[Epidemiological approach for sexually transmitted diseases in Antsiranana (north Madagascar). Between prevention and treatment, the choice of a strategy against sexually transmitted diseases].

We reported a study undertaken in a Sexually Transmitted Disease care unit in Antsiranana amongst two groups of patients: 299 prostitutes and 350 STD patients (204 women and 146 men). The 20-29 years old age group represented 50.3% of the patients. A 12 days average delay between appearance of first symptoms of STD and the visit to the care unit was recorded. The most important clinical signs were cervicovaginal discharge (83%), pelvic pains (67%), and pruritus (53%) in women, urethral discharge and urination pain (64%) in men. Among prostitutes on a routine visit, 22.7% had at least one STD clinical sign. Syphilis serology by TPHA showed a high prevalence among prostitutes (39%) and STD patients (32%). Direct examinations emphazed the major importance of gonorrhoea in more than 70% of STD patients, both men and women, and trichomonasis in women (22%). Chlamydia investigation could not be done. HIV antibodies were recorded in 4 prostitutes (1.3%) and in none of the STD patients. 79.3% of prostitutes and 39.4% of STD patients had at least 2 partners a week and 47.5% of prostitutes used a condom "every time" and only 21.1% STD patients "sometimes" used it. The role of STD care units must be reinforced for information, education and counselling of the population in a non medical context.