Abstract
BACKGROUND: Many studies have examined the inter-relationship between different STI. There are, however, a few data on patients presenting with more than one concurrent sexually transmitted infection (STI). The aim of the study was to determine the burden of patients with more than one concurrent STI and to characterize factors associated with such infections. MATERIALS AND METHODS: Two hundred seventy five patients with one or more of the complaints, as enunciated by the World Health Organization (WHO) in its syndromic approach for the diagnosis of STI, were included as subjects. Detailed history, demographical data, and clinical features were recorded. All the patients were screened for common STIs. Multivariate analysis was performed taking all significant risk factor obtained from univariate analysis. RESULTS: A total of 102 (37%) patients were identified as having multiple STIs amongst whom 72% (73/102) were male, 70% were married, and except one none reported regular use of condom The age of first sexual exposure was 13-17 years, 31.3% had more than three sexual partners in the past 6 months, and 76.4% had contact with commercial sex workers (CSWs). Multivariate analysis revealed statistical significance in relation to marital status, number of sexual partners exposed in the past 6 months, age of first sexual exposure, and age of patient at the time of presentation. Syphilis (48%) was the most common infection associated with multiple STI followed by HIV (45%) and HSV-2 (39.2%). None of the patients with multiple infections were detected and managed accurately by syndromic approach. CONCLUSION: Pattern of concurrent multiple STIs and the clinical severity of such multiple infections may serve as an indicator of the type of host-pathogen interaction determining the outcome of infection. When patient had multiple STIs, syndromic approach was not axiomatic and thus underscores the need for laboratory diagnosis.