whereas in developed countries most men acquiring STIs are younger, unmarried and living alone.

Adult↗
PubMed2003

[Principles for the control of sexually transmitted infections in tropical areas].

Owing to their frequency and their own complications, sexually transmitted infections (STI) constitute a very classical health problem, especially in developing areas. The interest for those diseases has been on the rise since the beginning of the AIDS pandemic. Conventional sexually transmitted diseases (such as syphilis, chancroid, infections due to Neisseria gonorrhoeae and to Chlamydia trachomatis) are potent cofactors of HIV transmission. It has been established that the treatment of patients with STI was able to lower the HIV incidence at the community level. Today the fight against STI relies mainly on preventive measures (promotion of lower risk sexual behaviours, blood transfusion safety), and on medical management of patients with STI. In order to treat rapidly cheaply and efficiently a great number of patients, standardised syndromic approaches, using generic drugs, have been elaborated for the most common STI. Other important complementary measures are based on the treatment of sexual partners and on the promotion of condom use. In addition to prevention of their specific complications, the fight against STI has become a major component of health policies against AIDS in developing countries.

Humans↗
PubMedDate not supplied

Changing patterns of sexually transmitted infections in India.

Sexually transmitted infections (STIs) are more dynamic than other diseases prevailing in the community. Their epidemiological profile varies from country to country and from one region to another within a country, depending upon ethnographic, demographic, socioeconomic and health factors. The clinical pattern is also a result of the interaction among pathogens, the behaviours that transmit them and the effectiveness of preventive and control interventions. We reviewed the changing patterns of different STIs (excluding HIV infection) in India and their various risk factors. A MEDLINE search was undertaken using the key words 'sexually transmitted infections, epidemiology, India'. Related articles were also searched. In addition, a manual search for many Indian articles, published in journals that are not indexed was also carried out. Wherever possible, the full article was reviewed. If the full article could not be traced, the abstract was used. Most of the published data are institution based. There is a paucity of community-based data, except for information obtained from high risk groups such as commercial sex workers, truck drivers, hotel workers and drug abusers. From the literature search undertaken, it was observed that during the 1960s and 1970s, bacterial infections including syphilis, chancroid and gonorrhoea were the major STIs, while viral infections caused by herpes simplex virus and human papillomavirus were so rare that they merited publication as case reports. Since the 1980s, the spread of human immunodeficiency virus (HIV) with subsequent behavioural (sexual and healthcare) change, the indiscriminate and prophylactic use of over-the-counter broad-spectrum antibiotics, upgradation of health services at the primary level and the success of 'syndromic' approach of treatment, has resulted in major changes in epidemiological patterns. As in developed countries, there has been a rise in viral and chlamydial infections and a relative fall in the incidence of traditional infections. This has forced a reappraisal of the importance of sexual and healthcare behaviours, since the control of incurable viral STIs depends to a great extent on societal efforts at primary prevention and counselling rather than their early diagnosis and treatment, which is an effective strategy against curable bacterial STIs.

Female↗