A survey of sexually transmitted diseases was attempted in Swaziland. Time and the terms of reference limited its scope, but much interesting information was gathered. Neither the prevalence nor the relative frequency of the different diseases in the community could be ascertained, but there was evidence to support the local impression that the sexually transmitted diseases present an increasing problem in Swaziland. An important problem was that of case finding and two aspects of this are stressed: (1) A general lack of knowledge concerning the venereal diseases; (2) The large number of men infected by 'casual' girl friends who cannot easily be traced, and who form a reservoir of infection in the community.
PIP: A survey was conducted in Swaziland between July 6 and September 28, 1973 to obtain information about sexually transmitted diseases. The survey sample was limited to the outpatient department of the government hospital at Mbabane. Patients included were those who reported at the outpatient department with an STD during the 3 month period of the survey and those of their contacts who could be pursuaded to attend and were found to be infected. Of 240 patients seen during the course of the survey, 124 were suffering from presumed gonorrhea, 67 had genital sores, and 23 reported with both. A further 26 had positive Venereal Disease Research Laboratory (VDRL) reactions and were assumed to have syphilis with or without some other STD. Of the 26 patients whose VDRL test was positive, 3 had lesions usually associated with primary syphlis and 3 had condylomate lata. The rest were cases of presumed latent syphilis presenting with another infection. With 1 exception cases of urethral discharge in men appeared to be due to gonorrhea. No cases of nonspecific urethritis were seen and the explanation of this is obscure. About 29% of the women and 4% of the men were infested with T. vaginalis. It was not possible to determine the prevalence of venereal diseases, but the evidence collected supported the local impression that these conditions were increasing. The need for a vigorous program of contact tracing is clear from the small proportion of female patients attending the clinic. Only 24% of those with a sexually transmitted disease and only 20% of those with a positive VDRL test were females, whereas in a survey undertaken by staff of the local public health unit in 1967, 54% of those with a positive Wassermann reaction were female. The large number of casual partners admitted by men in the 4 weeks before infection implies that this is a major source of infection. Recommendatons made for improving the situation include: offering education in the schools; developing a universal system for tracing contact for the whole country; and making a vigorous attempt to screen all pregnant women by means of the VDRL test.