Awareness about Sexually Transmitted Infections and Human Immunodeficiency Virus Infection among Patients with Genital Symptoms

Introduction: Sexually transmitted infections (STIs) are a major cause of public health problem. In developing countries, human immunodeficiency virus (HIV) infection is spreading rapidly, with sexually transmitted infections acting as a cofactor for the spread of HIV. Yet adequate awareness regarding these infections is lacking. Objective: To explore the knowledge and awareness about STIs and HIV infection in patients visiting Dermatology and Venereology Clinic of Institute of Medicine, Tribhuvan University Teaching Hospital ( TUTH) with genital symptoms. Material and Methods: A cross sectional descriptive study was carried out in the department of dermato-venereology, TUTH for a period of one year. Total of 130 consecutive cases were enrolled. After taking consent and assuring confidentiality they were interviewed regarding awareness of STIs and HIV/AIDS. Results: Out of 130 cases, 95% and 98.5% had heard of an STI and HIV/AIDS respectively. Only 43.8% could mention discharge from genitalia as a symptom of STI whereas 38.5% could mention none. Most (91.5%) knew about the sexual mode of transmission of both STIs and HIV. None could mention about mother to child transmission of an STI, whereas 15% knew that an infected mother can transmit HIV to her baby. About 58% were aware that condoms could protect them from acquiring an STI, 63% perceived this as best method of prevention from HIV. When only 26% knew that being faithful to one partner is the best mode of prevention from an STI, 45% mentioned avoiding contact with multiple partners could prevent them from HIV transmission. Conclusions: Awareness programme on STIs as a whole could improve knowledge and awareness on HIV and STIs and hence prevent both.


Introduction
W orldwide STIs are a major cause of acute illness, cervical cancer, infer lity, long-term disability, economic loss and death.Though preven on is the only solu on to get rid of HIV/AIDS and STIs, lack of knowledge makes people vulnerable to acquire and to spread STIs and HIV/AIDS.In the developing countries, risky behaviors (early ini a on of sex, premarital sex, bisexual orienta on and mul ple sexual partners) are prevalent due to lack of awareness about STI/ HIV, though government and various organiza ons are pu ng their eff ort to raise awareness about these infec ons.
Most of the studies conducted in our community are focused on diff erent focus groups like street teenagers 1 , Himalayan seasonal migrants 2 and boatmen 3 in which a signifi cant number of people had misconcep on regarding mode of transmission and preven on of STIs and HIV.While most of the high school students knew that it is spread by unprotected sexual intercourse and can be prevented by safe sexual prac ce 4 , majority of the university students felt that condom can protect them from HIV instead of limi ng sex to single partner and most of them were unaware regarding the mode of transmission of HIV 5 .In a similar Indian study, one third of the respondents felt HIV/AIDS could be cured 6 , likewise one third of Bangladeshi men did not know how to avoid AIDS and very less people knew that HIV can be transmi ed through infected blood and syringes 7 .
If diagnosed and treated early, most of the serious health problems caused by STIs are preventable.Not only it imposes tremendous public health burden but also acts as a facilitator for the spread of HIV.Limited study is available from Nepal about knowledge of STIs and HIV among the pa ents who visit hospital with symptoms related to genitalia.
Collected data about their awareness regarding STIs and HIV infec on will become cri cal informa on for the development of eff ec ve behavioral interven ons which are required for the control of STIs and HIV.

Material and Methods
A cross sec onal study was carried out in the department of dermatology-venereology of Tribhuvan University Teaching Hospital over a period of one year (June 2008 to May 2009).A total of 130 consecu ve adult pa ents who admi ed sexual exposure and presented with genital symptoms and/or posi ve serological tests for syphilis were enrolled in the study.A er assuring confi den ality for the provided informa on verbal consent was taken from each pa ent.The pa ents were interviewed according to a standard proforma which inquired symptoms, modes of transmission and preven ve measures of STI and HIV.

Results
A total of one hundred thirty pa ents who presented with genital symptoms were studied.
Baseline characteris cs of the study popula on are described in Table 1.

Knowledge and awareness about symptoms and mode of transmission of STIs
When asked, 95% said they had heard of STIs.Out of 130, 50 (38.5%)could not tell any symptoms of an STI while others had some idea about symptoms of STIs.Male seemed to be unaware compared to female.It was found that 43.8% could men on discharge from genitalia as a symptom of STI while 17.7% named genital ulcer (Table 2).Most (91.5%) could tell about the sexual mode of transmission of STIs, whereas nobody could tell about mother to child transmission

Knowledge about method of prevention of an STI
Majority (90%) knew that STIs can be prevented.About 58% were aware that condoms could protect them from acquiring an STI while only 26% knew that being faithful to one partner is the best mode of preven on.(Fig 1) Most (77%) were aware that treatment of partner is required for the eff ec ve preven on of STIs while 14% felt there is no need of partner treatment and 9% had no idea about this.

Knowledge and awareness about mode of transmission and prevention of HIV
It is sa sfying to know that 98.5% of the pa ents had heard of HIV/AIDS and majority 92% had knowledge about its sexual mode of transmission while only 15% people knew that an infected mother can transmit the infec on to her baby (Fig 2) The non-curable nature of HIV/AIDS was known to 83.8% of pa ents while 8.5% thought that cure is possible for this infec on and 7.7% did not know about it.Most of the study popula on (93.8%) knew that it is a preventable infec on while 4.6% were not sure about it.The best method of preven on for HIV/AIDS seems to be use of condom as perceived by 63% of the respondents while 45% men oned avoiding contact with mul ple partners could prevent them from HIV (Fig 3).

Discussion
It is sa sfying to note that 95% of our par cipants had heard of STIs and 98.5% had heard of HIV/AIDS which was a fi nding similar to Singh's observa on 4 .This fi nding contradicts with Rahman's fi nding 7 in which 86% of people had heard of HIV/AIDS but 45.2% of the men had no idea about STIs.In the present study, 58% could men on at least one or more symptoms while 38.5% could not tell any symptoms of an STI.This fi nding does not match with Rahman's study 7 in which 54.8% of men knew specifi c signs and symptoms of STIs.Whereas in Garg's 8 study 70% could not men on even one symptom of STI.The low level of awareness about STIs when compared to HIV could be due to diff erences in the resources spent in awareness raising programmes on HIV/AIDS versus STIs.Therefore, the fi ndings in our study suggest the need to highlight this aspect of health educa on.
Sexual mode of transmission of both STIs and HIV was known to 92% of the people which is much similar to that in other studies 1,4,9 .Only 15.4% knew about mother to child transmission of HIV while none could men on that some of the other STIs can also be transmi ed from mother to child.
In our study, 90% had an idea that STIs/HIV can be prevented; for the majority (58%) condom was the most reliable means to prevent STIs while only 26% knew that being in a monogamous rela onship is important to prevent STIs.Contrary to this fi nding 63% of the respondents perceived condom as most eff ec ve preven ve measure for HIV while 45% men oned avoiding contact with mul ple partners could prevent them from HIV.This fi nding is similar to that of Joshi 5 , whereas, in another study 73% of the slums knew that staying in a monogamous rela onship could prevent STI while only 39% were aware that condom could aff ord protec on against an STI 8 .In our study people seemed to be aware about the use of condom as a preven ve measure for STI/HIV similar to a Georgian study where, most students (71.4%) considered condoms protect against HIV and interes ngly, only 12% believed they were necessary when partners love each other and 76% of them stated that condoms can be reused a er washing 10 .Most of our respondent knew the importance of treatment of partner which is supported by a study from Vietnam 11 .

Conclusion
Our study showed a poor level of awareness with regard to knowledge about the symptoms, mode of transmission and preven on of STI in comparison to HIV.Very few knew about mother to child transmission of HIV and none had idea about the same for STIs.Par cipants gave much importance to condoms than avoiding mul ple partners or to stay in a faithful monogamous rela onship for the preven on of STIs/ HIV.The disparity in knowledge between STIs and HIV/ AIDS is due to a lot of emphasis put on HIV/AIDS without giving much importance to the other STIs in the past.Lots of money has been spent in the media, which has played an important role for the promo on of condom in the preven on of HIV/AIDS.Due to this 'condom campaign' the importance of mutual monogamous rela onship has been super shaded.Since majority of HIV is transmi ed through sexual route it can be prevented in combina on with other STIs if emphasis is given for the control of STIs as a whole.

Figure 1 :Figure 2 :Figure 3 :
Figure 1: Knowledge about modes of preven on of STIs

Table 1 :
Baseline characteris cs of the study popula on

Table 2 :
Knowledge of symptoms of STIs according to gender