A COMMUNITY-BASED APPROACH TO THE CONTROL OF SEXUALLY-TRANSMITTED DISEASES IN THE NORTHERN-TERRITORY

A program to control sexually transmitted diseases (STDs) was undertak en during a Men's Health Week in a remote Aboriginal community in West ern Arnhem Land, Northern Territory. A total of 151 men aged 13 years and over who attended over a five-day period underwent a full physical examination, and first-void urine specimens were tested for the prese nce of leukocytes, chlamydia (by enzyme immunoassay antigen detection) and gonorrhoea (by culture and antigen detection). Blood was taken fo r syphilis serology from all patients and for human immunodeficiency v irus (HIV) from patients with a proven STD or at the patient's request . Consent for testing was obtained from all participants. Patients wit h a positive urinary leukocyte test or symptoms were offered urethral swab investigations and treated empirically according to a set protoco l. Patients with STDs detected by subsequent laboratory investigations were followed up and treated. The overall prevalence of one or more o f syphilis, gonorrhoea or chlamydia was 17.4 per cent. No men presente d with genitourinary symptoms and none was HIV-infected. In this popul ation, STDs were an important cause of morbidity, and a community-base d approach was adopted to identify infected persons. The use of urine for the detection of gonorrhoea and chlamydia was highly acceptable. A lthough not used in this study, polymerase chain reaction and ligase c hain reaction technology will facilitate similar activities in the fut ure.