Men with sexually transmitted diseases in Bangkok: where do they go for treatment and why?

The determinants of treatment-seeking behaviors associated with sexually transmitted diseases (STDs) were investigated in a cross-sectional survey of 213 men recruited from government clinics (n = 101) private clinics (n = 50) and pharmacies (n = 62) in Bangkok Thailand. 142 of these men had had a prior STD. 34% of men who initially attended pharmacies and 19% of those who first attended a government clinic sought multiple treatments for prior STDs because of an incomplete response to treatment. 50% of STD clients had visited a commercial sex worker in the 3 months preceding the current STD; half believed a casual or new sex partner was the source of infection. 12% of men had sex while they were symptomatic with the current STD. Advice on condom use was conveyed to 88% of government clinic patients 94% of private clinic patients and 52% of pharmacy customers; only 72% 14% and 22% respectively were urged to contact their sexual partner. Men with less education and symptoms of dysuria were more likely to seek care at drugstores. Also associated with seeking care at a pharmacy rather than a government site were waiting less than 7 days to seek treatment having a travel time less than 20 minutes and feeling able to pay for treatment. Those seeking care at pharmacies were also more likely to believe that they would recover at least as well as those treated at a government clinic and to believe they were at risk for human immunodeficiency virus infection. Possible strategies for improving STD treatment at the first point of contact within the health care system include promotion of syndromic STD management among pharmacists and general practitioners integrated STD programs within health care services already providing care to adolescents and other high-risk groups and strengthening the referral network to government clinics.