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.