Survey of patients with sexually transmitted diseases seen by private physicians in Jamaica.

A survey of physicians in private practice in Jamaica was conducted between March and September 1993 to provide a descriptive analysis of the occurrence of patients with sexually transmitted diseases (STDs) seen in their practices. Questionnaires were delivered to 371 physicians of whom 127 (34%) responded, completing 683 (men 353, women 330) individual patient questionnaires. Each physician collected data over a period of one week. The median ages of the men and women were 27 years and 26 years, respectively. 464 (68%) patients were being seen for the first time for symptomatic STDs, and the visit was a follow-up for 132 (19%) who had been previously diagnosed; 40 (6%) patients were asymptomatic contacts referred by a sex partner, and 12 (2%), who were asymptomatic, asked for a 'checkup'. A history of previous STD was given by 358 (52%) patients. 470 (69%) patients had a genital discharge (M, 65%; F, 73%; p = 0.017), 52 (8%) had anogenital lesions (M, 10%; F, 5%; p = 0.013) and 45 (7%), inguinal lymphadenopathy (M, 10%; F, 3%; p = 0.002). Among women, 131 (40%) had lower abdominal pain on examination and 105 (32%) had cervical excitation tenderness or pain suggesting pelvic inflammatory disease (PID). A working diagnosis of gonorrhoea was made in 273 (40%) patients, trichomoniasis in 121 (18%), nongonococcal infection in 114 (17%), syphilis in 60 (9%), herpes genitalis in 20 (3%) and chancroid in 11 (2%). PID was diagnosed in 121 (37%) women and nongonococcal urethritis in 98 (28%) men. The most frequently prescribed treatments were for chlamydia, gonorrhoea and trichomoniasis. In general, working diagnoses correlate well with clinical observations and treatment given, matched with diagnosis according to national guidelines. A comparison of the STD burden between the public and private sectors was not possible because of sample bias.