A surveillance model for sexually transmitted infections in India.

The strategy for prevention and control of sexually transmitted infections (STIs) in India is based on syndromic case management delivered through designated STI/reproductive tract infection (RTI) centers (DSRCs) situated in medical colleges, district hospitals, and STI-clinics of targeted interventions programs. Laboratory tests for enhanced syndromic management are available at some sites. To ensure country-level planning and effective local implementation of STI services, reliable and consistent epidemiologic information is required on the distribution of STI cases, rate and trends of newly acquired infections, and STI prevalence in specific population groups. The present STI management information system is inadequate to meet these requirements because it is based on syndromic data and limited laboratory investigations on STIs reported passively by DSRCs and laboratories. Geographically representative information on the etiology of STI syndromes and antimicrobial susceptibility of STI pathogens although essential for optimizing available treatment options, is deficient. Surveillance must provide high quality information on: (a) prevalence of STIs such as syphilis, trichomoniasis, gonorrhea, and chlamydia among high-risk groups; syphilis in the general population and pregnant antenatal women; (b) demographic characteristics such as age, sex, new/recurrent episode, and type of syndromically diagnosed STI cases; (c) proportion of acute infections such as urethral discharge (UD) in men and nonherpetic genital ulcer disease (GUD) in men and women; (d) etiology of STI syndromes; and (e) gonococcal antimicrobial susceptibility. We describe here a framework for an STI sentinel surveillance system in India, building on the existing STI reporting systems and infrastructure, an overview of the components of the proposed surveillance system, and operational challenges in its implementation.

Chlamydia trachomatis among HIV infected patients using PCR technique

Background and Objectives: Chlamydia trachomatis is a sexually transmitted organism and an important public health problem in the sexually active age group. Limited studies are found regarding the prevalence of Chlamydia trachomatis in Nepal. Moreover, no study in Nepal reports the association of Chlamydia and HIV infection. The current study attempts to determine the burden of Chlamydia on HIV positive patients. Material and Methods: A total of 117 HIV positive patients visiting a HIV clinic in Kathmandu, were screened for Chlamydia infection. For this, Urine samples were collected and analyzed using the Multiplex polymerase chain reaction technique (MPCR) and Agarose gel electrophoresis. DNA isolation was performed using QIAamp DNA and Blood mini kit handbook protocol. Results: C. trachomatis was detected in 4.27% of the total 117 HIV patients. Out of positive cases 60% were males and 40% were females. However, Chlamydia is found more prevalent among females (6.89%) than in males (3.4%). Eighty percent of positive cases were asymptomatic. Conclusion: Chlamydia infection was found less commonly among studied patients and most of those cases were asymptomatic. So there is difficulty in timely detection of C. trachomatis and track the clinical sequel, which might be devastating. Hence, routine checkup is recommended for all suspected cases for timely management of the disease.

Male Circumcision: Is It the Proper Treatment or Not?

Recently the male circumcision becomes a hot issue not only in abroad but especially in Korea. Under this circumstance, it will be right that doctors and scholars restart to study about the merits and demerits of the male circumcision. There are little clear answers about its advantages in urinary infection, penile cancer, sexual function, etc. The only issue is that WHO and UNAIDS admit the male circumcision as a significant precautionary measure against HIV (human immunodeficiency virus) after finishing a large scale study. As a doctor, it will be desirable to explain to the patients or parents about the advantages and disadvantages of the male circumcision and help them make a choice considering its cultural, religious, legal, social, and emotional situation when the patient comes to the hospital for a male circumcision. However, it will be difficult to follow the Western statistics impetuously since the course of diffusion of HIV in Korea is different from that in USA, and there is no study in Korea about the merits and demerits of the male circumcision. Therefore, we conclude that it will be an impetuous assertion to argue that the male circumcision should be done before the adolescence, before starting an active sexual life, without any countermeasure.

Historical Changes and the Present Situation of Sexually Transmitted Diseases

STDs (sexually transmitted diseases) refer to a variety of bacterial, viral, and parasitic infections that are acquired through sexual activity including vaginal intercourse, oral sex, and anal sex. The term sexually transmitted infection (STI) is used increasingly because it has a broader range of meaning; a person may be infected and may potentially infect others without showing signs of diseases. Approximately 340 million new cases of STDs occur each year in the world. According to the Korea Centers for Disease Control and Prevention, notified cases of STDs in Korea decreased from 32,872 in 2002 to 12,486 in 2007. Bacterial STDs such as gonorrhea and chlamydial infection declined continuously but syphilis and chlamydial infection increased again. Viral STDs such as genital herpes and condyloma acuminatum increased continuously. Gonorrhea and chlamydial infection are still the two most commonly reported STDs in Korea. Bacterial STDs can be cured. However, the problem is that viral STDs cannot be cured completely at present. Safe sex with proper education and the correct use of condom are important to prevent STDs and unwanted pregnancy. Early diagnosis and screening, proper treatment, and appropriate counseling from qualified physicians are necessary to prevent the complications and spread of STDs. Also, continuous monitoring and strategies of prevention of STDs will be necessary for improvement of the public health.