A comparison of prevalence rates of genital ulcers among persons attending a sexually transmitted disease clinic in Jamaica

Two cross-sectional surveys were undertaken, from December 1982 to August 1983 and from November 1990 to January 1991, to estimate the prevalence rates of genital ulcer disease (GUD) in all patients presenting with a new sexually transmitted disease (STD) complaint to the STD clinic at the Comprehensive Health Centre in Kingston, Jamaica. Diagnosis of syphilis and human immunodeficiency virus (HIV) infection was based on results of laboratory tests, but diagnosis of other STDs was based on clinical features. Data from these two surveys were compared, and reported national annual incidence data for GUD reviewed. In 1982/83 6.8 percent of 23,050 patients had GUD, men (9.3 percent) more often than women (4.2 percent; p < 0.001). In 1990/91 the prevalence rate was 12.8 percent with increased rates for both men (18.2 percent) and women (6.8 percent; p < 0.001). In patients with GUD, a clinical diagnosis of genital herpes was made, in 1982/83 and 1990/91, respectively, in 16.8 percent and 7.8 percent of the patients; syphilis, in 12.9 percent and 18.8 percent; chancroid, in 12.4 percent and 13.3 percent; viral warts, in 5.7 percent and 6.3 percent; lymphogranuloma venereum, in 4.1 percent and 3.9 percent; and granuloma inguinale, in 3.6 percent and 2.3 percent. In men the rate for syphilis was 19 percent in 1990/91 and 8 percent in 1982/83 (p=0.001); and for genital herpes it was 7 percent in 1990/91 and 17 percent in 1982/83 (p=0.025). These reversals were attributed to intense media coverage of herpes in 1982/83. There was no difference in prevalence rates between the two surveys for these diseases in women, or for lymphogranuloma venereum, granuloma inguinale and genital warts in men and women. A clinical diagnosis could not be made in 44.4 percent of cases in 1982/83 (particularly in men), and in 47.6 percent of cases in 1990/91. GUDs faciltate transmission and adversely affect the prognosis of HIV. The increase in their prevalence has implications for the evolution of the local HIV epidemic, and hould be addressed effectively by stregthening the STD/HIV control programme.

Survey of patients with sexually transmitted diseases seen by private physicans in Jamaica

A survey of physicians in private practice in Jamaica was conducted between March and September 1993 to provide a descriptive analysis of the occurrence of patients with sexually transmitted diseases (STDs) seen in their practices. Questionnaires were delivered to 371 physicians of whom 127 (34 percent) responded, completing 683 (men 353, women 330) individual patient questionnaires. Each physician collected data over a period of one week. The median ages of the men and women were 27 years and 26 years, respectively. 464 (68 percent) patients were being seen for the first time for symptomatic STDs, and the visit was a follow-up for 132 (19 percent) who had been previously diagnosed; 40 (6 percent) patients were asymptomatic contacts referred by a sex partner, and 12 (2 percent), who were asymptomatic, asked for a "check up". A history of previous STD was given by 358 (52 percent) patients. 470 (69 percent) patients had a genital discharge (M, 65 percent; F, 73 percent; p = 0.017), 52 (8 percent) had anogenital lesions (M, 10 percent; F, 5 percent; p = 0.013) and 45 (7 percent), inguinal lymphadenopathy (M, 10 percent; F, 3 percent; p = 0.002). Among women, 131 (40 percent) had lower abdominal pain on examination and 105 (32 percent) had cervical excitation tenderness or pain suggesting pelvic inflammatory disease (PID). A working diagnosis of gonorrhoea was made in 273 (40 percent) patients, trichomoniasis in 121 (18 percent), nongonococcal infection in 114 (17 percent), syphilis in 60 (9 percent), herpes genitalis in 20 (3 percent) and chancroid in 11 (2 percent). PID was diagnosed in 121 (37 percent) women and nongonococcal urethritis in 98 (28 percent) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlated well with clinical observations and treatment given, matched with diagnosis according to national guidelines. A comparison of the STD burden between the public and private sectors was not possible because of sample bias.

Is under-reporting of AIDS a problem in Jamaica?

A survey of physicians in Jamaica was conducted between March and September, 1993 in order to estimate the level of reporting of HIV and AIDS. A questionnaire was delivered to nearly all of approximately 1,200 physicians practising in Jamaica. Completed questionnaires were received from 518, a response rate of 35 per cent. Of the physicians responding, 46 per cent were in private practice only, 22 per cent in the public sector only and 32 per cent in both. Two-thirds (66 per cent) of the physicians in private practice had not diagnosed a case of AIDS and 65 had not had a patient with a positive HIV test result. Half (54 per cent) of the private physicians had reported all their AIDS cases, 8 per cent had reported some and 38 per cent (45 doctors) had reported none. The main reasons for not reporting were: "thought someone else had reported" (15 doctors), concern for confidentiality (11) and not knowing where to report (8). Only 9 per cent of private practitioners were currently seeing an AIDS patient and 12 per cent were seeing an HIV-infected person. Of physicians with current AIDS patients 16 per cent preferred not to report, 21 per cent intended to report and 63 per cent had reported. Nearly one-third (29 per cent) of private practitioners expressed reservations about treating persons with HIV/AIDS. Most (75 per cent) public sector physicians had seen one or more AIDS patients. Sixty-four per cent of these physicians said that all of their AIDS cases were reported, 4 per cent said some, 4 per cent said none and 28 per cent didn't know. Reporting of AIDS cases is better in the public sector than among private physicians. It is likely that some, if not many, of the AIDS cases not reported by private physicians are reported when admitted to hospital. It is not possible to estimate the precise level of under reporting of AIDS in Jamaica from this survey. However, more needs to be done to address the reservations of some private physicians and convince them of the need for timely reporting of HIV/AIDS cases

A practical manual on sexually transmitted diseases for the Caribbean

This manual is intended as a guide for a systematic approach to STD management, and as an easy reference for the busy clinician.

A practical manual on sexually transmitted diseases for the Caribbean

The manual is intended for use as a reference tool by physicians engaged in STD control programmes in the Caribbean. All presumptive diagnosis warrant full treatment and follow-up