Abstract

The health education and medical counselling given by the social health worker to index patients with sexually transmitted disease (STD) attending our clinic were reinforced by a doctor attending a "treatment group" of patients in a randomised controlled trial. Sixty four patients were randomised into two groups of 32. Of the 96 follow up visits required four each group (three per patient), there were 20 defaults in the control group compared with only four in the patients whose health education had been reinforced by the doctor. Four of the control patients had been re-exposed to risk of infection during follow up compared with none in the reinforced group. Also five of the primary and none of the secondary sexual contacts of the control patients came for investigation and treatment (without the need for extra field contact tracing by the social worker) compared with eight primary and two secondary sexual contacts of the reinforced group. The appreciable impact of counselling reinforcement by a doctor shown in this study leads us to emphasise the importance of this practice, especially in developing countries where various infrastructural and cultural factors usually make contact tracing an unrewarding exercise.