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Sexually Transmitted Diseases in Women: A case for Syndromic management

The WHO defines "Essential drugs as those which satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms."

The goal for health for all has been approached in many countries through strengthening of primary health care. Providing this network of dispensaries with regular supplies of quality drugs to treat the most common health conditions is perhaps the most important factor, which boosts the confidence of the population in the health care delivery system.

It is not a simple matter to ensure the availability of safe, affordable essential drugs. Legislations, technical and medical logistic skills of an advanced nature are needed for ensuring supplies. Pharmaceutical companies market their products with little concern for the different health needs or priorities of a country and they fuel demand by manufacturing and selling non-essential drugs like latest antibiotics, tranquilizers, tonics most with no proven therapeutic value.

Developing countries cannot afford to waste their resources on the luxury of non-essential drugs Pharmaceutical companies perceive the vast potential of these countries in terms of the sheer size of the population and laxity of rules. These countries are therefore considered ideal for selling their high priced, non-essential formulations with a consequent burden on the individual.

In the interest of social justice and health, out of which the concept of essential drugs was born, it is time that the principle is adopted by all developing countries. They should draw up their priorities, develop national drug policies and thus ensure access of quality medicines to all.

STDs are a public health problem, Reproductive Tract Infections are compounded by complications of STD and can result in primary and secondary infertility, poor pregnancy outcomes such as abortions, pre-terry delivery, malformations and congenital STDS. In addition these diseases can cause stress and marital problems.

While studies have been done to find out the extent of the problem, these cannot describe the personal anguish and harm that such diseases can cause to women. These research findings urgently need to be translated into policy and used to raise awareness about these diseases among women and men. Most women diagnosed with an STD are symptomless they only find out they are infected when tested at a clinic for another reason usually for ante-natal and family planning services. This fact is emphasized by a study in which women from twelve different African countries attending ante-natal clinics were screened for STDs and were found to have syphilis at rates varying from 2-33%. The effect of STDs on pregnancy associated conditions is severe. STD infection while pregnant can lead to stillbirth, pre-mature birth, post partum pelvic inflammatory disease, eye impairment in the new-born and perinatal AIDS.

In order to deal with the serious problem of STDs in pregnant women it is important to at least carry out syphilis screening at ante-natal clinics and provide prompt treatment to protect the mother, baby and the sexual partner(s). STDs have a negative effect on women's fertility although the actual number of women who become infertile due to STDs is not known. Female commercial sex workers are even more at risk of contracting STDs than other women. This is because they have multiple sexual partners and condom use is low.

The high rate of various types of infections among CSW cannot be over-emphasised because these workers are part of society and interact with the male population, locally, nationally and internationally. During this decade research on relationship and other STDs has revealed that sexual transmission of HIV may be facilitated by the presence of STDS, this may partly be an explanation of varying HIV rates around the world. HIV infection and consequent immunodeficiency may alter the progress of the disease, diagnosis or response to other STD treatment. STDs may influence the natural progression of HIV by accelerating the progression of clinical disease. HIV infection may also increase the susceptibility to other STDs.

In India according to a baseline study conducted in l992,in a red light area in Calcutta 59% of the CSWs were found to have STDs. In Madras the VDRL positivity was as high as 10% in female remand prisoners and the rate among women attending antenatal clinics 1.74%. In a population based cross-sectional study in rural Maharashtra 92% of all women surveyed were found to have one or more gynaecological problems. Infections of the genital tract (vaginitis cervicitis and PID) contributed to half of thin morbidity.

The fundamental goal of STD control programmes is early detection and treatment of the disease preferably at the point of patient's first contact with the health system. The syndrome approach to STD case management uses common symptom complex of STD as a starting point and to treat and counsel about STD prevention and partner notification. Condom provision is an essential part of syndromic management. Besides being simple and inexpensive syndromic case management allows for diagnosis and treatment in a single visit. Standardisation of treatment regimens is of paramount importance as they facilitate training and supervision, delay the development of antimicrobial resistance in sexually transmitted agents such as N.gonorrhoez and H. ducreyi and most importantly, rationalise the procurement of drugs.

The chart below gives the treatment path for Genital Ulcers:

TREATMENT REGIMENS:

Syphilis

Chancroid