STIs are among the leading public health problems that individuals seek health care in the town. Our finding is in agreement to the report by Dallabetta et al. where STIs, in most nations, are ranked among the top five leading causes that individuals seek health care . Similarly, even in developed countries like the United States, five of the 15 most commonly reported notifiable diseases are STIs (gonorrhea, Chlamydia, HIV, syphilis and hepatitis B) including the first and second most commonly reported diseases, gonorrhea and Chlamydia, respectively . In fact, reported STIs represent only the “tip of the iceberg” because most infections—typically more than half of any specific diagnosis regardless of bacterial or viral etiology—are entirely asymptomatic and/or unrecognized [3–5]. This is especially true for women [6–8]. Furthermore, adequate data are not available in developing countries to even analyze reporting rates in those settings . This obviates that the actual situation in the study area could even be harsher as only symptomatic cases came to the clinic. There could also be unreported symptomatic cases due to stigma and discrimination, fear of potential conflict with sexual partner especially in the married group, self prescription of medicines from pharmacies, preference to traditional healers, and because of the general poor health seeking behavior of the community. There could be a hell of asymptomatic cases, subclinical cases, and cases with minor symptoms. There could also be unnoticed symptomatic cases. The level of awareness to distinguish between abnormal vaginal discharges from the normal ones, in women, could be one factor. The fact that STI was more reported by women in this study could also be one other sign of high prevalence of STIs in the community as women tend to be more asymptomatic or subclinical in most of the cases [6–8]. However, the actual prevalence of STIs and the aforementioned assumptions need to be proved through further studies.
In line with the 2006 WHO report the age distribution showed patients in the reproductive age group (15–49 years) were the major STI affected (97.9%) portion of the population . Our result is in agreement with the report by Klouman et al. in Tanzania  where they found the highest rate of STIs among 25–34 years of age females and 35 to 44 age group of males Considerably STIs affected women (78.6%) in the town. This could be due the geographic location of the clinic and increased level of awareness to STI treatment in towns than rural areas. As discussed earlier, factors affecting the health seeking behavior of individuals in the community need to be explored.
In this study, the most frequent chief complaints of study participants were vaginal discharge (38.38%), combination of the sign and symptoms (28.7%) and urethral discharge (13.58%). The reason for higher proportion of vaginal discharge could be due to the fact that majority of the participants were females. The majority of STI causing organisms be it fungal, bacterial and/or protozoal has also manifestations of vaginal discharge in women. Higher rates of similar STI syndromes were also reported in by Wolday et al. Addis Ababa, Ethiopia . Seven out of 58 (12.07%) urethral discharge cases were bacteriologically diagnosed to be due to N. gonorreae. Four out of the eight (50%) genital ulcer cases were serologically diagnosed to be syphilis. As the etiologic approach was used sporadically and randomly in the study clinic, the actual proportion of etiologic cases for discharge or ulcerative STIs needs to be determined. This could strengthen the empirical syndromic approach by showing the frequent etiologic agent in the community.
Treatments of the cases were delivered as per the national guideline of syndromic management of sexually transmitted infections . Despite having its own huge contribution for drug resistance, the syndromic management might be helpful for the existing relief of patients. Re-treatment was reported by 2.7% (8/301) of female cases but not males. Among the cases visited the clinic for re-treatment, 62.5% were with chief complaint of vaginal discharge. This might indicate that the syndromic flowchart for the management of vaginal discharge does not work well for controlling sexually transmitted infections in women because this symptom is a poor proxy for endocervical Chlamydia and gonorrhea [16–18]. On the other hand, treatment failure due to several other factors could be the reason for the re-treatment like failure to bring sexual partner, antimicrobial resistance, poor compliance to treatment, HIV co-infection (which we were unable to retrieve from the participants’ record) and another infection. This obviates an urgent need for the evaluation of the sensitivity and specificity of the syndromic approach and test for antimicrobial resistance. In addition to this, some cases might visit a different health institution for the re-treatment or may get self prescribed medication from pharmacies with a resultant under estimation of re-treatment.
In the case of this study where 77% of the cases didn’t bring their sexual partners for treatment, the percentage of cases visiting clinics for re-treatment is even underestimated. On top of this, the new cases in the study clinic might have previous history of treatment in other clinics in the town. Besides, cases may not return to the same clinic for re-treatment for several reasons. Among those who brought their sexual partner for treatment, 13.6% were from the rural areas. Age and sex were found to be significantly associated with partner treatment. This shows the need to fostered counseling of patients while they are getting the service. Higher proportion of older age groups brought their sexual partners for treatment compared to other age groups. Young adults may not be transparent for their partners and prohibit discussions for such issues, due to cultural and other influences, which is again an area where an intervention should have to be taken.
Our study is limited to a clinic where only health care seeking individuals are found. Many important variables were not also included in the study due to incomplete/absence of the variables in the record. Population based studies could be helpful to show the real picture of STIs in the area.