INTRODUCTION

Sexually transmitted infections (STIs) are a major global public health problem and a frequent reason for consultation. General practitioners, as key figures in the healthcare sector, frequently encounter these cases, underscoring the importance of evaluating their knowledge and attitudes toward STIs. This study, conducted in the Fez region, aimed to assess general practitioners’ knowledge and practices regarding STIs.

MATERIAL AND METHODS

We conducted a descriptive, cross-sectional study whose objective was to assess the knowledge of general practitioners in the region of Fez and their conduct toward STIs by filling an anonymous questionnaire including 17 questions, developed with Google Forms software and hand-delivered to doctors at health centers and private practices in the Fez region. It is to be mentioned that some of the older practitioners had difficulties using the software, which is why we had to fill it for them.

RESULTS

A total of 73 general practitioners responded to the questionnaire, 63% of whom stated that they had received specific teaching on STIs during their studies.

69.9% of the doctors worked in the public sector.

95.9% had already been confronted with treating a case of STI at least once. The pathologies treated were diverse, with urethritis as the main one at 87.14%, followed by syphilis at 60%, genital herpes at 52.85%, then condyloma at 40% and the rest of the STI.

Faced with a genital ulceration or urethral discharge, 88.57% of the doctors treated immediately without recourse to a specialist opinion, after a good questioning and a meticulous clinical examination, while 60% asked for a serological assessment before treating, and 25.71% referred the patient directly to specialists without any treatment (Fig. 1). Thus, the patients were sent to either dermatologists in most of the cases (58.7%), gynecologists (28.57%), or urologists (24.28%).

Figure 1: General practitioners’ approach to genital ulceration and urethral discharge.

83.6% of the general practitioners said that they knew the syndromic approach to genital ulceration and urethral discharge.

Regarding the treatment of genital ulceration, 89% proposed a combined treatment for both syphilis and chancroid according to the syndromic approach. 6.8% treated as syphilis and 4.1% as chancroid.

The answers to the questions were intentionally varied in order to get an idea of the skills and abilities of the doctors.

69.9% prescribed a single dose of intramuscular injection of benzathine penicillin 2.4 MU with 500 mg of oral ciprofloxacin. 13.7% gave a single dose of intramuscular injection of benzathine penicillin 2.4 MUI with 250 mg of oral ciprofloxacin.

6.8% treated with an intramuscular injection of benzathine penicillin 2.4 MU, while 5.5% gave an intramuscular injection of 1.2 MU of benzathine penicillin with oral 250 mg of ciprofloxacin. 4% gave only oral ciprofloxacin.

Concerning the treatment of urethritis, 94.5% of the doctors prescribed an anti-gonococcal and anti-chlamydia treatment, and 4.1%% targeted gonorrhea alone.

80.8% said they would prescribe ceftriaxone 250 mg and doxycycline 200 mg/day of a week, while 11% would give a single dose of ceftriaxone 500 mg. 6,8% would treat by a week of 200 mg/day of doxycycline, and 1.4% would give a single dose of intramuscular ceftriaxone 250 mg.

A check-up for other associated STIs was requested by only 58.9% of the doctors.

However, the treatment of the sexual partner was prescribed by 91%.

At the end of the consultation, 95.9% of the doctors acknowledged that they had a role in educating and raising awareness among the patients (Fig. 2).

Figure 2: General practitioners’ attitudes to patient education.

DISCUSSION

STIs are mainly transmitted by sexual activity [1]. They are widespread because of their potential complications and their interaction with HIV [2], hence the importance of adequate diagnosis and management to avoid long-term complications.

In Morocco, the incidence of STIs continues to rise. There was a marked annual increase in STIs cases from 1992 to 1996. 33 years later, chancroid disappeared, yet other STIs apparently exploded [3].

The main objective of the WHO is to eradicate STIs by 2030 by relaying on a syndromic approach [4].

This study allowed us to assess the knowledge of general practitioners in the region of Fez regarding the management of STIs, particularly genital ulcerations and urethritis.

Indeed, the majority seemed to master the syndromic approach.

Our results were different from a study conducted in France on 350 general practitioners, where only 33% treated according to the recommendations of the French Society of Dermatology. However, Lerebours et al. reported similar results toward the treatment of the partner and education [5]. On the other hand, an Ethiopian study concluded to a poor knowledge and practice of clinicians regarding syndromic management of STIs [6]. Likewise, Pakistani general practitioners appeared to be deficient in appropriately managing and counseling STI patients [7].

The management of STIs is one of the main priorities of Moroccan Ministry of Health.

Since its introduction by the WHO, the syndromic approach to the management of STIs was adopted in Morocco in 1998 and generalized in 2000 [8,9].

Since then, the ministry has been involved in the fight against STIs through awareness-raising campaigns, workshops, and other activities.

In March 2022, the Moroccan League for the Fight against Sexually Transmitted Diseases published the 3^rd edition of its updated guide to sexually transmitted infections, including AIDS.

Moreover, as it is stated in a paragraph of the National Health Programme 2025, the main objective is to the strengthen the STI control programs [10].

CONCLUSION

STIs remain a frequent reason for consultation, especially in underprivileged and poorly educated environments. This study indicated satisfactory knowledge and practices among general practitioners in the Fez region, a result of awareness campaigns by the Ministry of Health of Morocco. Continuous medical education is recommended to strengthen practitioners’ skills in STI management, aligning with national health programs and global objectives for STI control. The effectiveness of awareness campaigns underscores the need to continue medical education for practitioners and intensify STI control programs to achieve public health goals.

REFERENCES

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