Title

Factors associated with sexually transmitted diseases among men attending Std clinics in Karachi Pakistan

Date of Award

1999

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Globally, around 340 million new cases of curable sexually transmitted diseases (STDs) were estimated by the World Health Organization (WHO) in 1995. In developing countries, STDs and their complications rank in the top five disease categories for which adults seek health care. Determinants for sexually transmitted diseases are directly related to different patterns of sexual behavior, and in the light of increasing prevalence of incurable viral diseases, especially HIV infection, modification of sexual behavior has emerged as a key intervention for STD prevention and control. Surveillance of STDs in developing countries is uneconomical, but it is possible to track changes in the high risk behaviors that lead to those infections. Furthermore, unless the context and forms of risk behavior are well understood it is not possible to provide and effectively support relevant safe alternative behaviors. The current lack of behavioral data within Pakistan could result in losing the brief time period during which public health interventions may have the greatest impact. A hospital based case control study was conducted, with an objective to identify factors associated with STDs among men attending tertiary care government hospitals in Karachi We enrolled 127 male STD patients and 165 controls from different specialties of the respective hospitals. The cases were diagnosed on clinical sign / symptoms and tested for gonorrhoea (Gram staining), syphilis (RPR), and HIV (ELISA). Among cases, 72.4Vo had genital ulcers, 26% had urethral discharge, and 1-6% were positive for HIV-1 antibodies. Face to face interviews through trained interviewers were conducted and structured questionnaire was used to assess the sexual behavior of the study subjects. Among study subjects, 87% cases and 42% controls had premarital sex, 86% cases and 24% controls had extramarital sex, while 43% cases and 22% controls were illicit drug users. Among cases, 42% had their last sex with a sex worker, while 48% started their sexual life with a friend. Anal sex reported by 58% cases and 26% controls. Insertive fellatio was the most common oro-genital sex practiced by 18% cases, while 8% controls reported cunnilingus. STD patients had early sexual debut (41% before 17 years of age), had formal education [AOR. 2.21, 95% C.I (1.14, 4.28)], and were married but living without wives [AOR. 2.84, 95% C.I. (1.15, 7.03)]. Anal sex with commercial sex workers [AOR 5.16. 95% C.I (1.94, 13.71)), alcohol use [AOR 2.23, 95% C.l (1 .06, 4.7I)] and non-use of condom [AOR. 2.27, 95% C.I. (1 .06, 4.71)] were also associated with STDs. Our study subjects also showed a heterogeneous sexual mixing pattern. Married men reported extramarital sexual relationships, with commercial sex workers (40% cases, 6% controls), with non-commercial partners (18% cases, 75% controls), and with both (28% cases, 4% controls). To control and prevent STDs transmission including HIV in Pakistan, a multi-factorial approach is needed, which includes sex education, condom promotion, and proper STD management among adolescents, migrant workers, and STD patients, and interventions to minimize urban migration.

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