Sexually transmitted diseases and their consequences for fertility are currently a major preoccupation in public health. A joint research project is being carried out in France to develop an STD prevention program and then to implement it experimentally to evaluate its efficiency. It includes 2 phases: a feasibility phase, currently concluded, and an active phase, a community randomized trial. The aim of the feasibility phase was to test the research methods and tools and to act as a basis for the design of the prevention program. It measured the incidence of discharge (men and women) at a one-year interval and patient characteristics. Participating physicians were GPs in a French administrative department near Paris. Between the two measurements, information and sensitization actions were carried out in the same department among health professionals and the general public. The results show that the incidence of discharge (chosen here as indicators of STDs) in daily general medical practice is low, of the order of 6 cases per 1000 consultations. The community randomized trial will now be conducted in 6 French administrative departments, randomly divided into 3 treated departments, benefiting from a prevention campaign, and 3 controls, where no actions will be undertaken, and its results will be used in a national STD prevention campaign.
PIP: The complications of sexually transmitted diseases -- epididymitis in men and pelvic inflammatory disease in women -- result in 12,000 cases of infertility a year in France. It is therefore necessary to implement a program for the prevention of sexually transmitted diseases in France. The 1st step in such a program must be a feasibility study to determine the level of participation of general practitioners and the suitability of the questionnaires. The feasibility study was carried out in 2 steps, one in 1984 and a similar one in 1985. In each year, during a 4-week period, 57 participating doctors filled out questionnaires for each patient consulting for leucorrhea or urethral discharge. During the year between the studies, information brochures on sexually transmitted diseases were produced for doctors and the public. In 1984, the physicians noted 154 cases of leucorrhea and urethral discharge; in 1985, they noted 121 cases, an average of 6 cases/1000 patients. Of the 275 cases, 141 were in men, 134 in women. Only 4% of the men and 9% of the women were under 20, indicating that young patients go to a free health clinic rather than to private practitioners. Over 1/2 of the men, but only 1/5 of the women had multiple sexual partners, and 1/2 the patients were consulting for a recurrence. Bacteriological screening showed that the commonest organisms in the male infections were Gonococcus and Chlamydia trachomatis, while in women mycoses were more prevalent. The feasibility study showed that general practitioners cooperated and that the quality of the data was good. The 2nd phase of the study, a community randomized trial, is currently being conducted in 6 French administrative departments, 3 for treatment and 3 to act as controls. In each department 50 physicians are participating. All available information will be disseminated in the 3 treatment departments for 3 months after beginning the experiment.