When it comes to sexually transmitted diseases (STDs), doctors and nurses at public hospitals and clinics provide better care than private doctors. These are the findings from a national study conducted by the Centre for Health Policy at the University of the Witwatersrand.

The study found that private doctors countrywide are much more likely to prescribe the wrong treatment for STDs than doctors and nurses at public hospitals and clinics. Only 23 percent of private doctors provide adequate treatment for urethral discharge. By comparison, 82 percent of nurses at public health facilities know the correct drugs to prescribe.

These findings contradict the widely held belief that private doctors always provide better care than public health professionals do.

“People pay high fees for care that may be no better, and indeed is often worse, than that of the public sector,” said Dr Helen Schneider from the Centre for Health Policy.

One reason why STD care in the public sector is of better quality is that the control of STDs has been identified as a public health priority. STDs make people much more vulnerable to HIV/AIDS, and fuels the HIV epidemic. Health professionals in the public sector have therefore been brought up to date with the latest and best approaches to STD management.

Another reason for inadequate care in the private sector is that doctors don’€™t prescribe the expensive medicine required to patients who can’€™t afford it.

“I’€™ve got to give patients the treatment they can afford to pay. If Mrs Jones comes in for treatment and she has medical aid, and her maid comes in and she doesn’€™t, obviously treatment is going to differ from patient to patient,” says one of the general practitioners in the survey.

By comparison, all patients at public clinics are given the antibiotics they need, free of charge.

The preference for private care for STDs is widespread. In Hlabisa, a rural district in KwaZulu-Natal, resources have been poured into providing the best possible STD care at public facilities, but nearly 50 percent of patients still prefer to go to private doctors. And in Alexandra, in Gauteng, 63 percent of all STDs are treated in the private sector.

“The stigma and embarrassment associated with STDs may be a reason why people with STDs seek the relative privacy and anonymity of general practitioners,” said Schneider.

“It has been estimated that private doctors in South Africa treat about 5 million cases of STDs each year, possibly out-numbering cases seen in the public sector.”

Schneider and her colleagues argue that state intervention is required to improve STD services in the private sector, especially in those private services which provide treatment to the poor.

“Lack of proper STD management in the private sector undermines STD control efforts (and HIV prevention) undertaken in the public sector,” Schneider said. ‘€“ Health-e News Service.