OBSERVATIONS OF SEXUALLY-TRANSMITTED DISEASE CONSULTATIONS IN INDIA

Objectives: To assess the quality of sexually transmitted disease (STD ) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommen dations for improving the quality of care and promote the syndromic ap proach to STD treatment. Methods: Structured observations of consultat ions for STDs in health care facilities. Scoring of the observations a ccording to standards for history taking, examination, treatment and p rovision of basic health promotion advice allows evaluation of STD cas e management. Results: With STD treatment adequacy scored against Indi an national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndromic approach towards selected STD (m ale urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactorily managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms i n order to prevent STD or HIV/AIDS was given. Instructions regarding h ow to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterio n of adequate use of the STD consultation for health promotion, requir ing both promotion of condoms and encouragement to refer partner(s) fo r treatment, was met during 13 (12%) of consultations. Conclusions: Mo nitoring and improving the standards of care at facilities at which ST Ds an treated have become key roles of STD/HIV/AIDS programmes. The pr esent report suggests that in Madras the activities of medical practit ioners who treat STD patients are far from ideal at present. Improveme nts would involve simplifying existing treatment guidelines by promoti ng the syndromic approach to STD management, continuing education prog rammes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.