Background and objectives: Self-treatment for sexually transmitted diseases (STD) is common, but little studied, in Thailand, and its influence on human immunodeficiency virus (HIV) infection is unknown.
Goals: To assess STD self-treatment and self-prophylaxis behaviors as well as HIV risks and serostatus among northern Thai men.
Study design: Cross-sectional report from a cohort of military conscripts (N = 869). HIV and STD seroprevalence and reported risk behaviors, including STD history and antibiotic self-treatment, were obtained. Associations between STDs and self-treatment or prophylaxis and HIV infection were analyzed using t-tests, odds ratios, and logistic regression.
Results: The prevalence rate for HIV was 12.3%, and for syphilis it was 2.2%. Men who were seropositive for HIV were more likely to report having sex with commercial sex workers (OR 9.1), to have had an STD (OR 5.96) and to report inconsistent condom use with commercial sex workers (OR 3.13). Of 282 men reporting any STD, 65.2% treated themselves with antibiotics, and 8.5% used them before commercial sex. Among those who frequented commercial sex workers, 98.7% took preventive steps after sex by increasing urine output (69.2%), washing the genital area (28.9%), and using antibiotics (0.9%). Men reporting STD self-treatment were less likely to be HIV infected (OR 0.53; 95% CI 0.31, 0.93).
Conclusions: These men are attempting to prevent HIV and STDs. Self-treatment with antibiotics may lower HIV risks associated with bacterial STD in a high-prevalence population.
PIP: In May 1993, at 11 military camps in the upper northern region of Thailand, civilians interviewed 869 men aged 21-29 years (most of whom were 21 years old) so researchers could determine the frequency and variety of self-treatment and self-prophylaxis behaviors for sexually transmitted disease (STD) and the relationship of these behaviors with the prevalence of HIV infection. 12.3% of the men at conscription into the military tested positive for HIV infection. 32.5% had ever had an STD. The leading STDs and syndromes were gonorrhea (16.1%), penile discharge with pus (15.5%), and pain while urinating (11.4%). HIV-positive men were more likely to have had sex with commercial sex workers (CSWs) (odds ratio [OR] = 9.14), to have had an STD (OR = 5.96), and not to use condoms consistently when having sexual intercourse with CSWs (OR = 3.13). 65.2% of men who had ever had an STD self-treated with antibiotics. 8.5% of men who had ever had an STD used antibiotics, particularly chloramphenicol, before having intercourse with a CSW. Among all the men who had sexual intercourse with CSWs, almost all (98.7%) had adopted steps to prevent STDs: increasing urine output (69.2%), washing the genitals with soap and water (28.9%), and using antibiotics (0.9%). Men who self-treated with antibiotics after having intercourse with CSWs were less likely to have HIV infection (OR = 0.53). Antibiotic use before intercourse with CSWs did not have as strong a protective effect as it did after intercourse (OR = 0.74). The protective effect of self-treatment was significant, even when controlling for syphilis, gonorrhea, lymphadenopathy, penile discharge with pus, and condom use with a CSW. These findings show that some sexually active men in northern Thailand are trying to prevent HIV and other STDs and that self-treatment with antibiotics may reduce the HIV risk associated with bacterial STDs in a high prevalence population.