Status of STD Screening, Diagnosis and Treatment in Thailand 

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Country Profile

Thailand is an agricultural country in Southeast Asia with an area of 513,115 square kilometers. There are 76 provinces. The population in 1994 was 58.33 million with a population density of 112.62 per square kilometer. About 20 percent of the population live in urban areas. The population growth rate is approximately 1.2 per annum. The trend of population growth indicates that the country is growing more urbanized with an increased proportion of working and elderly and a decrease in the dependency ratio. 

Thailand has experienced a period of rapid economic growth since the 1960s. Much of the growth in the Thai economy has emanated from the manufacturing industry, with particular and continued emphasis on expert-led growth. The store of agriculture had fallen from about 40 percent in 1960 to 20 percent in 1987, while industry s store increased from 14 percent to 21 percent during the same period. On the whole, the recent rapid economic growth and structural changes have enabled Thailand to double its per capita income over the last two decades.

The Ministry of Public Health (MOPH) has taken major responsibility for the delivery of health services in Thailand. In addition, other ministries such as the Ministry of University, Ministry of Interior and Ministry of Defense as well as the private sector also provide health services.

Introduction

Sexually transmitted diseases have affected millions of people with incurable illnesses having such long-term consequences as pelvic inflammatory disease, tubal occlusion leading to infertility and ectopic pregnancy, chronic pelvic pain and cervical cancer. Other major long-term sequelae are neonatal morbidity and mortality caused by transmission of STDs during pregnancy and childbirth. Most important is the epidemiologic synergy of STDs with HIV. The most effective way to reduce the adverse consequences of STDs is by prevention or management of the infection through proper screening, diagnosis and treatment.

In Thailand, STDs have been a major public health problem since 1967 (Figure 1), with the increasing rate paralleling the growth and economic development of the country. The control of STDs is the responsibility of the Department of Communicable Diseases Control through the Venereal Diseases (VD) Division and has been the focus of a national program for more than 25 years. The VD Division provides STD services and facilities through 12 regional centers and 8 clinics in Bangkok. At the provincial level, VD Clinics operate throughout the country under the administration of the office of the Permanent Secretary with technical support from the VD Division. Since 1991 STD services have been offered at the district level and all districts will be covered by 1995. The integration of STD services at selected primary health care centers was implemented in mid-1994. Table 1 shows a breakdown of the different types of STDs for 1990–1992.

Figure 1. Total STDs in Thailand, 1967–1992

Table 1. Percentage of Different Types of STDs, 1990–1992 STDs in Thailand

Types of STDs 1990 1991 1992 N % N % N % Syphilis 17,168 6.81 12,429 6.83 9,861 8.23 Gonococcol 133,615 52.97 93,000 51.09 62,457 52.16 Soft chancre 19,610 7.77 12,374 6.80 5,468 4.57 LGV 9,968 3.95 6,860 3.77 2,840 2.37 Bubo - - - - - - Non-GC 71,902 28.50 57,361 31.51 39,126 32.67 TOTAL 252,263 100.00 182,024 100.00 119,752 100.00

There was a rapid increase in cases of STDs in the early 1980s due to rapid socioeconomic development, enormous industrialization, migration from rural to urban areas, changing sexual behavior and expansion of the commercial sex industry. The first HIV infection in Thailand was reported in 1984. The resulting mass media communication campaign for prevention of HIV infection caused a decline in all type of STDs. In 1986, the incidence of STDs was 7.85 per 1000; by 1992, the incidence had decreased to 2.07 per 1000 (Figure 2).

Figure 2. Rate of STDs per 1000 Population

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