A study of the changing trends in the pattern of sexually transmitted infections in the state of Kerala.

Sir,

This was a retrospective 10-year study conducted in the Department of Dermatology and Venereology, Medical College Hospital, Trivandrum, Kerala, from 1996 to 2005. Data were collected from the STI case records of all patients who presented with sexually transmitted infections. For the purpose of comparison, data were collected and divided into two groups based on the period: From 1996 to 2000 and from 2001 to 2005.

A total of 2130 cases were analyzed in the study. There were 1184 cases in 1996–2000 and 946 cases in 2001–2005. Genital ulcer STIs accounted for 1453 cases and genital discharge STIs accounted for 240 cases. The comparative pattern and frequency of STIs between 1996–2000 and 2001–2005 is depicted in Table 1. There was a decrease of 11.17% in the total number of STIs in the period 2001–2005 compared to 1996–2000. Syphilis was the commonest STI in this study, late latent syphilis (LLS) being the commonest. There was a significant increase in the number of LLS cases in the period 2001–2005 compared to 1996–2000 (P=0.0000). Herpes genitalis accounted for 427 cases. There was a significant increase in the number of HIV cases in 2001-2005 compared to 1996–2000 (P=0.001). There was a significant decrease in the number of condyloma acuminata cases in 2001–2005 compared to 1996–2000 (P=0.007). Gonorrhea was the commonest genital discharge disease in this study (75 cases); however, there was a 60% decrease in the number of gonorrhea cases in 2001–2005.

Table 1

Comparison of STIs between 1996-2000 and 2001-2005

The concept of “syndromic treatment” advocated by the Government of India in the recent years has contributed in decreasing the number of STIs. In a study conducted by Jain et al., herpes genitalis was found to be the commonest STI.[12] LLS was the commonest type of syphilis seen in this study, which is a unique highlight of this study. Moreover, there has been a dramatic increase in the number of LLS cases in the period 2001–2005 compared to 1996-2000. This is because of the compulsory screening for VDRL and TPHA for visa requirements to Middle East countries. The actual prevalence of herpes genitalis may be even higher as studies have shown positive serology for HSV-2 using enzyme immunoassay for asymptomatic individuals.[3] HIV/AIDS was the third commonest STI seen in this study, which is similar to other studies done in India.[4] The significant increase in the number of HIV cases during 2001-2005 is another important highlight of this study. This is because of the recent functioning of ICTC centers in many parts of the state where HIV testing is done free of cost.

Gonorrhea was the commonest genital discharge STI seen in this study. Other studies in India have shown both Gonnorhea and Chlamydia to be the common etiological agents for genital discharge STI, even though Chlamydia is now emerging as the commonest etiological agent for genital discharge STI.[5] However, there was a drastic reduction by 60% in the number of gonorrhea cases in 2001–2005. This is again due to the use of over-the-counter antibiotics and due to “syndromic treatment”. Vaginal candidiasis was the commonest cause of vaginitis in this study, while other studies in India have shown bacterial vaginosis as the commonest cause.[5]

We would like to state that this study has demonstrated that bacterial STIs, especially syphilis, is still common in India, while viral STIs like herpes genitalis and HIV are emerging as significant STIs in India.