[Prospective study of sexually transmitted infections in Dakar, Senegal]

The objectives of this study conducted from January to December 2001 at our reference centre for sexualy transmitted infections (STI) were to determine the epidemiological profile of men who consulted our facility for symptomatic STI, describe the clinical manifestations of STI, and propose recommendations for improving therapeutic management of STI in tropical areas. A total of 100 men consulting for symptomatic STI were included over the one-year study period. In addition to administering a standardized questionnaire to each patient, a thorough clinical examination especially of the urogenital tract was performed and blood and urethral discharge specimens were obtained for analysis at the Reference STI laboratory of Institut d'Hygiène Sociale (IHS). Analysis of study data demonstrated that the mean age of patients was 25 years, that 52% were single, and that level of education was generally low (primary school for 37% and secondary school for 27%). However it should be pointed out that 12% of patients had a university level education. Most patients were Wolof people living in or around Dakar and working in the trades sector (shopkeeper, artists, tailors, drivers, and seamen). Thirty-seven percent of patients reported previous STI involving urethral discharge in 34% and genital ulcer in 3%. Risk factors included sex with random partners in 51% including 31% with prostitutes, more than two partners at the time of the study in 34%, and regular alcohol use in 44%. Neisseria gonorrhoea was by far the most frequent infectious agent found in urethral discharge specimens (52%). Genital ulcer was found in only 13 cases. Eight of 13 patients with genital ulcers had positive syphilis serology suggesting that syphilis was the most frequent aetiology. The other aetiologies were uncommon STI, ie., condyloma (n=3), balanitis (n=2), venereal lymphogranuloma (n=1) and secondary syphilis (n=1). Serology was positive for HIV in 4% of patients. The epidemiologic profile of the patients in our study was similar to those previously reported in the literature. However it is interesting to note the non-negligible number of cases of STI transmission involving illegal prostitution, the high incidence of mismanagement of STI by the health care workers who provided initial treatment, the poor availability of drugs used for treatment of STI therapy in the centre's Banako Initiative (BI) pharmacy, and the frequency of condom non-use by patients with STI.