Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 40 | Issue 2
Page Nos. 97-193

Online since Tuesday, November 26, 2019

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REVIEW ARTICLES  

Premalignant male genital dermatoses Highly accessed article p. 97
Rochit Rajesh Singhal, Trusha Manoj Patel, Kira Antony Pariath, Rita Vipul Vora
DOI:10.4103/ijstd.IJSTD_106_17  PMID:31922098
The spectrum of conditions affecting the penile skin is varied and ranges from simple, benign dermatoses to premalignant and malignant conditions. Anogenital malignancies and premalignancies are an important personal/public health problem due to their effects on individuals' physical, mental, and sexual health. Furthermore, due to their etiological association with human papillomavirus infection, anogenital malignancies, and premalignancies constitute an immense public health burden. Bowen's disease, Bowenoid papulosis, and erythroplasia of Queyrat are the most widely seen premalignancies of anogenital region and are all forms of squamous intraepithelial neoplasia. Histopathologically, these conditions share identical histologic features of squamous cell carcinoma in situ, but their clinical features differ. In this article, we explore the common precancerous states that can lead to penile carcinoma.
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Genital lichen planus: An underrecognized entity Highly accessed article p. 105
Ananta Khurana, Sidharth Tandon, Yogesh S Marfatia, Nina Madnani
DOI:10.4103/ijstd.IJSTD_45_19  PMID:31922099
Genital lichen planus (LP) is an underrecogonized dermatosis. The appearance is often unlike classical LP elsewhere, and hence, the condition goes undiagnosed in many. Vulvo-vaginal LP in particular, can be a distressing condition often leading to scarring and a poor quality of life. Treatment for most of the genital LP variants is similar to managing LP elsewhere; however, the erosive variant requires special attention as treatment outcomes are often disappointing and the disease runs a protracted course. Potential for development of malignancy also exists, as in oral LP, and hence close follow up is essential.
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ORIGINAL ARTICLES Top

Prevalence of reproductive tract infections in women attending a tertiary care center in Northern India with special focus on associated risk factors p. 113
Nisha Chaudhary, Rajkumar Kalyan, Mastan Singh, Jyotsna Agarwal, Sabuhi Qureshi
DOI:10.4103/ijstd.IJSTD_17_16  PMID:31922100
Background: Reproductive tract infections (RTIs) continue to present major health, social, and economic problems worldwide, and their complications are the most important causes of morbidity and mortality for women, especially in developing countries. Interest in RTIs and their management has increased tremendously because the presence of a RTI in the sexual partner increases the risk of acquisition of HIV. Aims: The aim of this study is to know the prevalence of RTIs, its correlation with clinical features and associated risk factors in women of reproductive age group attending a tertiary care center in Lucknow. Materials and Methods: The present study was conducted on 318 women of the reproductive age group (18–45 years) attending the RTI/sexually transmitted infection clinic at our center; they were evaluated for the prevalence of following RTIs: Chlamydia, gonorrhea, syphilis, bacterial vaginosis, trichomoniasis, and candidiasis; their correlation with clinical features and associated risk factors. Results: The prevalence of reproductive tract infections in women attending our centre reported 9.7%. The prevalence of candidiasis was maximum (11.5%) followed by chlamydia (4.1%), syphilis (4.1%), bacterial vaginosis (1.73%), and trichomoniasis (0.57%). None of the women were found positive for gonorrhea. The most common presentation was genital discharge (52.8%) followed by lower abdominal pain (45.2%). Conclusion: The factors found to be significantly associated with RTI were illiteracy (P < 0.05), unemployment (P < 0.05), history of RTI in patient (P = 0.001), and the presence of RTI in their partner (P < 0.05). The genital discharge was the most common presentation.
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Seroprevalence of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus among hemodialysis patients in a Tertiary Care Teaching Hospital in a developing country p. 120
Sonam Kansay, Jannat Sekhon, Saifi Rana
DOI:10.4103/ijstd.IJSTD_53_17  PMID:31922101
Background: Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) prevalence in hemodialysis patients varies geographically, both within and between countries. High prevalence of these infections in dialysis patients reflects the increased presence of common risk factors for their acquisition, including transfusion, transplantation, history of drug abuse, plus susceptibility to nosocomial transmission during dialysis. Objective: The aim of this study is to investigate the seroprevalence and clinical profile of HIV, HBV, and HCV patient's on hemodialysis. Materials and Methods: Clinical and epidemiological data of patients undergoing maintenance hemodialysis in the dialysis unit of a teaching institution were obtained and analyzed over a 5 years' period. Results: A total of 127 males and 69 females were studied. Their mean age was 50.45 years. Out of the total 196 dialysis-dependent patients, 2 (1.02%) were seropositive for HIV antibodies, 6 (3.06%) were hepatitis B surface antigen positive, and 30 (15.30%) were anti-HCV antibody positive. There was no coexistence of HIV, HBV, and HCV markers. The major primary renal diseases in hemodialysis patients included diabetes mellitus (42%), hypertension (22%), chronic nephritis (15%), urologic diseases (6%), cystic renal diseases (4%), and others (11%). Conclusion: Prevalence of transfusion-transmissible viral infections was higher among hemodialysis patients, especially HCV infection which was an alarming situation and therefore strict adherence to infection control strategies, barrier precautions, and preventive measures, including routine hepatitis B vaccination and regular virological follow-up were recommended along with regular education and training programs of technical and nursing personnel's involved with dialysis patients.
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Extensive tests for extermination: Need for incorporation of molecular detection methods of human immunodeficiency virus in screening algorithm in tertiary hospitals in India p. 126
Priya Singh, Ruchita Tyagi, Surjit Singh, Aman Sharma, Ritu Aggarwal, Ranjana W Minz
DOI:10.4103/ijstd.IJSTD_55_17  PMID:31922102
Context: A downward trend is being observed in the incidence of human immunodeficiency virus (HIV) infection in India due to strategic activities of National AIDS Control Organisation (NACO) in the last 24 years. Opt-out testing has consistently shown high seroprevalence in our tertiary care center. Aim: This study aims to audit opt-out testing and compare various commercial test kits used to detect HIV seroprevalence in patients in our tertiary care institute and suggest new algorithm for HIV testing in tertiary hospitals in India. Materials and Methods: Retrospective analysis of 30,021 samples tested in Department of Immunopathology using opt-out testing delinked from the NACO-sponsored testing for Integrated Counselling and Testing Centre (ICTC) was performed. Study population comprised of presurgery and emergency patients which at the time of our reporting were not included in ICTC testing. Results: Microlisa was the first test performed on 76% samples. 1.02% cases were reactive only with Microlisa and negative with other rapid kits hence were reported as negative, according to NACO scheme of reporting. Advanced testing algorithm followed by centre for disease control (CDC) showed that 80% of these 4th-generation positive and rapid test-negative patients turned out to be acute HIV infections on molecular testing. Conclusion: Patients in tertiary referral center constitute high-risk population and should be screened with 4th-generation enzyme-linked immunosorbent assay which incorporates p24 antigen. Those which are found indeterminate should have molecular testing by nucleic acid amplification test or real-time polymerase chain reaction, as our study has demonstrated that 1.02% of these cases may harbor acute HIV infection.
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Persons living with HIV continue to present late for care: A trend analysis from 2011 to 2015 p. 133
Abhijit Vasantrao Kadam, Shilpa Chandrashekhar Bembalkar, Narayan Uddhavrao Panchal, Megha Sunil Mamulwar, Ashwini Vinod Shete, Sheela Virendra Godbole
DOI:10.4103/ijstd.IJSTD_5_18  PMID:31922103
Context: The clinical and prevention benefits of early initiation of antiretroviral therapy (ART) have led to the adoption of test and treat policy for HIV. Early diagnosis of HIV is crucial for maximal benefits from ART. Aims: This study aims to assess trends in CD4 cell counts at diagnosis and determinants of late presentation. Settings and Design: We analyzed 5-year data from a free HIV/sexually transmitted infection referral clinic immune. Subjects and Methods: Persons presenting for HIV testing from January 2011 to December 2015, for whom CD4 cell count results were available within 3 months of HIV diagnosis, were included in the analysis. Persons on ART were excluded from the study. Statistical Analysis: The predictors of CD4 cell count at presentation were assessed using univariate and multivariate linear regression. Results: Of 1001 persons diagnosed HIV-1 positive, 659 had received CD4 test within 3 months of diagnosis. The median CD4 count at presentation ranged from 212 to 352 cells/cmm in these 5 years and did not show any significant change with time. Nearly 40% had CD4 cell counts below 200 cells/cmm (AIDS); additionally, 23% presented below 350 cells/cmm. Older age (beta: -5.78; P= 0.001), education above matriculation (beta: -123.72; P= 0.014), having current opportunistic infections (beta: -173.58; P= 0.037), and being symptomatic (beta: -101.8; P= 0.002) were predictors of presenting at lower CD4 counts. Conclusion: Between 2011 and 2015, persons with HIV continued to present late in spite of changes in ART access program. Education focused on the benefits of early diagnosis and availability of free immediate treatment in the public sector, are crucial to the achievement of the India's 90-90-90 goals.
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Human immunodeficiency virus/acquired immunodeficiency syndrome-related discriminatory practices among health-care providers in apex health institutions of Bhubaneswar, Odisha p. 139
Ipsa Mohapatra, Om Prakash Panigrahi
DOI:10.4103/ijstd.IJSTD_54_18  PMID:31922104
Context: Stigma and discrimination in health-care settings, against human immunodeficiency virus (HIV)-positive patients, not only affects patient care but also creates an unnecessary culture of secrecy and silence based on ignorance and fear. Aims: This study was designed to determine if there were any such discriminatory practices against people living with HIV/acquired immunodeficiency syndrome (AIDS) by health-care providers at apex hospitals in the city of Bhubaneswar, Odisha. Settings and Design: A cross-sectional study was designed in clinical departments, among all doctors and paramedical workers who had been providing health services to patients with HIV/AIDS for at least a year in the three large multidisciplinary tertiary care teaching hospitals in Bhubaneswar. Materials and Methods: A semi-structured questionnaire was used to collect data through in-person interviews after obtaining informed consent. Statistical Analysis Used: Data were entered into Microsoft Excel spreadsheet and were analyzed using Epi Info 7 (version 7.1.2.0); results represented using frequencies, proportions, Z-tests, and Chi-square tests. Results: Around 76.73% of the participants agreed that they were personally aware of discrimination that occurred in health-care settings. About 92.86% of the doctors, 78.12% of the nurses, while 38.09% of other health-care providers (HCPs) agreed to the fact there were some form of discriminatory practices at health facilities; this was also found to be statistically significant. As high as 88.10% of the doctors, 90.62% of the nurses, and 80.96% of other HCPs agreed that there were discriminatory practices against HIV/AIDS patients by HCPs, although this difference was not statistically significant. Conclusions: Existence of discriminatory practices in these healthcare settings was due to the lack of correct information about HIV/AIDS and lack of protective materials needed for prevention of infection transmission.
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Prevalence of pruritic papular eruption among HIV patients: A cross-sectional study p. 146
Shoubin Mohammed, Seethalakshmi Ganga Vellaisamy, Kannan Gopalan, Lekha Sukumaran, AS Valan
DOI:10.4103/ijstd.IJSTD_69_18  PMID:31922105
Introduction: Pruritic papular eruption (PPE) remains as one of the most common cutaneous manifestations in HIV-infected patients. Proper knowledge about understanding the risk factors associated with this disease may help to decrease the prevalence of PPE. Objective: The present study was conducted to determine the prevalence of PPE in HIV-infected patients and to correlate between the severity of PPE and individual CD4 count. Materials and Methods: This was a cross-sectional study, conducted in Palakkad Antiretroviral Therapy Centre, Kerala, between March 2017 and April 2017. A total of 100 HIV patients with evidence of multiple itchy skin lesions of 1-month duration were included in the study. Severity of lesion was evaluated using an objective “rash severity scale” for PPE. Data were coded and analyzed. Results: Prevalence of PPE was 11.35% in our study. The mean age of the study population was 41.17 ± 12. Male-to-female ratio was 1:2. In our study, 97% of the patients were giving history of mosquito bite. Most of the patients (40%) had moderate type of PPE. In our study, majority (86%) had a CD4 count of more than 200, and the incidence of PPE was more frequently seen in patients with CD4 count more than 200 cells which was statistically significant. Conclusion: PPEs are unique dermatosis, which is having a devastating impact on the quality of life, stigmatizing them in their communities. Thus, recognizing those lesions helps in allowing better treatment of this distressing condition.
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Multiplex nested polymerase chain reaction targeting multiple genes for the detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens p. 152
Ketan Priyadarshi, Pradyot Prakash, Anjali Rani, Satyendra Kumar Singh
DOI:10.4103/ijstd.IJSTD_73_18  PMID:31922106
Objectives: The objective of this study was to design and evaluate a novel multiplex nested polymerase chain reaction (PCR) protocol for simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens obtained from symptomatic patients clinically suspected of sexually transmitted infections (STIs), targeting two different genes each for these pathogens. Materials and Methods: A total of 116 genitourinary specimens were collected from men (n = 12) and women (n = 104). Direct microscopy, culture isolation, and antimicrobial susceptibility testing for N. gonorrhoeae were performed. Multiplex nested PCR was performed on clinical samples using novel designed primers targeting porA pseudogene and opa gene of N. gonorrhoeae and momp gene and cryptic plasmid of C. trachomatis simultaneously. DNA sequence analysis of nested PCR amplicons for each of four gene targets was carried out for the validation of in-house designed primers and PCR protocol. Results: A total of 51.72% (60/116) patients were detected to have either of the two STIs. About 35.35% (41/116) of patients were positive for C. trachomatis and 33.62% (39/116) for N. gonorrhoeae by employing multiplex nested PCR. Coinfection with N. gonorrhoeae and C. trachomatis was detected in 17.24% (20/116) patients. 31.5% endocervical swabs (n = 54), 64.4% speculum-assisted high vaginal swabs (n = 45), and 80% self-collected vaginal swabs (n = 5) were detected positive for either of two STIs. Conclusions: The multiplex nested PCR protocol designed and employed in the present study may be used in the diagnosis and management of both symptomatic as well as asymptomatic cases of N. gonorrhoeae and C. trachomatis, particularly among high-risk groups.
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Characterization of human immunodeficiency virus-infected patients of suspected first-line antiretroviral treatment failure within 5 years – Evidence from a tertiary hospital, Kolkata p. 159
Dolanchampa Modak, Nivedita Dutta, Shantasil Pain, Rajyasree Ghosh (De), Subhasish Kamal Guha
DOI:10.4103/ijstd.IJSTD_81_18  PMID:31922107
Objectives: Antiretroviral therapy (ART) has immense survival benefit on human immunodeficiency virus (HIV)-infected people. However, every year, a proportion of patients were failing to the first-line drugs. The aim of this study is to characterize the patients developing first-line failure within 5 years of ART. Materials and Methods: A retrospective observational study was carried out at the Centre of Excellence in HIV care, School of Tropical Medicine, Kolkata. A total of 190 referred patients' data of suspected first-line treatment failure who failed first-line ART within 5 years of initiation were collected and analyzed using R software. Results: Among 190 patients, 100 (52.4%) patients had virologic failure. Male patients 78 (41.05%) outnumbered females 22 (11.57%) and needed to switch to the second-line drugs. The median age was 37 years (range 8–65 years), and the median duration of first-line ART taken was 2.85 years. Among the first-line failed patients, zidovudine, lamivudine, and nevirapine (23.6%) was the most common antiretroviral regimen and 77 (40.5%) referred in the WHO stage I of illness. Seventy-three (38.42%) patients were referred for immunological failure, 26 (13.7%) for both immunological and clinical failure, and only 1 (0.52%) had only clinical failure at the time of referral. We found a significant association of suboptimal adherence (P < 0.05) and high viral load in this study. Conclusion: This study enables that poor adherence was the most important factor responsible for the first-line treatment failure. As adherence is a dynamic process, interventions in every visit following ART initiation should be optimized, and a multidisciplinary approach toward adherence is needed to get the highest treatment outcome benefit.
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CASE REPORTS Top

Extensive condylomata lata in an adolescent: An uncommon and unusual presentation p. 165
Parul Aggarwal, Kamal Aggarwal, Vijay Kumar Jain
DOI:10.4103/ijstd.IJSTD_63_16  PMID:31922108
Sexually transmitted infections (STIs) in children account for a great physical and psychosocial morbidity. Being rare, they require a high index of suspicion for diagnosis. STIs may also be the first indication of child sexual abuse (CSA). Consequences of an undetected infection are potentially devastating; conversely, a false suspicion can have equally detrimental effects on both the child and the parents. Herein, we report a case of acquired secondary syphilis in a child presenting with unusually extensive condylomata lata at multiple sites and review the literatue to understand the possible interrelationship of syphilis and CSA.
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In situ squamous cell carcinoma of male and female external genitalia p. 168
Ketan Kallappa Kolekar, Swagata Arvind Tambe, Chitra Shivanand Nayak
DOI:10.4103/ijstd.IJSTD_108_17  PMID:31922109
In situ squamous cell carcinoma (SCC) of male and female genitalia can present as Bowen's disease (BD), erythroplasia of Queyrat, Bowenoid papulosis, Paget's disease, pseudoepitheliomatous keratotic, and micaceous balanitis. BD is SCC in situ. It affects both skin and mucous membranes and has the potential to progress to invasive SCC. BD can be found on any body site, including both sun-exposed and non-sun-exposed regions of the body. However, BD presenting on the genitalia is rare. Here, we present a report of three cases of in situ genital malignancies. Two females had BD, and one male had erythroplasia of Queyrat.
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Stomatognathic manifestations of human immunodeficiency virus-infected patients: A case report and review p. 172
Rakashree Chakraborty, Sourav Sen
DOI:10.4103/ijstd.IJSTD_100_18  PMID:31922110
Oral lesions in the stomatognathic system in human immunodeficiency virus (HIV)-infected patients are associated with a series of opportunistic disease that are caused due to immune suppressive state. Oral manifestations are the earliest sign of HIV infection. Here, we are reporting a case of a patient suffering from HIV infection with typical oral manifestations and the effect of treatment for the manifestations after a week. The patient was under highly active anti-retroviral treatment since 2011.
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Verrucous lesions over external genitalia as a presenting feature of pemphigus vegetans p. 176
Ankush A Ajbani, Kajal S Mehta, Yogesh S Marfatia
DOI:10.4103/ijstd.IJSTD_80_19  PMID:31922111
Pemhigus vegetans is a rare variant of pemphigus vulgaris which primarily occurs in the flexures of the body. We report a case of pemphigus vegetans in an 85-year-old female presenting with hypertrophic verrucous lesions over external genitalia and perianal region. There was no history of preceding oral lesions. The diagnosis of pemphigus vegetans was considered on the clinical ground and confirmed by histopathological examination.
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LETTERS TO EDITOR Top

Two sporadic cases of Penicillium marneffei infection associated with human immunodeficiency virus infection from West Bengal: A word of caution p. 180
Priyanka Sarkar, Abhijit Saha, Suruchi Shukla
DOI:10.4103/ijstd.IJSTD_131_15  PMID:31922112
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Antibiotic resistance in Neisseria gonorrhoeae isolated from a tertiary care center in North India p. 182
Jyotsna Agarwal, Shruti Radera, Swastika Suvirya, Manish Awasthi
DOI:10.4103/ijstd.IJSTD_48_16  PMID:31922113
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Pre- and post-sexual exposure prophylaxis of HIV: An update p. 184
Gulnaz Fatima Siddiqui, Shahid Akhtar Siddiqui, Prabha Verma, Rahul Jaiswal, Aishvarya Adhaulia
DOI:10.4103/ijstd.IJSTD_75_17  PMID:31922114
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RESIDENTíS PAGE Top

Serological tests for syphilis p. 186
Dhiral Shah, Yogesh S Marfatia
DOI:10.4103/ijstd.IJSTD_86_19  PMID:31922115
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PHOTO QUIZ Top

IJSTD quiz based on articles in volume 40 issue 2 p. 192
Jatin Chauhan, Abhishek Parekh, Yogesh S Marfatia
DOI:10.4103/ijstd.IJSTD_87_19  PMID:31922116
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