Prevalence of genital infections in medical inpatients in Blantyre, Malawi

Abstract

The limited information on the prevalence of sexually transmitted diseases (STDs) in Malawi suggests that they are common. In studies in Lilongwe in 1989 and Blantyre in 1990, the prevalence of STDs was 4.4% in unselected outpatients and 42% in antenatal clinic patients respectively. Malawi is one of the countries worst affected by the HIV pandemic, with an estimated national HIV seroprevalence of 10% in the age group over 15 years and of 32% in pregnant women who attended antenatal clinics in Blantyre in 1993. Heterosexual intercourse is the main mode of HIV transmission in sub-Saharan Africa, accounting for up to 80% of cases of HIV infection. Concomitant genital ulcer disease facilitates sexual transmission of HIV. Non-ulcerative STDs may also play a role in facilitating sexual transmission of HIV but the evidence is less clear. The identification and treatment of people with STDs therefore presents an opportunity for decreasing HIV transmission. Queen Elizabeth Central Hospital (QECH) is the District Hospital for Blantyre, Malawi's largest city (about 500,000 population) and the tertiary referral hospital for Malawi's Southern Region. There are two general medical wards, one male and one female, to which about 11,000 patients were admitted in 1993. Bed occupancy can run at up to 150-200% and resources are limited. The top ten causes of admission are malaria, gastroenteritis, anaemia, pneumonia, dysentery, tuberculosis, AIDS, meningitis, hypertension and ascites. The leading causes of death are AIDS and tuberculosis.

PIP: Malawi is one of the countries that has been most affected by the HIV epidemic with an estimated national HIV seroprevalence rate of 10% in the age group over 15 years and 32% among pregnant women who attended prenatal clinics in Blantyre in 1993. Queen Elizabeth Central Hospital (QECH) is the district hospital in Blantyre, Malawi, and the tertiary referral hospital for Malawi's southern region. About 11,000 patients were admitted there in 1993. The aim of this cross-sectional study was to determine the prevalence of sexually transmitted diseases (STDs) in inpatients under general medical care in view of the limited examination facilities in the wards. All patients who were in the general medical wards on June 23, 1994, were enrolled for the study. After obtaining informed consent, external genital lesions were identified visually noting the presence of ulcers, warts, and urethral discharge in men. The patients' case notes were reviewed to identify those with known current STDs. A total of 123 patients were examined: 62 males (age range 20-90 years) and 61 females (age range 16-65 years). There were 6 (9.7%) males vs. 8 (13.1%) females with discrete ulcers; no males vs. 2 (3.3%) females had nondiscrete ulcers; 3 (4.8%) males and 6 (9.8%) females had genital warts; 6 (9.7%) males had urethral discharge; and 13 (21%) males vs. 14 (23%) females had one or more lesions. One man had Kaposi's sarcoma of the glans penis. The survey showed that STDS are common in general medical patients in Blantyre with an overall prevalence of 22%. This percentage is an underestimate given the fact that the limited facilities precluded the diagnosis of trichomoniasis, gonorrhea, and chlamydia in women. Of the 123 patients, 14 (11.4%) who had discrete genital ulcers received treatment with erythromycin and penicillin to cover the main possible causes (chancroid, syphilis, and lymphogranuloma venereum). In view of the known link between STDs and the risk of HIV transmission, treatment of STDs may be more effective in preventing sexual transmission of HIV.