Sexually transmitted diseases in the tropics. Epidemiological, diagnostic, therapeutic, and control aspects.

PIP: Sexually transmitted diseases, especially syphilis, gonorrhea, granuloma inguinale, and lymphogranuloma, are on the increase in the tropics. Several environmental factors contribute to disease transmission, including polygamy, high bride price, prostitution, civil war, urbanization, and economic development. Diagnosis is generally made on clinical grounds due to inadequate laboratoary facilities, and it is not possible to differentiate syphilis from yaws. This diagnostic inaccuracy has meant that there are no reliable data with which to assess epidemiologic trends, institute control measures, and evaluate their effects. Inadequate treatment, caused by a lack of drugs and poorly trained medical attendants, is also a major problem. Inappropriate treatment has caused over 80% of gonococcal strains in some areas to be penicillin-resistant. Late complications of gonorrhea, epididymitis, and salpingitis are frequently seen and lead to sterility in many cases. These complications are as prevalent in some areas today as they were in pre-sulfonamide days. A determined effort is needed to control the spread of these diseases. A central unit with modern facilities for diagnosis and treatment should be established. Diagnostic tests, such as culture and serology, should be introduced at the district and provincial levels. Rural health centers should employ a polyvalent microscopist who is trained to recognize gonococcus in stained smears. Given the high default rates, treatment should be simplified, using a single dose schedule where possible. The impracticality of follow-up requires epidemiologic treatment of contacts in many cases. If mass screening of pregnant women is not possible, Crede's silver nitrate eyedrops are recommended to prevent ophthalmia neonatorum. High risk populations, including bar girls, migrant workers, soldiers, and sailors, should be targeted for health education campaigns. Such education should focus on regulation of sexual behavior, condom use, and, when infection is present, the importance of avoiding self-medication, early treatment, and cooperation in contact tracing.^ieng

The role and training of doctors and midwives

When plans are being made for improved maternity services the training of doctors and midwives who are to staff them must also be considered. Each of the two professions brings special skills to the service of the parturient. The role of the midwife is to deal with normal obstetrics, to detect abnormalities and to refer patients who develop them to a doctor, and to provide for all mothers and their newborn babies the special nursing care they require (AU)