KOCHI : Kerala is witnessing a worrying spike in cases of sexually transmitted infections (STIs).
The latest figures show a prominent prevalence, with the numbers steadily on the increase. From April 2022 to March 2023, the volume of cases was 19,323, a marked increase from 15,296 in the previous year.
This fiscal, till February, the number of cases reported is 13,840. “This figure is expected to cross numbers from the last fiscal once we collate the final data in April,” says an official of the Kerala State AIDS Control Society.
“Cases of one of the STIs, gonorrhoea, which was not to be found for at least a decade, have been spotted in some patients,” notes Dr K Ajithkumar, professor of dermatology, Government Medical College, Kottayam.
Syphilis, the most common STI found in Kerala, has for long only come up in blood probes. “But now, the disease has moved on to its next phase — physical manifestations such as lesions showing up among people affected with the disease,” says Dr Binesh V G, professor at Government Medical College, Thrissur.
The syphilis numbers show a marked increase to 1,361 in the last fiscal from 948 in the previous one. This fiscal, till February, the cases have been 1,209. Of this, Thiruvananthapuram has 186 cases and Ernakulam, 181.
Experts say the worrying part is that the data-collection mechanism is confined to just the 23 STI clinics in the state. Also, the lack of awareness about safe sexual behaviour among young adults could lead to more HIV-AIDS cases.
“The data we have now do not speak of the total picture,” says Dr Thankachy Yamini Ramachandran, deputy director (care, support and treatment), Kerala State AIDS Control Society (KSACS).
“The numbers are from just the 23 STI clinics, leaving behind the cases in the larger government hospital network and, more importantly, the private sector.”
Many cases go undocumented because the system in the government sector, as of now, does not have a referral mechanism to the department concerned with STIs.
“Medical officers at our STI clinics have clearly spotted a rise and often flagged the need for a proper record of cases,” says Dr Yamini.
Anson P D, managing director of Kanal, an NGO that coordinates Project X sex education project, echoes similar views. “Students need to be told about STIs. Even those in schools,” he says.
“Especially nowadays, when dating and exposure to physical relations begin early. Age-appropriate sex education should include information on the prevalence of STIs and safe sex procedures.”
Anson adds that he often comes across several minor students engaged in “consensual relations”.
“Most know nothing about sexual relations, except what comes to them through social media and interactions through apps such as Instagram, Snapchat, Tinder, etc., which are hard to monitor by the parents,” he says.
“The result of all these translates to unsafe sexual practices. Most of these kids do not even know that, even if by consent, physical relations under the age of 18 come under the ambit of Pocso cases.
A psychologist, who requests anonymity, also highlights the need to enhance awareness among youngsters. “Girls and women get affected more, as they yield to pressures from their partners,” she says. Add to this the drug menace, says Dr Yamini. “Young adults have a ‘no-big-deal’ policy towards premarital sex. Some among them use drugs,” she says. “It’s not the syringes that are dangerous. Even oral drugs can create an ambience where inhibitions get dropped. What follows could lead to unsafe sex and scope for STIs. We cannot tell the youngsters to do as told. But, they should make sure the decision they make is an informed one.” The increasing STIs could be indicative of a rising trend in HIV-AIDS cases, too. “STIs and HIV-AIDS are friends,” Dr Yamini. “Most HIV patients in the state, (last fiscal this was 1,183, till Feb this year, 1,094), are now in their 40s and 50s. They could have contracted the virus in their 20s. The virus takes at least five years even to manifest and when the patient comes to the hospital, battling all personal and social odds, he or she would be in the latter stages.” This is why data becomes imperative, she adds. “The KSACS has put forward proposals. It has urged hospitals to start recording the sexual history (risk behaviour) of patients who come for consultations,” Dr Yamini says. “STIs could sometimes show up as a headache. Hence, a ‘risk behaviour’ history of patients could be recorded and, if found necessary, referred promptly to us. This will help us spot the cases early on. And, in the case of HIV-AIDS, ensure the patient gets medical intervention on time.”
Official speak
A highly placed source in the health department says:
The government is planning better coordination between medical departments for data collection and early detection of the STIs
“We will be using social media and mass media campaigns along with awareness sessions among vulnerable groups. In schools and colleges too, there will be sessions on the need to take care of STIs and the ways to do it.”
As part of Continuing Medical Education (CME) programme, the government plans to train professionals to be better aware of the symptoms of the STIs
WHO Speak
The problem
STIs have a direct impact on sexual and reproductive health
They can increase the risk of HIV
Mother-to-child transmission can result in neonatal death, low birth weight, sepsis, neonatal conjunctivitis and congenital deformities
HPV infection causes cervical and other cancers
Aims by 2030
To reduce cases of 4 STIs among adults from 374 million to less than 150 million worldwide
Reduce HIV and viral hepatitis cases from 4.5 million to less than 500,000
Increase in the number of countries validated for the elimination of mother-to-child transmission of syphilis, HIV, or hepatitis B from 15 to 100
Reduce deaths from STIs, HIV, and viral hepatitis from 2.3 million to less than 1 million
Cut down new cases of cancer due to STIs, HIV, and viral hepatitis from 1.2 million to less than 700,000
Prevention
When used correctly and consistently, condoms offer one of the most effective protection against STIs, inlcuding HIV
However, condoms do not offer protection against syphilis or genital herpes
Vaacination are available for two viral STIs — hepatitis B and HPV