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Browsing Theses and Dissertations by Author "ABEYEWICKREME, I"
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Item An Evaluation of some aspects of the screening programmes for syphilis and gonorrhoea in Sri Lanka(Post Graduate Institute of Medicine, Colombo: PGIM ., 1990) ABEYEWICKREME, ISexually Transmitted Diseases (S.T.D.S) are important public health problems through out the world. The main approaches in the S.T.D. control programmes include early detection of disease and effective management of those infected. This study was aimned at assessing the characteristics of those found 'positive' in the routine screening procedures adopted in the control programme in Sri Lanka as well as attempting to validate the screening procedures themselves by studying the validity of the screening tests used and by assessing coverage. The methodology included a clinic based study, a field study and an attempt to assess the feasibility of introducing an alternative screening test. The findings indicate that the prevalence of syphills varied from 1per cent in pregnant women to 23 per cent in persons attending a S.T.D. clinic. Higher proportions of 'seropositives' for syphilis were those below 30 years of age, with a poor educational background, unemployed or employed in occupations with low monthly wages and not using any contraception. Homosexuals and promiscuous heterosexuals were also found to be at risk for syphilis. The screening test used was the veneral Diseases Research Laboratory (VDRL) test which was found to be of decreased sensitivity in the low prevalence populations, and in persons with late syphilis. Reproducibility of the VDRL test was found to be satisfacory. The assessment of the feasibility of introducing a more sensitive test (the TPHA) to the routine screening procedure indicated that it may not be feasible at present due to financial constraints. The prevalence of gonorrhoea in persons attending S.T.D. clinics was 20.6 per cent. Of this, 33 per cent were penicillinase producing Neisseriae gonorrhoeae (PPNG) infections. there was a male preponderance noted among those with gonorrhoea. No difference was observed between sexes in the proportion of PPNG. Socio-demographic characteristics of persons with gonorrhoea were similar to those found seropositive for syphilis, but homosexuality did not emerge as a risk factor. The gram stain smear test used in screening for gonorrhoea was found to be a test of low sensitivity in females but of high specificity. Repeatability of the gram stain smear was satisfactory. Poor specimen collection, inadequate stanining and lack of expertise of the microscopists reading the slides were probably the reasons for the low sensitivity recorded in this study. Antenatal VDRL screening coverage was shown to be low, both in respect of the number of institutions which carry out screening as well as the proportion of mothers being screened. The current level of antenatal VDRL screening could be greatly improved by the provision of inexpensive logistics support and improved motivation of health personnel. This study identified characteristics of persons at risk for syphillis and gonorrhoea, the methods of improving the usefulness of screening tests that are routinely used, the need for consideration of alternative screening tests for special groups, and the approaches that need to be considered to improve existing national level screening programmes. Utilization of these findings are likely to have an impact on the control of S.T.D. in Sri LankaItem Screening for cervical cancer using exfoliative cervical cytology at a sexually transmitted diseases clinic in Colombo(Post Graduate Institute of Medicine, Colombo: PGIM ., 1987) ABEYEWICKREME, ISquamous cell neoplasia (including cancer precursors) of the uterine cervix is the second most prevalent neoplasm affecting women, after breast cancer in the world as a whole. It is estimated that approximately half a million new cases occur each year (Parkin etal, 1984). It is also the most common cancer in women in developing countries. Since these countries currently contain some three quarters of the global population, the size of the cancer problem, and the investment, needed for its control are likely to increase considerably in the future. Carcinoma of the cervix is one of the best studied human neoplasms. Even though it's epidemiology and natural history are well understood, and there are effective forms of treatment available, the morbidity and mortality continue to increase, especially in those under 35 years (Draper and Cook, 1983) Carcinoma of the cervix is now being considered a sexually transmitted disease (S.T.D.) because, the oncogenic agent, or agents, appear to be sexually transmissible. These agents are thought to act on the cervox during periods of metaplasia (Coppleson and Reid, 1968). such periods are most active at puberty, early pregnancy, and during oral contraceptive use. All the factors of increased risk for this neoplasm are related to coitus, and cervical carcinoma has been shown to be extremely uncommon in virgins and nuns (Rotkin, 1973, Gagnon, 1950). women attending S.T.D. clinics are most vulnerable to developing cervical cancer because, they commonly share two major risk factors: early onset of coitus and multiple sex partners (Rotkin, 1973). therefore it is necessary that these women be screened for cervical cancer in order to control further increases in morbidity and mortality. Exfoliative cervical cytology which forms the basis for such a screening programme, is routinely carried out on female patients attending S.T.D. clinics in the western countries. this facility is available to a greater or lesser extemt in other Asian countries as well. However, cervical cytology screening is not carried out in S.T.D. clinics in Sri Lanka. A literature search also revealed that no previous research has been done on this subject in this country. Taking these factors into consideration, a preliminary study of cervical cytology screening of patients attending a S.T.D. clinic was designed. Objective of the study: General objective to assess the usefulness of screening for cervical pre-cancer and cancer in women attending S.T.D. clinics in Sri Lanka. Specific objectives: (1)To determine the proportion of cervical smears showing abnormal cytology, in women attending the central veneral diseases clinic in Colombo. (2)To describe the different types of abnormalities that are to be found in the abnormal smears. (3)To describe findings in age, sexual history, contraceptive practices, number of pregnancies and S.T.D. diagnossed in the women screened, and to compare this data between those with normal smears and abnormal smear.