25September2018

India on verge of eliminating syphilis

India is on the verge of eliminating syphilis, one of the most common sexually transmitted diseases (STD) in the country.

According to the National Aids Control Organization (NACO), syphilis, which earlier used to affect about 8% of pregnant women, has been reduced to less than 1%. Among female sex workers, it affects about 4% as against 30% till a few years ago.

There has also been a massive dip in Chancroid infections. Till a decade ago, India recorded 1.2 lakh cases of Chancroid infections that have come down to less than 3,000. Chancroid causes high numbers of genital ulcers. Around 14% of all genital ulcers were caused by Chancroid, which has since come down to less than 0.1%.

“STDs have dropped, thanks to the opening of more clinics. There are 1, 033 STD clinics in the government sector along with another 4, 500 in the private sector. Earlier, there were 535 government-run STD clinics,” said Dr T L N Prasad, technical expert at NACO.

India records 30 million episodes of STDs annually, of which the government treats about 10 million.

“Eliminating syphilis will be a great achievement,” a ministry official said. Syphilis caused by a bacteria is often been called “the great imitator” because many signs and symptoms are indistinguishable from those of other diseases. Usually, it is passed from one individual to another via a direct contact with syphilis sore.

The syphilis bacterium can infect the baby of a would-be mother during her pregnancy. Depending on how long a pregnant woman has been infected, she could be at risk of giving birth to a stillborn or delivering a baby who dies shortly after birth.

An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may have seizures, or die.

Rates of STDs in the general population were similar in urban and rural areas – 11 % of women and 5 % of men in the age group of 15-49 in sexual relationship reported STDs in 12 months (National Family Health Survey (NFHS-3).

The high-risk groups (HRGs) like female sex-workers, men who have sex with men, transgender and injecting drug users have higher prevalence of STDs. Various studies have shown a high but variable level of syphilis sero-positivity (1.7% to 39.6%).

“The NACP IV, which will begin in 2012, will continue its focus on prevention activities. Some new activities of the programme will be STD sentinel surveillance, scale-up of services for HRGs and bridge population,” experts added.

Dr Prasad said seven centres were set up in the country as per WHO guidelines to monitor the drug sensitivity of gonococci. To overcome the emergence of drug resistance problem, colour-coded pre-specified STD drug kits were introduced in the STD clinics in government hospitals to promote standardized treatment protocols. Akin to tuberculosis, the government has introduced for STD a direct observed therapy, DOTS programme, to ensure 100% compliance.

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