Sharma Vinod K, Khandpur Sujay
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Natl Med J India. 2004 Nov-Dec;17(6):310-9.
Sexually transmitted infections (STIs) are more dynamic than other diseases prevailing in the community. Their epidemiological profile varies from country to country and from one region to another within a country, depending upon ethnographic, demographic, socioeconomic and health factors. The clinical pattern is also a result of the interaction among pathogens, the behaviours that transmit them and the effectiveness of preventive and control interventions. We reviewed the changing patterns of different STIs (excluding HIV infection) in India and their various risk factors. A MEDLINE search was undertaken using the key words 'sexually transmitted infections, epidemiology, India'. Related articles were also searched. In addition, a manual search for many Indian articles, published in journals that are not indexed was also carried out. Wherever possible, the full article was reviewed. If the full article could not be traced, the abstract was used. Most of the published data are institution based. There is a paucity of community-based data, except for information obtained from high risk groups such as commercial sex workers, truck drivers, hotel workers and drug abusers. From the literature search undertaken, it was observed that during the 1960s and 1970s, bacterial infections including syphilis, chancroid and gonorrhoea were the major STIs, while viral infections caused by herpes simplex virus and human papillomavirus were so rare that they merited publication as case reports. Since the 1980s, the spread of human immunodeficiency virus (HIV) with subsequent behavioural (sexual and healthcare) change, the indiscriminate and prophylactic use of over-the-counter broad-spectrum antibiotics, upgradation of health services at the primary level and the success of 'syndromic' approach of treatment, has resulted in major changes in epidemiological patterns. As in developed countries, there has been a rise in viral and chlamydial infections and a relative fall in the incidence of traditional infections. This has forced a reappraisal of the importance of sexual and healthcare behaviours, since the control of incurable viral STIs depends to a great extent on societal efforts at primary prevention and counselling rather than their early diagnosis and treatment, which is an effective strategy against curable bacterial STIs.
性传播感染（STIs）比社区中流行的其他疾病更具动态性。其流行病学特征因国家而异，在一个国家内也因地区不同而有所差异，这取决于人种志、人口统计学、社会经济和健康因素。临床模式也是病原体、传播病原体的行为以及预防和控制干预措施有效性之间相互作用的结果。我们回顾了印度不同性传播感染（不包括艾滋病毒感染）的变化模式及其各种风险因素。使用关键词“性传播感染、流行病学、印度”在MEDLINE上进行了检索。还检索了相关文章。此外，还手动搜索了许多未被索引的期刊上发表的印度文章。只要有可能，就对全文进行了审阅。如果无法找到全文，则使用摘要。大多数已发表的数据都是基于机构的。除了从商业性工作者、卡车司机、酒店工作人员和吸毒者等高风险群体获得的信息外，基于社区的数据很少。从所进行的文献检索中可以观察到，在20世纪60年代和70年代，包括梅毒、软下疳和淋病在内的细菌感染是主要的性传播感染，而由单纯疱疹病毒和人乳头瘤病毒引起的病毒感染非常罕见，以至于作为病例报告发表都值得。自20世纪80年代以来，人类免疫缺陷病毒（HIV）的传播以及随后行为（性和医疗保健方面）的变化、非处方广谱抗生素的滥用和预防性使用、初级卫生服务的升级以及“综合征式”治疗方法的成功，导致了流行病学模式的重大变化。与发达国家一样，病毒和衣原体感染有所增加，而传统感染的发病率相对下降。这迫使人们重新评估性和医疗保健行为的重要性，因为对无法治愈的病毒性性传播感染的控制在很大程度上取决于社会在一级预防和咨询方面的努力，而不是早期诊断和治疗，早期诊断和治疗是对抗可治愈细菌性性传播感染的有效策略。
