LETTER TO EDITOR
Year : 2012  |  Volume : 33  |  Issue : 1  |  Page : 67-68

Comments: "Pattern of sexually transmitted infections and performance of syndromic management against etiological diagnosis in patients attending STI clinic of a tertiary care hospital"

Bhushan Kumar
Department of Skin, STD and Leprosy, PGIMER, Chandigarh, India

Correspondence Address:
Bhushan Kumar
Department of Skin, STD and Leprosy, PGIMER, H. No. 81, Sector 16, Chandigarh - 160 015
India

1. The diagnosis of herpes simplex infection was made on the basis of smear with giant cells, positive serology for HSV-2/HSV-1 or on clinical examination or all of them together or in some other combination?
2. VDRL test is a non treponemal test and does not indicate the presence of T.pallidum in a given patient. T.pallidum has to be demonstrated only by dark ground illumination, immunofluorescence or by a special staining procedure in a smear or biopsy specimen- so the translation of VDRL positivity to presence of T.pallidum is not correct. Same is true for TPHA test supposed to reflect presence of T.pallidum. Both tests can be positive due to past infection and may not relate to the present ulcer.
3. To attach significance to the venereal disease research laboratory test /treponoma pellidum heam aglutinin test positivity-a particular titre is important - but the cut off is not given in the text.
   
   So the basic question - how was the ulcer diagnosed to be syphilitic: on the basis of clinical appearance or the positivity of either serological test or a combination of all?
4. [Table 1] gives total number of patients with genital ulcers to be (61+30=91) - but in [Table 2] the number of patients with HSV-2 (37+49=86) and with T.pallidum is (45+26=71), so the total is 157 -where is the catch? But to me it means (even if we exclude patients with more than one infection) that patients with positive laboratory reports - even without ulcers have also been included in the category of GUD. The results given also prove my contention. Genital herpes (86/300), syphilis (71/300), total ulcers in only 91 - obviously so many cannot be with mixed infection ulcers so there is an overlap in the laboratory positives.
5. [Table 3] gives the number of patients given syndromic treatment to be (60+15) but originally there were 91 patients with genital ulcers?