A Cross Sectional study of Sexually Transmitted Infections among High Risk Groups attending Sexually Transmitted Infections Clinic in a Tertiary Care Hospital

INTODUCTION: Sexually Transmitted Infections (STIs) are combination of infection and syndrome that are epidemiologically heterogeneous and often transmitted sexually. They show various trends in different parts of the country. Men who have Sex with Men (MSM) and female sex workers (FSW) must be screened for HIV and STI. FSW is a person who provides sexual service for money and material. MSM are a diverse and often hard-to-reach group, spanning all age group and socioeconomic backgrounds. MSM in India can be divided into various sub groups: self-identified MSM, behaviorally MSM with no identity and Bisexual men. STIs commonly diagnosed are Herpes Simplex Virus (HSV) infection, genital warts, balanoposthitis, syphilis, molluscum contagiosum, gonorrhoea occasionally chancroid, lymphogranuloma venereum and donovanosis. AIM OF THE STUDY: 1. To assess and provide clinical and epidemiological data of STIs among high risk groups attending STI OPD. 2. To study the Age wise distribution of STIs in high risk groups. 3. To study the sexual behaviour pattern and mode of sex among high risk groups. 4. To study the prevalence of HIV infection in high risk. MATERIALS AND METHODS: The study included 460 high risk patients who attended STI OPD from 1st January 2018 to 30th June 2019 in Tirunelveli medical college. The diagnosis of various types of STI’s were made clinically and confirmed by relevant investigations. HIV screening, HBsAg, Anti- HCV were carried out in all patients. Other investigations like Tzanck smear, KOH mount, wet mount, gram staining, Rapid Plasma Reagin tests (if positive TPHA will be done for confirmation), pus culture and sensitivity were done. CONCLUSION: High risk groups are the ― bridging population for transmission of STIs and HIV. ◈ The prevalence of STIs is seen commonly in 2nd to 4th decade of age, hence they are main target population to be focused in order to prevent STI/HIV. ◈ Men are most commonly indulged in high risk sexual practice than female so, they need to be screened regularly. ◈ The population with EMC/PMC sexual behaviour had more STI’s than MSM and most of them had unprotected intercourse. ◈ Increased prevalence is seen among married high-risk groups with unknown paid partners. ◈ Increased prevalence of STIs are seen in high risk groups with unprotected sex. ◈ Most common mode of sex in high risk groups with STI’s was vaginal route among heterosexual and ororeceptive among MSM. ◈ Most common examination findings among high risk groups was painful ulcer, fissure, and papules over genitals. ◈ Viral STIs are on the rise when compared to the bacterial infections among high risk groups. Among viral STIs HIV, Herpes genitalis and Warts is the commonest, and among bacterial infections, Latent Syphilis is the common infection and it shows increase in trend of syphilis among high risk groups. Hence consistent screening with RPR and ELISA for HIV is a must in high risk groups. ◈ Among 101 HIV reactive individual 31 persons were co-infected with other STIs. ◈ Sex education is essential for high risk groups as earlier the age of sexual activity. ◈ Discourse the stigma among FSW and TGs to increase the health care awareness among them. ◈ Partner identification treatment needs to be initiated. ◈ Vaccination for Hepatitis B should be advised. ◈ Counselling for consistent use of condom should be done especially when contact with unknown partners and during anal sex. ◈ Promoting awareness about HIV-AIDS transmission & its prevention may alert them to use condom properly during each sexual act. ◈ STIs management in high risk groups requires the expert clinician to be conversant with risk valuation, the clinical presentation, and current diagnosis of certain diseases, and to be familiar with new medications. Successful STI care can be achieved because many infections are easily identified and treatable with simple single dose therapy. ◈ The current challenges lie in effective risk reduction and enhancing preventive care in a cost-effective way. Newer diagnostic studies will offer visions into the etiology of several clinical syndromes, but the basis of care will always rely on listening and talking to patients. ◈ More work is required to govern how to help high risk group minimize sexual risk, address their mental health concerns, and engage them in disease free lives. ◈ Regular monitoring of programs and research are necessary for further success of prevention and control of HIV in this HRG