Showing papers in "Indian Journal of Sexually Transmitted Diseases and AIDS in 2017"

Knowledge and attitude about sexually transmitted infections other than HIV among college students.

Abstract: Background: Sexually transmitted infections (STIs) are the infections which are mainly transmitted through sexual intercourse.Young individuals in the age group of 16 to 24 years are considered to be at more risk for STIs compared to older adults. Young individuals are more likely to practice unprotected sex and have multiple sexual partners. If the STIs are not treated adequately, it can lead to various complications.Most of the people may be aware about HIV/AIDs because of the awareness created by media and the government programs, however knowledge about STIs other than HIV/AIDS is low in the developing countries. Materials and Methods: This study was a descriptive cross sectional study to assess the knowledge, awareness and attitude of college students about STIs other than HIV. A total of 350 engineering students from various semesters were included in the study. They were asked to fill up an anonymous questionnaire. Results: Two hundred and fifty six (73%) males and 94 (27%) females participated in the study. 313 (90%) students had heard about sexually transmitted infections (STIs) and 223 (64%) students had heard about STIs other than HIV. 99% of students knew about HIV where as less than 50% of students knew about other STIs. Teachers, internet and media were the source of information for most of the participants. Almost 75% of the students knew about the modes of transmission of STIs. Less than 50% of the participants knew about the symptoms of STIs and complications. Also attitude of the students towards sexual health and prevention of STIs was variable. Conclusion: The findings of our study shows that it is important to orient the students about sexual health and safe sexual practices as it will go a long way in prevention and control of STIs. Also the morbidities and complications associated with STIs can be prevented.

Epidemiology and clinico-investigative study of organisms causing vaginal discharge.

Abstract: Background: Abnormal vaginal discharge is a common clinical problem in reproductive age group. It is the second most common problem after abnormal uterine bleeding. It is a neglected health problem, most commonly caused due to vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis (BV). Objectives: The present study was conducted to determine the prevalence of common organisms causing vaginal discharge and also to know the variety of clinical presentation. Materials and Methods: A cross-sectional descriptive study was conducted in the Skin and STD Outpatient Department of Vinayaka Mission Kirupananda Variyar Medical College Hospital, Salem, who presented with abnormal vaginal discharge between September 2012 and September 2014. A total of 100 women in the reproductive age group who had symptoms of vaginitis were examined. Data were coded and analyzed. Results: Out of the 100 patients examined, 77 (77%) cases were organism positive. Among the positive cases, BV (27%) was the most common microbiological cause of abnormal vaginal discharge, followed by trichomoniasis (25%), vaginal candidiasis (22%), combined infection (Candida and BV) (3%), and nonspecific cases (23%). Conclusion: Out of 100 cases, few cases showed discordance between clinical and laboratory diagnosis. This discordance can be due to pitfalls in identifying the causative agent clinically or obscuring of the findings due to improper treatment received for other ailments. Thus, clinico-investigative correlation is more important than other clinical findings alone.

Effects of fitness training on physical fitness parameters and quality of life in human immunodeficiency virus-positive Indian females.

Abstract: Purpose: Highly active antiretroviral therapy has significantly extended survival of human immunodeficiency virus (HIV) infected patients. These drugs suppress replication of HIV but at the same time, have many physical and mental side effects which may affect daily activities of the patients. The present study assessed if moderate intensity exercise program helped in enhancing the physical fitness and quality of life (QoL) in HIV positive females which may reduce the comorbidities associated with the disease and medications. Aim and Objectives: The aim of this study is to study the effects of moderate intensity physical training on physical fitness parameters and QoL in HIV positive females. Methodology: Post IEC approval, a randomized control, single-blinded, parallel group trial was conducted on 55 females (20 experimental HIV, 20 control HIV, 15 control normal) matching the selection criteria. Post informed consent, their muscular endurance, flexibility, aerobic capacity, and QoL was assessed. Moderate intensity physical exercises were given to experimental HIV and control normal 5 days/week for 8 weeks and subjects were reassessed for above parameters. Intragroup analysis was performed using paired t-test while inter-group was by one-way ANOVA with alpha set at ≤0.05. Results: Moderate-intensity exercises improved muscular endurance ( P < 0.05), flexibility (P < 0.05), and aerobic capacity ( P < 0.05)in experimental HIV and control normal group as compared to control HIV group. QoL in experimental HIV showed improvement in all the domains. Conclusion: Moderate-intensity exercises help improve the physical fitness as well as enhance the QoL in HIV positive females.

Pre- and post-sexual exposure prophylaxis of HIV: An update.

Abstract: Pitfalls in current HIV prevention strategies include late HIV testing, vulnerability among youth and females; lack of emphasis on treatment, low acceptance of circumcision, and nonavailability of protective vaccines. Continuing high-risk sexual behavior, forceful sex, coercive and nonconsensual sex, rape, and unprotected sexual activities make women the most vulnerable to acquisition of sexually transmitted infection/HIV and necessitates a more radical approach of prevention in high-risk individuals who do not have HIV. Preexposure prophylaxis is defined as the administration of antiretroviral drugs to an uninfected person before potential HIV exposure to reduce the risk of infection and continued during risk. The rationale of this approach is to administer preventive dose of drug(s) before exposure to HIV so the moment virus enters the body, HIV replication is inhibited and HIV is not able to establish permanent infection. Postexposure prophylaxis (PEP) following potential sexual exposure is an important form of nonoccupational PEP which is an emergency intervention to abort HIV acquisition arising from exposure to HIV-infected blood or potentially infectious bodily fluids following sexual exposure.

Inflammatory dermatoses in human immunodeficiency virus

Abstract: Various inflammatory dermatoses have been described in association with human immunodeficiency virus (HIV) infection. These either present in the usual way or in varied atypical presentations. This article gives a brief review about the etiopathogenesis and clinical presentation of the common inflammatory dermatoses associated with HIV such as psoriasis, reactive arthritis, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption, photosensitivity disorders prurigo nodularis, atopic dermatitis, and ichthyosis.

Number of HIV-infected cases in Iran: True or just an iceberg.

Abstract: Background: The number of HIV cases in Iran is increasing. Knowledge of the changing epidemiology of HIV is fundamental for service planning and prevention activities. This study aims to estimate the number of HIV-infected cases by the capture and recapture method for size estimation. Materials and Methods: From 2002 to 2009, we used three different centers – hospitals, the Voluntary Counseling and Testing (VCT) center, and a central prison in Fars Province for data retrieval. The overlaps between these centers were investigated to determine the true estimate of HIV cases. Finally, interactions were analyzed by a linear logarithm model with STATA version 9 software. Results: We observed 5167 HIV cases. The number of males was ten times more than that of females. The most frequent age range was between 15 and 44 years. The majority of cases (n = 3347) were retrieved from the VCT center. The least number of infected persons were located in the prison and hospitals. The estimated number of cases in Fars Province was 14,925 from 2002 to 2009. The best model consisted of three sources. Conclusion: Covering the system of medicine deputy for registering the number of infected cases with HIV is poor in Iran. Improvements in making arrangements for enhancing the quality of data related to HIV-infected cases are essential for solving this problem and must be on the agenda for medical policymaking.

Pattern of sexual behavior in adolescents and young adults attending STD clinic in a tertiary care center in South India

Abstract: Background and Objectives: There is an alarming increase in the prevalence of sexually transmitted infections (STIs) among adolescents and young adults of our country. The aim of our study is to depict the current pattern of sexual behavior in this vulnerable sector of population. Materials and Methods: The study was performed by reviewing the medical records of 1140 adolescents and young adults from January 2015 to June 2015. Demographic and sexual behavior data were collected in a predesigned format. The outcome variables such as age of coital debut, sexual promiscuity, and knowledge about condom usage were statistically analyzed among the study population. Results: The male: female ratio was 1.6:1. Nearly 78.2% were unmarried and 60% have completed their high school level education. Mean age of coital debut was 21.1 years in males and 18.6 years in females and 201 (17.6%) were practicing risky sexual behavior. Homosexuality was observed in 109 (33.4%) men. Furthermore, 149 (13.1%) had exposure to commercial sex workers. Prevalence of STIs was 99 (8.7%). The overall condom usage at least once was reported only by eighty (23.5%) adolescents. Complete knowledge about condom usage was found to be very low (8%). Conclusion: Our study reports a high incidence of risky sexual behavior as well as a lack of complete knowledge about safe sex practices in the study population. The need of the hour is to implement sex education program at high school level to prevent STIs in this vulnerable population.

Current trends in opportunistic infections in children living with HIV/AIDS in a tertiary care hospital in Northern India.

Abstract: Introduction: A prospective cohort study was undertaken from November 2010 to March 2012 at Kalawati Saran Children's Hospital (KSCH), Lady Hardinge Medical College (LHMC), New Delhi. The study included all HIV positive children aged between 0-15 years that were registered in the anti-retroviral therapy (ART) centre during the study period. HIV +ve children enrolled at the ART centre were started on ART on the basis of CD4counts (National/NACO guidelines). Materials and Methods: Various samples were collected from the patients depending on their presenting complaints as per the standard protocols. These included stool, sputum, gastric aspirate, urine, blood, pus and CSF. All the samples were processed in the microbiology laboratory as per the standard techniques. Majority of children presented to the hospital with respiratory system involvement. Fever with cough was the presenting symptom in around half of all the children suggesting involvement of upper and/or lower respiratory tract. Diarrhea and protein energy malnutrition (PEM) were the next most common findings. Clinical presentations more suggestive of HIV (e.g. generalized lymphadenopathy, mucocutaneous lesions, oral thrush etc.) were less commonly the presenting complaints. Results: OIs are still a major health hazard in children living with HIV/AIDS. The pattern of OIs encountered in a developing country like ours is different from the pattern observed in western countries. Tuberculosis is still a major problem as well as other bacterial infections. Fungal and parasitic infections are also a common health hazard. ART is a major pillar for combat against this dreadful disease. As suggested by our study, timely initiation of ART leads to an increase in CD4+ counts which is imperative in protection against OIs in HIV infected patients. Hence, routine monitoring of CD4+ counts and timely initiation and continuation of ART should be a major event in the life of a child infected with HIV.

Drug reaction with eosinophilia and systemic symptoms related to antiretroviral treatment in human immunodeficiency virus patients.

Abstract: Background: The drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening condition caused by different medications. The objective of this study was to analyze DRESS cases related to antiretroviral therapy in human immunodeficiency virus (HIV) patients. Materials and Methods: Systematic review of DRESS suspected cases in HIV patients associated to antiretrovirals published between January 1998 and April 2017. The registry of the severe cutaneous adverse reactions score was used to classify each report as a “definitive,” “probable,” “possible,” or “no” DRESS case. Clinical characteristics, management, and outcomes were evaluated. Results: Thirty-five case reports were analyzed involving 5 antiretrovirals: Abacavir in 10 (28.6%) cases, efavirenz in 6 (17.1%), nevirapine in 12 (34.3%), raltegravir in 6 (17.1%), and tenofovir in 1 (2.9%). Mean age of the patients was 40 ± 13 years, 65% of which were male. A total of 57.1% reports were classified as having a “definitive-probable” DRESS case. Management was based on withdrawal of the causal antiretroviral and corticosteroids in 68.6% of the cases. None of the patients died. Treatment with nevirapine or raltegravir, the longer onset of symptoms and the presence of lymphadenopathy, eosinophilia, liver involvement, and a longer time for clinical resolution were more frequent among “definitive-probable” DRESS cases. Conclusions: A DRESS syndrome has to be suspected in HIV patients with lymphadenopathy, eosinophilia, and liver involvement developing weeks after the initiation of nevirapine or raltegravir. Suspension of the causal antiretroviral and in most cases treatment with corticosteroids allowed adequate clinical control.

Assessment of metabolic syndrome in HIV-infected individuals.

Abstract: Background: Metabolic syndrome (MS) is a cluster of risk factors for cardiovascular disease and Type 2 diabetes mellitus. Objectives: The aim is to assess the prevalence of MS in HIV patients receiving highly active antiretroviral therapy (HAART) and to compare it with treatment naive HIV patients. Methods: Cross-sectional study carried out in a teaching hospital in North India. A total of 116 HIV positive patients who were on HAART and those who were treatment naive were included in the study. Adult Treatment Panel III (ATP III) and International Diabetes Foundation (IDF) definitions were used to define MS. Clinical and laboratory investigations were performed as per requirement and then analyzed using SPSS software. Results: A high prevalence of MS was observed in HIV positive patients (ATP III – 19.8% and IDF – 25.9%). The prevalence of MS was higher in the anti-retroviral therapy (ART) group (ATP III – 33.3% and IDF – 36.4%) than ART-naive group (ATP III – 2% and IDF – 12%). Conclusions: A sincere effort should always be made to detect MS in patients on HAART, especially in Indian subcontinent where there is a genetic predisposition to cardiovascular risk.

Clinico-epidemiological profile of patients attending Suraksha Clinic of tertiary care hospital of North India.

Abstract: Background: Sexually transmitted infections (STIs) are a global health problem. Trends of STIs vary from place to place depending on various epidemiological factors prevailing in that respective geographic area. Aims and Objectives: The present study was conducted to find the pattern and prevalence of different STIs out of total STI clinic attendees, to identify any change in the trend of STIs, various epidemiological factors, and behavior of individual diseases. Materials and Methods: Case records of the patients, attending the STI clinic (Suraksha Clinic) attached with Department of Dermatology, Venereology, and Leprosy of a tertiary care medical college and hospital of North India from April 2007 to March 2014, were analyzed. All the patients were thoroughly examined and investigated. Results: This study included a total of 5468 STI clinic attendees out of which 3908 were diagnosed to have STIs. Most of the patients were male, married, and in the third decade of their lives. In our study, the highest number of patients had herpes genitalis, i.e., 850 patients (21.75%) followed by 415 patients (10.61%) having genital warts. Molluscum contagiosum was present in 239 patients (6.11%), 106 patients (2.71%) had urethral discharge whereas 81 patients (2.07%) diagnosed to have syphilis. Viral infections accounted for 38.48% of cases. Human immunodeficiency virus (HIV) positivity was seen in 414 patients (10.59%) of total STI cases. Conclusion: The trend of STIs is changing from bacterial to viral diseases. This is because of the widespread use of antibacterial, self-medication, and treatment through national program. STIs enhance the susceptibility of an individual to acquire or transmit HIV through sexual contact.

A retrospective study of the pattern of sexually transmitted infections from a tertiary care hospital of Rajasthan.

Abstract: Background: Knowledge about the current patterns of sexually transmitted infections (STIs) is essential as they pose a major health problem worldwide and even more so in the developing countries like ours. Owing to the lack of advanced laboratory facilities at most of the centers, the cases are evaluated and managed as per the syndromic approach proposed by the National AIDS Control Organization. Aims: We aim to study the patterns of STIs seen over the past 4 years based on the syndromic approach. Materials and Methods: A retrospective analysis of the data of STI clinic over 4 years (April 2012–March 2016) was carried out. Showing all cases attending STI clinic are subjected to clinical examinations and investigated. Tests for HIV and venereal disease research laboratory were performed in all patients. STIs were categorized as per the syndromic approach. The proportions were calculated and data collected were analyzed. Results: A total of 4847 cases (1845 males and 3002 females) were studied. The most common STI overall was cervicovaginal discharge followed by genital herpes, warts, molluscum contagiosum, genital ulcerative disease-nonherpetic, lower abdominal pain, and urethral discharge in decreasing order of frequency. Genital herpes was the most common STI in males. Collectively, the proportion of viral STI was more as compared to nonviral STI. The number of newly diagnosed HIV cases was 19 (0.4%). Conclusion: The contemporary trend of STIs is relative rise in the proportion of viral STIs including genital herpes, warts, and molluscum contagiosum. Since STIs and HIV perpetuate each other, prompt diagnosis and adequate treatment of all cases of STIs is necessary to prevent HIV transmission.

Correlating CD4 count with mucocutaneous manifestations in HIV-positive patients: A prospective study.

Abstract: Background: Mucocutaneous findings may be the presenting symptoms in HIV-afflicted individuals. A multitude of mucocutaneous diseases also occurs during the course of the ailment, with some conditions being classed as disease defining. They include infectious diseases and noninfective inflammatory and neoplastic dermatoses. With progressive fall in CD4 count, there is a change in the types of mucocutaneous lesions encountered. Aim: This study aims to statistically correlate the CD4 counts with the mucocutaneous manifestations in 100 HIV-positive patients. Materials and Methods: A total of 100 cases of HIV-positive patients with skin and mucous membrane manifestations were selected serially. A complete history was taken, clinical examination was done, and the CD4 count was noted. Patients were divided into four groups (Groups I, II, III, IV) with different ranges of CD4 values, namely, 500, respectively. Results: The distribution of study population in CD4 ranges showed that majority (47%) of the study population had CD4 count between 201 and 500, and 29% of the study group had CD4 count between 50 and 200 cells. Almost 21% of the patients had the count > 500 cells and 3% had cell count 200. Conclusion: Statistically significant association with the CD4 count was seen in herpes zoster ophthalmicus, genital wart, genital herpes, vaginal discharge syndrome, scabies, pyoderma, dermatophytosis, Hansen's disease, herpetic gingivostomatitis, seborrhoeic dermatitis, lichen planus, and drug reactions. These dermatoses may indicate the worsening of immune status and the need for regular monitoring with periodical CD4 counting. Occurrence of dermatoses such as photosensitive eczema, drug reaction, lichen planus, Type I lepra reaction, and herpes zoster ophthalmicus in patients on ART may be due to IRIS. To avoid the more frequent occurrence of infectious dermatoses and to reduce the development of IRIS with ART, all HIV-positive cases may be started on ART at higher CD4 count. Screening for HIV infection is suggested whenever the following conditions are seen: persistent oral candidiasis, atypical manifestations of zoster, herpes zoster ophthalmicus, herpetic gingivostomatitis and MC in adults, exaggerated IBA, and extensive seborrhoeic dermatitis.

A clinico-etiological study of urethritis in men attending sexually transmitted disease clinic at a tertiary hospital

Abstract: Introduction: Urethritis is an important sexually transmitted infection in the present day. Causative agents are many for urethritis, ranging from bacteria, virus, to protozoa. Aim: The aim was to study the various etiological agents and clinical presentation of men with urethritis. Materials and Methods: This was a cross-sectional study conducted at a tertiary care center in Bengaluru. After taking written informed consent, 100 men with symptoms of urethritis were enrolled in the study. Their demographic details, presenting symptoms, and examination findings were documented using a questionnaire and a pro forma. Results were tabulated and analyzed using mean. Results: Nearly 68% had urethral discharge with dysuria as the presenting symptom. Nearly 27% had only dysuria without discharge as the main complaint. Almost 15% had coexistent genital ulcer disease. Human immunodeficiency virus infection was present in 10% in the population studied. The most prevalent organism isolated was Neisseria gonorrhoeae (45%). Chlamydia trachomatis was isolated in 13%. Trichomonas vaginalis was isolated in two patients. Conclusion: Our study highlights the high prevalence of gonorrhea in India when nongonococcal urethritis is the forerunner in the Western world. In addition, T. vaginalis as a cause of urethritis has to be considered in our setup.

Determinants of HIV positivity among injecting drug users in Delhi and Punjab.

Abstract: Context: In India, the HIV positivity among injecting drug users (IDUs) stands at a staggering 7.71%. Among the states, HIV positivity among IDUs is highest in Punjab and Delhi, 21.2% and 18.3%, respectively. Interestingly, these two states are near to the “Golden Crescent.” Aims: The aim of this study was to examine the similarities and differences between the IDUs in Punjab and Delhi, in the context of vulnerability to HIV. Settings and Design: This study uses data from the HIV Sentinel Surveillance-2010–2011 (HSS). The HSS is a cross-sectional data collection process for HIV surveillance in India. HSS, apart from collecting the blood samples from the respondents, also collects basic sociodemographic as well as some information on the drug use patterns of the IDUs. Data and Methods: The raw data from HSS 2010–2011 were used for this study. Bivariate and multivariate analyses performed to obtain the results. Results: Descriptive analyses revealed that the IDUs of Punjab and Delhi are very different from each other. In Delhi, 62.4% of IDUs inject drugs for more than 5 years; whereas in Punjab, it was only 32.4%. Majority of the Delhi IDUs (86.5%) inject more than three times a week whereas the corresponding percentage in Punjab was only 29.5%. The profiles of the HIV positives also differ between these two states. Conclusions: It would be prudent to adopt state-specific strategies to prevent the spread of HIV among the IDUs.

An approach to venerophobia in males.

Abstract: Venerophobia is a lesser recognized entity in clinical practice though the prevalence is on the rise. Our observations of current trends in the Sexually Transmitted Diseases (STI) clinic indicate that venerophobia is not an uncommon presentation among youngsters following an isolated or multiple episodes of sexual contact. This has a major bearing on the mental as well as sexual health. So far, there is no published data available in literature on the prevalence and extent of the problem. In this paper, we have made an attempt to cover the various modes of presentation, laboratory investigations and have outlined an approach towards the management of venerophobia in males.

Study of pruritus vulvae in geriatric age group in tertiary hospital.

Abstract: Background: According to the World Health Organization criteria, geriatric population is people above 60 years of age. In this phase of life, a woman has already gone through menopause and its associated emotional, physical, and hormonal changes. These changes are due to gradual loss of estrogen that comes with menopause which results in dramatic changes in the appearance of vulva and vagina. With age, skin of vulva becomes thin, loses elasticity, and moisture so that the patient starts feeling burning and itchy sensation. The normal acidic pH changes to basic which alters the flora and makes the person prone to other bacterial infections. Apart from infections, there are many other dermatological and nondermatological causes of vulvar itching in this age group such as eczema, contact dermatitis, lichen planus (LP), lichen sclerosus atrophicans, lichen simplex chronicus (LSC), prolapse, incontinence, and carcinoma. The aim is to diagnose the causes of pruritus vulvae in the geriatric age group to decrease the misery of these patients. Methods: We selected 40 consecutive females of age group ranging from 60 to 75 years coming to skin OPD with the complaint of pruritus of vulvar region over a period of 1 year. Clinical examination, complete blood count, fasting blood sugar, wet mount, pap smear, and skin biopsy were done in every case. Results: Out of the forty patients who were included in this study, 17 (42.5%) were diagnosed as a case of LSC and 11 (27.5%) patients had atrophic vaginitis. Three (7.5%) patients presented with tinea. Three (7.5%) cases were clinically diagnosed as scabies. Another 2 (5%) cases were diagnosed as LP and Candida was seen in other 2 (5%) cases. 1 (2.5%) case was diagnosed as bacillary vaginosis and 1 (2.5%) patient was of lichen sclerosus. Conclusion: Pruritus vulvae of geriatric age group are of diverse etiology, therefore, treatment based on precise diagnosis is of prime importance.

Treatment outcomes and loss to follow-up rate of male patients with gonococcal and nongonococcal urethritis who attended the sexually transmitted disease clinic: An 8-year retrospective study.

Abstract: Background: Poor follow-up compliance of patients with infectious urethritis is a recognized and serious public health problem in Thailand. Aim: The aim of this study was to determine treatment outcomes and loss to follow-up rate of male patients with gonococcal urethritis (GU) and non-GU (NGU) at a sexually transmitted disease (STD) clinic at Thailand's tertiary hospital. Methods: This retrospective chart review of male patients who sought treatment at STDs Clinic, Siriraj Hospital, and who were diagnosed with GU and/or NGU was conducted during January 2007 to December 2014 study period. Results: Two hundred and twenty-seven male urethritis patients were included in this study with a mean age was 29.5 years. GU and NGU were found in 120 (52.9%) and 107 (47.1%) of patients, respectively. Overall prevalence of GU and NGU during the 8-year study period at STD Clinic, Siriraj Hospital, was 8.6% and 7.8%, respectively. Ninety-six patients (42.3%) were lost to follow-up. Recurrent urethritis was found in 23.8% of patients, and HIV infection was identified in 11.6%. Mean age of patients lost to follow-up was 29 years. Compared with patients who attended every scheduled follow-up visit, men who have sex with men had a significantly lower rate of loss to follow-up (P = 0.012). Conclusion: Almost half of patients with GU or NGU were lost to follow-up, and one-quarter had recurrent urethritis. Fast and easy access to services that provide accurate diagnostic testing and effective treatment should be a public health priority to prevent complications and reduce rates of disease transmission.

Sexual abuse in males: An underreported issue.

Abstract: Sir, Sexual abuse (SA) is a multidimensional problem having legal, social, medical, and psychological implications. It can have lifelong deleterious effects on the victim’s physical and mental health.[1] Conventionally, SA is underrecognized when the victims are males. The significance of the problem is undermined all the more when the abuse is perpetrated by a parent or by a peer. We hereby report two cases of male SA (MSA) who also had the presence of sexually transmitted infections (STIs). The purpose of this report is to enhance awareness among primary care physicians, policy makers, and the community to the neglected issue of MSA in a sexually conservative country like India. In addition, the importance of evaluating such cases for STIs is highlighted.

Haemophilus parainfluenzae urethritis through orogenital transmission.

Abstract: Urethritis, which is characterized by urethral inflammation, results from infectious, traumatic, and immune sources. Amongst the infectious causes, urethritis is usually acquired through sexual route and all show similar symptoms and signs. The present case is from India of a patient with urethritis caused by Haemophilus parainfluenzae transmitted through orogenital route.

Study of prevalence of sexually transmitted infections/human immunodeficiency virus and condom use among male-to-female transgender: A retrospective analysis from a tertiary care hospital in Chennai.

Abstract: Context: A “Transgender” person is one who dresses as, desires to be, has undergone surgery to become or identifies with opposite sex. They have a higher risk of sexually transmitted infection (STI) due to a combination of biological and social reasons. They have risky sexual behaviors but low-risk perception. Aims: The aim of this study is to determine the prevalence of STI/human immunodeficiency virus (HIV) in transgender (TG) and association with condom use. Settings and Design: A retrospective study of 82 male-to-female TGs attending our sexually transmitted disease (STD) clinic from 2011 to 2014 was undertaken. Subjects and Methods: Detailed history including sexual exposure, high-risk practices, and condom usage was obtained, and clinical examination for any evidence of STI was done. They were screened for the presence of STI/HIV and other appropriate investigations were done whenever required. Statistical Analysis Used: Retrospective analysis was used. Results: In our study, the total prevalence of STI/HIV in the studied population was 48.8% which was considerably higher than the prevalence in the general population which was 5.4%. Promiscuity rate of TGs studied was 45%, 33% of them were male sex workers. Syphilis was the most common STD, followed by HIV, genital warts, and gonorrhea. The prevalence of condom use was 45.1%, and the prevalence of STI/HIV in the condom used TGs was 14.6%. Conclusion: Based on the above findings, the TG group is found to have a higher prevalence of HIV/STI despite the higher use of condoms which is mostly attributable to the lack of correct and consistent use of condoms. This stresses upon the importance of promoting the condom usage and knowledge, and also this group should be the focus of intensive intervention programs aimed at STI screening and treatment, reduction of risky sexual behavior, and promotion of HIV counseling and testing.

Study of clinical profile of herpes zoster in human immunodeficiency virus positive and negative patients at a rural-based tertiary care center, Gujarat.

Abstract: Background: Herpes zoster usually presents with typically grouped vesicles on erythematous base involving single dermatome with self-limiting nature in immunocompetent individuals while it may present in extensive form involving multiple dermatomes involvement or disseminated form in immunocompromised, especially in human immunodeficiency virus (HIV). Aims and Objectives: The aim of this study was to study the prevalence of HIV in patients of herpes zoster, to compare the clinical presentation of herpes zoster in HIV-infected and noninfected patient. Materials and Methods: The study was carried out in the Department of Dermatology in a Teaching Institute of Gujarat, from June 2008 to May 2014 after ethical clearance. The study population included all the patients with a clinical diagnosis of herpes zoster. All the patients were investigated for HIV infection after written consent. Results: Out of total 688 patients of herpes zoster, 35 (5.1%) were HIV-positive, 26 (74.3%) were males and 9 (25.7%) were females. Among HIV-positive patients, 29 (82.85%) patients had localized dermatomal involvement, 4 (11.42%) patients had multiple dermatomal involvement, and only 2 (5.71%) had disseminated zoster while among HIV-negative, 636 (97.40%) had localized dermatomal involvement, 14 (2.14%) patients had multiple dermatomal involvement, and 3 (0.45%) had disseminated zoster. Cervical dermatome was most commonly involved dermatome in patients of HIV. Conclusion: Disseminated and multiple dermatomal involvement was more commonly involved among HIV-positive patients when compared to HIV-negative patients.

Proton pump inhibitors are associated with a reduced likelihood for sexually transmitted diseases in women in the emergency department.

Abstract: Background: Proton pump inhibitors (PPIs) have been shown in cell culture to kill Trichomonas vaginalis (TV) at lower half maximal inhibitory concentration values than metronidazole (Flagyl), the most common medication used to treat the infection. However, there have been no previous clinical investigations to determine if PPIs are associated with reduced risk for TV. Materials and Methods: We examined the records of female patients who received testing in the emergency department for TV, Neisseria gonorrhoea (GC), and Chlamydia trachomatis (CT) between 2010 and 2014 at two academic medical centers to determine if PPI and histamine type 2 receptor antagonist (H2RA) drugs were associated with TV and GC/CT infections. Results: We found that H2RAs were associated with an increased likelihood for TV (odds ratio [OR]: 2.0, P< 0.0001) and GC and/or CT infections (OR: 1.49, P< 0.0001). PPIs were associated with a reduced likelihood for TV (OR: 0.75, P< 0.0001) and GC and/or CT infections (OR: 0.57, P< 0.0001). In patients infected with GC and/or CT, the likelihood of coinfection with TV was reduced in those taking a PPI (OR: 0.64, P = 0.054) and increased in those taking an H2RA (OR: 1.62, P = 0.003). Conclusions: PPIs are associated with a reduced risk for TV and GC/CT infection.

Vulvo-vaginal ano-gingival syndrome: Another variant of mucosal lichen planus.

Abstract: Vulvo-vagino-gingival syndrome was described as a distinctive pattern of erosive plurimucosal lichen planus (LP), and it is a clinical triad of vulval, vaginal, and gingival LP. It can lead to sequelae such as vaginal and urethral stenosis which can have severe implications on the quality of life. We report a case of a 40-year-old female who developed urethral, vaginal, as well as anal stenosis as a result of long-term exclusive mucosal LP involving vulvo-vaginal and anal mucosa along with oral LP without any other cutaneous involvement. This case is being reported because of the rare association of anal LP with vulvo-vagino-gingival syndrome and its gross similarity to lichen sclerosus.

What puts them at risk? A cross-sectional case-control survey of demographic profile and sexual behavior of patients with sexually transmitted infections at a tertiary care center in North India.

Abstract: Background: Sexually transmitted infections (STIs) are a major public health problem in developing nations. Identification of risk factors can help in formulating effective strategies against them. The present study was conducted in a tertiary care hospital in North India over 1 year to identify the risk factors associated with STIs. Materials and Methods: A questionnaire-based cross-sectional case–control survey was conducted where participants answered questions on demographic details, sexual behavior, and awareness of STIs. Cases were patients with STIs whereas controls were randomly selected from healthy individuals accompanying patients with nonvenereal complaints attending our hospital. Results: There were 106 cases and 64 controls. STI patients had sexual debut 2 years before controls. A higher proportion of STI cases had lower education, multiple sexual partners, lived separately from their partner, had nonregular partners, had protected sex in the last month, had sex under influence of alcohol/illicit drugs, sex in unstructured settings, and engaged in transactional sex, in comparison to controls ( P P P Conclusions: Our study identifies risk-behavior patterns in patients with STIs, which should be modified to reduce the burden of these diseases. Increasing the knowledge about STIs in these patients can translate into more common condom usage that lends support for strengthening sexual health programs at grass-root levels. Limitations: The small size of the study population could have led to decreased power of the study to detect differences between cases and controls. The external validity of our results needs to be tested in different population groups involving larger sample sizes.

Hypersexuality - a cause of concern: A case report highlighting the need for psychodermatology liaison.

Abstract: Sexual addictions are behavioral addictions. Hypersexuality is used to describe non-paraphilic "excesses" of sexual behavior. Hypersexual disorder (HSD) can be accompanied by clinically significant social, personal distress, and medical morbidity. Common medical comorbidities seen with HSD are the sexually transmitted diseases (STDs). We present one such case with management. A psychodermatology liaison clinic would be the ideal one-stop for screening patients with STDs for HSD.

Co-infection of syphilis and hepatitis B with carcinoma penis in a human immunodeficiency virus male.

Abstract: Human immunodeficiency virus (HIV) infections have a high probability of co-infections with Syphilis and hepatitis B virus since they share the common routes of transmission. We report a 41-year-old HIV male (on antiretroviral therapy for the past 6 years) admitted for a complaint of penile ulcer for 2 months. Serology for syphilis and hepatitis B were positive. Skin biopsy of the penile ulcer confirmed squamous cell carcinoma. Henceforth, the patient was referred to oncology department for further management. We present this rare combination of syphilis and hepatitis B with carcinoma penis in an HIV patient.

Giant seborrheic keratosis of the genitalia with an unusual histopathological finding

Abstract: Seborrheic keratosis (SK) of the external genitalia is a rare entity which can be easily misinterpreted as genital warts. Histopathology is a useful tool to make a diagnosis in such cases. We report a 62-year-old male who presented with multiple polypoidal lesions exclusively on the external genitalia. Histopathology was suggestive of hyperkeratotic type of SK which showed some unusual features.

Ramsay Hunt syndrome in a patient with human immunodeficiency virus infection.

Abstract: Ramsay Hunt syndrome (RHS) is a rare, severe complication of varicella-zoster virus reactivation in the geniculate ganglion, characterized by hearing loss, pain, and vesicles in the ear or mouth along with ipsilateral facial palsy. Although it is rare, it is more commonly found with immunodeficiency conditions. We report a case of a 35-year-old human immunodeficiency virus positive male, having CD4+ count of 336/μl, who presented with RHS and had vertigo, painful vesicular eruptions on the right ear and unilateral sensorineural hearing loss. He was treated immediately with valacyclovir and prednisolone, and the complete recovery was achieved at 6 months after the onset.

Solitary plaque in the perianal region.

Abstract: 96 Indian Journal of Sexually Transmitted Diseases and AIDS Volume 38, Issue 1, January-June 2017 et al. Incidence and risk factors for the prozone phenomenon in serologic testing for syphilis in a large cohort. Clin Infect Dis 2014;59:384‐9. 3. Sidana R, Mangala HC, Murugesh SB, Ravindra K. Prozone phenomenon in secondary syphilis. Indian J Sex Transm Dis 2011;32:47‐9. 4. Nayak S, Acharjya B. VDRL test and its interpretation. Indian J Dermatol 2012;57:3‐8.