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
January-June 2019
Volume 40 | Issue 1
Page Nos. 1-85

Online since Friday, May 10, 2019

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HIV – Is a cure possible? Highly accessed article p. 1
Murugan Sankaranantham
DOI:10.4103/ijstd.IJSTD_112_15  PMID:31143852
HIV is a chronic well manageable disease. Highly active antiretroviral therapy improves the quality of life of people living with HIV, but the treatment has to be continued lifelong, as the total cure has not been established. Cost of treatment, drug toxicities, interaction with other drugs and persistence of inflammation and acceleration of the aging process, all put together, warrant an urgent need for a total cure. Even though one case had been proved to be cured, still a practical cure is far beyond the reach. Numerous approaches and strategies had been put forth to achieve a cure; still they are to be proved with human studies. This article reviews the major approaches, recent advances in the venture of HIV cure, and the safety concerns involved.
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Genital lichen sclerosus et atrophicus in females: An update Highly accessed article p. 6
Yogesh Marfatia, Ashma Surani, Reema Baxi
DOI:10.4103/ijstd.IJSTD_23_19  PMID:31143853
Lichen sclerosus et atrophicus is an acquired chronic inflammatory dermatosis commonly affecting the vulvar and perianal regions. It is associated with an increased risk of vulvar cancer even though it is not a premalignant condition itself. The true precursor of cancer associated with lichen sclerosus (LS) is vulvar intraepithelial neoplasia (VIN), differentiated type. The diagnosis is usually clinical, but in some cases, a biopsy can be performed, especially to exclude VIN or cancer. All females with anogenital LS can be offered clobetasol propionate 0.05% ointment on a regimen for 3 months (once a day for a month, followed by alternative days for a month, and then, twice weekly for a month), combined with a soap substitute and a barrier preparation.
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Dermatoscopy of nonvenereal genital dermatoses: A brief review p. 13
Divya Kamat, Keshavamurthy Vinay
DOI:10.4103/ijstd.IJSTD_20_19  PMID:31143854
The scope of dermatoscopy has now vastly expanded and shows promising use for characterization of both pigmentary and inflammatory dermatoses affecting the skin, nail, and mucosae. Due to concerns of contamination and spread of infection, dermatoscopy has not been widely studied for genital mucosal dermatoses. In this article, we review the dermatoscopic features of nonvenereal dermatosis affecting the genitalia. Although biopsy is required for a definitive diagnosis, dermatoscopy is useful to identify atypical and suspicious pigmentary lesions. For the inflammatory dermatoses and other benign dermatoses, presence of few characteristic findings can aid in the diagnosis.
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A study on hypogonadism in male HIV patients in northeastern part of India p. 20
Nungsangla Pongener, Ranabir Salam, Robinson Ningshen, Vizovonuo Visi, Tamphasana Wairokpam, L Shaini Devi
DOI:10.4103/ijstd.IJSTD_67_17  PMID:31143855
Context: After the introduction of highly active antiretroviral therapy (ART), the prevalence of hypogonadism among human immunodeficiency virus (HIV)-infected males is decreasing. Aims: The aim of this study was (i) to estimate the prevalence of hypogonadism among HIV-infected males and (ii) to determine the risk factors for hypogonadism. Settings and Design: This was a cross-sectional study undertaken at ART center of a medical Institute. Subjects and Methods: The study recruited HIV-infected males aged 18–65 years receiving ART. Patients with any debilitating chronic illness, diabetes mellitus, chronic smokers or alcoholic, currently on opioids, or methadone were excluded from the study. Androgen Deficiency in Aging Male (ADAM) questionnaire was used to screen patients for the possible presence of hypogonadism. For those screened positive on ADAM questionnaire underwent biochemical evaluation for serum total testosterone, luteinizing hormone (LH), and CD4 count. Statistical Analysis Used: The Chi-square test was used to compare different parameters. Pearson's correlation coefficient was used to assess any relationship between CD4 count, LH, and testosterone. P < 0.05 was considered statistically significant. Results: In the study, 426 were initially screened and 120 patients who had probable hypogonadism were further evaluated. The mean age of the patients was 41.61 years. The mean body mass index (BMI) of the patients was 22.47 kg/m2. The mean duration of ART was 6.13 years and the mean CD4 count was 442.63 cells/mm3. Hypogonadism was seen in 20 (23.3%) and majority (85.7%) had secondary hypogonadism. There was significant association between hypogonadism and CD4 count, but no association was found with BMI and duration of ART. Conclusions: Hypogonadism is seen in 23.3% of HIV-infected males. Majority (85.7%) had secondary hypogonadism. There was significant association of hypogonadism with lower CD4 count.
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Incidence of tuberculosis in human immunodeficiency virus-infected children in India: Is there a role of isoniazid preventive therapy? p. 25
Naman S Shetty, Ira Shah
DOI:10.4103/ijstd.IJSTD_59_18  PMID:31143856
Aim: The aim of this study is to determine the role of isoniazid preventive therapy (IPT) in human immunodeficiency virus (HIV)-infected children in India. Materials and Methods: Factors associated with the development of tuberculosis (TB) in 81 HIV-infected children were analyzed. Results: The mean age of presentation was 6.36 ± 3.67 years. According to the CDC classification, 4.9% of patients were in Class N, 11.1% were in Class A, 56.8% were in Class B, and 27.2% were in Class C at presentation. TB at presentation was more common in children in CDC Class B and C (P = 0.026). Gender, CD4 count, TB contact, prior TB, and ART status did not have any effect on the development of TB. Children up to 3 years of age developed TB after 6.23 ± 14.07 months after presentation, those between 3 and 6 years developed TB after 14.6 ± 23.27 months, those between 6 and 9 years developed TB after 6.54 ± 21.23 months, those between 9 and 12 years developed TB 40.2 ± 35.98 months after presentation (P = 0.042). Eight patients (16.7%) had multidrug-resistant (MDR) TB and 1 patient (2.08%) had extensively drug-resistant TB. Conclusion: Younger children are more likely to develop TB within a year of presentation whereas those who were near the adolescent age group were more likely to develop TB after 3 years of diagnosis of HIV. Thus, role of IPT in adolescents for 3 years at the time of diagnosis may not be useful as they tend to develop TB later on whereas IPT may be useful in the younger age group. With high incidence of MDR-TB, role of IPT in HIV-infected children in India needs to be re-assessed.
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Felt needs and expectations of adolescents regarding sexual and reproductive health from schools and health systems: A descriptive study p. 30
Sreenidhi Sreekumar, Jayalakshmy Ramakrishnan, D Harisankar, Kamaruddeen Mannethodi
DOI:10.4103/ijstd.IJSTD_20_17  PMID:31143857
Background: Much focus has been given to find ways to overcome the barriers that exist among adolescents in the utilization of sexual and reproductive health (SRH) services. This study attempts to explore the felt needs of adolescents regarding SRH education at schools and their expectations regarding SRH care from a health system. Methodology: A cross-sectional study was conducted among 400 1st-year arts and science college students in Puducherry, India. Data collection and analysis were done from January 2015 to February 2015. Data were captured using a self-administered pretested questionnaire. Results: Seventy percent participants felt that it is necessary to have educational contents on SRH at schools and 33.5% felt that the current SRH education is inadequate. About 28.9% felt uncomfortable to discuss their doubts on SRH with teachers. Almost 90% preferred schools as the source of SRH education in the community. Nearly 42% of adolescents thought that they would consult a doctor in the instance of a sexual illness. Thirty-nine percent preferred specialized SRH clinics. More than half expected privacy and confidentiality and the presence of a same sex doctor as the most important feature of an SRH-care facility. The least preferred SRH-care facility was government clinics (18%), and the major reasons for not preferring government facilities were lack of quality (43%) and overcrowding (43%). Conclusion: It is important to conceive schools as the foundation for providing SRH education among the adolescents supported by a friendly and responsive health system.
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Human immunodeficiency virus/acquired immunodeficiency syndrome knowledge level and implications for health promotion program on high school students at Banjarbaru city p. 35
Fauzie Rahman, Lenie Marlinae, Ayu Riana Sari, Mira Surya Ramadhani, Andini Octaviana Putri
DOI:10.4103/ijstd.IJSTD_28_15  PMID:31143858
Introduction: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) cases were found in South Kalimantan; until June 2012, based on residence, the cases include 164 people of Banjarmasin, 54 people of Banjarbaru, and 141 people of Tanah Bumbu. Although the number of cases in Banjarbaru is not as high as in the city of Banjarmasin, there remains a concern that the case did not increase and may even be pressed. Aims: This study aimed to describe adolescents' knowledge about HIV-AIDS and the implications on the health promotion program among the senior high school students in Banjarbaru in an effort to prevent HIV-AIDS. Materials and Methods: This research used quantitative design with descriptive statistic test. The respondents were senior high school adolescents in Banjarbaru. Respondents were selected by purposive sampling technique with the inclusion criteria, such as willing to be a respondent, a native person of Banjarbaru, grade XI–XII, can cooperate and communicate well, and physically and mentally healthy. Results: The result of this research showed as many as 308 respondents (96%) had a high level knowledge. Statistical test showed there were no correlation between level of knowledge about HIV /AIDS with attitudes toward people living with HIV/AIDS (PLWHA (p=0,813). Conclusions: Optimal support be required as the efforts to reduce HIV/AIDS cases from various network.
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Clinical, immunological, and virological outcomes in HIV patients on raltegravir-based salvage therapy p. 42
Rajesh Deshwal, Sumit Arora
DOI:10.4103/ijstd.IJSTD_23_18  PMID:31143859
Objectives: The objective of the study is to assess the clinical, immunological, and virological outcomes in treatment-experienced HIV patients on raltegravir (RAL)-based salvage therapy. Methods: This was a retrospective, observational study of patients with suspected second-line antiretroviral therapy failure who were followed up for at least 6 months, from January 2013 to January 2017, after switching to salvage regimen. A total of 20 patients who fulfilled the inclusion criteria and who had RAL-based salvage therapy were assessed for clinical, immunological and virological response. The data were picked up from the electronic database of the center and analyzed. Results: Age, sex, date of initial diagnosis, date, and type of first line and second line regimens were documented, CD4 count, and plasma viral load at the time of initiation and after 3 and 6 months were recorded. Undetectable viral load was documented in all patients at 6 months. No noticeable adverse effects were noted. Conclusion: This study clearly shows that RAL containing regimens have a high degree of effectiveness in treatment-experienced patients and show effective and durable suppression of viral load with low adverse effect rates and reliable long-term safety.
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A study of adherence to antiretroviral therapy in a tertiary care hospital at Allahabad, India p. 46
Arkapal Bandyopadhyay, Rakesh Chandra Chaurasia, Sarika Palepu, Rakesh Kumar Yadav
DOI:10.4103/ijstd.IJSTD_81_17  PMID:31143860
Introduction: India has a large proportion of the global HIV-infected patients. Antiretroviral therapy (ART) is the cornerstone of HIV treatment. Antiretroviral drugs are highly toxic and lead to diverse adverse drug reactions (ADRs). Adherence to medications plays a prominent role in success of the therapy. This prospective study was done to study the adherence and analyze its associated factors. Methodology: The present study was conducted at ART Centre, Swarup Rani Hospital, Allahabad, Uttar Pradesh, India. Selection of the patients was done based on systematic random sampling method. Baseline enrollment was done over 2 months and follow-up was done monthly over 6 months. Information regarding sociodemographic profile, ART regimen, occurrence of ADRs, adherence to ART and factors affecting adherence was collected. Bivariate logistic regression was done to analyze the association of selected variables with adherence. Results: This study enrolled 163 participants among which 152 participants completed the study. During the study period, 94 participants reported the occurrence of at least one ADR. Nonadherence to ART therapy was seen in 31.6% of patients. The most common reason was forgetting to take the medicine (21.8%) followed by occurrence of ADRs (18.3%). No statistically significant association of nonadherence was found with the selected variables. Conclusion: Comprehensive research to assess nonadherence to ART therapy is the need of the hour. Policy formulations ought to be made to assess and promote effective adherence to enhance the longevity and quality of life of people living with HIV/AIDS. Concerted efforts by government and intersectoral collaboration are further needed to sustain promotive measures.
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A prospective study to evaluate efficacy of second-line antiretroviral therapy given to human immunodeficiency virus patients at Antiretroviral Therapy Plus Centre in India p. 51
Jigar P Modi, Amita Kubavat, Shailesh Mundhava, Usha Lalwani
DOI:10.4103/ijstd.IJSTD_53_18  PMID:31143861
Introduction: Despite a very large number of patients being covered under antiretroviral therapy (ART), there are limited data in the Indian population regarding second-line ART. Hence, this study was undertaken to evaluate the efficacy of second-line ART. Materials and Methods: After consultation with the physician of ART Plus Centre, the patient was interviewed, and details of patients' case record were obtained. In our ART Plus Centre, CD4 count has been done at the start and after 6 months of second-line ART which were recorded as effectiveness indicator of second-line ART. Results: Out of seventy patients, 16 (22.86%) had a history of second-line ART from private ART clinics and 54 (77.14%) patients were transferred from other government ART centers. The most common reason to start second-line ART was immunological failure in 27 patients. The mean increase in CD4 count of 106.09 cells/mm3 was observed after 6 months of second-line ART in 63 patients. The mean increase in CD4 count (57.16%) after 6 months was statistically significant (P < 0.05) with tenofovir + lamivudine + atazanavir/ritonavir regimen in forty patients. Conclusions: Irrational practice by private hospitals limits treatment options, with increasing the chances of drug resistance. On the other hand, the National AIDS Control Organization-sponsored second-line ART was found to be effective as 84.12% of patients had improvement in their mean CD4 count.
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Association of abnormal cervical cytology with coinfection of human papillomavirus and Chlamydia trachomatis p. 57
Nisha Madaan, Deepika Pandhi, Vineeta Sharma, Sambit Nath Bhattacharya, Kiran Guleria, Kiran Mishra, Mausumi Bharadwaj
DOI:10.4103/ijstd.IJSTD_9_19  PMID:31143862
Introduction: Chlamydia trachomatis (CT) and human papillomavirus (HPV) are considered to be major sexually transmitted infections (STIs) and likely health hazard among women. In addition, HPV and CT are considered as potential cofactors in the development of cervical intraepithelial neoplasia (CIN). Objectives: The main objective of this study was to investigate the association of HPV and CT infection with the presence of abnormal cervical cytology. Materials and Methods: A cross-sectional study was carried out on 90 women with complaints of vaginal discharge attending STI clinic in a tertiary care hospital in New Delhi. Papanicolaou staining and polymerase chain reaction were done for the detection of HPV and CT. Statistical analyses were performed for comparison. Results: Abnormal cervical cytology was observed in 42.2% of the study participants (41.1% low-grade squamous intraepithelial neoplasia and 1.1% high-grade intraepithelial neoplasia). HPV and CT were positive in 21.1% and 31.5% of participants with abnormal cervical cytology, respectively. Coinfection with HPV and CT was observed in 84.2% of participants with cervical atypia. Further, genital herpes was diagnosed in 18.9% of the studied population and a significant association was observed between genital herpetic ulcers and abnormal cervical cytology (P = 0.016). Conclusion: CT was found to be a significant risk factor for cervical cytological abnormalities in our study. HPV and CT coinfection were also associated with a higher prevalence of cervical atypia. As chlamydial infection is easily treatable, we recommend screening and treatment of all women of the reproductive age group for Chlamydia to decrease the risk of cervical dysplasia. Limitation: This is a single-center STI clinic-based study. Multicenter and community-based studies with a larger cohort will confirm the association.
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Systemic lupus erythematosus in HIV: An insight into clinical implications and management p. 64
Vasudha A Belgaumkar, Ravindranath B Chavan, Prernaa R Suryataley, Aarti S Salunke, Pallavi P Patil, Sandhya M Borade
DOI:10.4103/ijstd.IJSTD_26_18  PMID:31143863
Although HIV infection can mimic the manifestations of various autoimmune disorders, the coexistence of HIV and systemic lupus erythematosus (SLE) has been rarely reported. The exact impact of HIV on SLE and vice versa is unclear. We report an HIV-seropositive female on highly active antiretroviral therapy presenting with features of SLE. Herein, an attempt has been made to discuss the various complex clinical and therapeutic implications along with the influence on disease course and prognosis.
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Eosinophilic gastroenteritis: Atypical cause for chronic diarrhea in human immunodeficiency virus-associated immunosuppression p. 67
Om Shrivastav, Nirzar Samir Parikh, Ajay Bharat Jhaveri, Rajni Ahlawat
DOI:10.4103/ijstd.IJSTD_78_18  PMID:31143864
Eosinophilic gastroenteritis (EGE) is an uncommon disease in both immunocompetent and immunocompromised. We describe a 57-year-old male with human immunodeficiency virus who presented to us with chronic diarrhea. He had no history of allergies and had significant weight loss, normal systemic examination, and a complete blood count showing no eosinophilia. After an esophagogastroduodenoscopy, the diagnosis of EGE was made by histopathological findings. The symptoms started improving with the initiation of treatment with oral prednisolone.
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Psoriasiform lesions of glans and palms: A rare presentation in secondary syphilis p. 70
Tasleem Arif, Mohammad Adil, Syed Suhail Amin, Noora Saeed
DOI:10.4103/ijstd.IJSTD_28_17  PMID:31143865
Erythematous scaly papules on the palms and soles are a common manifestation of secondary syphilis. We report a case of 19-year-old male who presented with erythematous, scaly, psoriasiform lesions over the palms and glans penis. The papules over the palms showed tenderness on blunt vertical pressure. There was a history of sexual contact and ulcer over the glans around 2 months back, which resolved on its own. Venereal Disease Research Laboratory test was positive in 1:32 dilution. Treponema pallidum hemagglutination test was also positive. This case highlights the atypical presentation of secondary syphilis.
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Horizontal transmission of HIV-1 infection in a child: With phylodynamic evidence-case study p. 73
Janak Keshavlal Maniar
DOI:10.4103/ijstd.IJSTD_4_19  PMID:31143866
Mother-to-child transmission is the predominant mode of transmission of HIV infection in children. Occasionally, horizontal transmission has also been reported. We report a child who was diagnosed HIV positive at the age of 3.5 years born to HIV-negative mother. Based on the available histories, no alternative modes of HIV transmission could be implicated. However, the paternal grandmother of the child was found to be HIV infected. To explore the likelihood that this HIV-infected relative was the most likely source from which this child acquired HIV infection postnatally, Bayesian phylodynamic analysis of the HIV of the child and parental grandmother was performed, which showed evidence of linkage of HIV transmission from an HIV-infected paternal grandmother to a child living with her through unknown route. Studies to identify modes of nonvertical HIV transmission may be useful in devising strategies to avert such nonvertical infections.
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Rising trends of herpes simplex virus - 1: A global public health concern p. 77
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
DOI:10.4103/ijstd.IJSTD_121_15  PMID:31143867
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Metabolic syndrome and cardiovascular disease risk assessment among human immunodeficiency virus-infected individuals on antiretroviral therapy p. 79
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/ijstd.IJSTD_58_18  PMID:31143868
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Extensive vulval and perianal ulceration due to genital herpes virus infection p. 80
Santoshdev Pitamber Rathod, Bela Padhiar, Bela Shah
DOI:10.4103/ijstd.IJSTD_71_18  PMID:31143869
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Prevalence and knowledge of HIV/AIDS among the tribal women of Jaintia Hills, Meghalaya (North East India) p. 82
Soma Mondal, Roumi Deb
DOI:10.4103/ijstd.IJSTD_32_18  PMID:31143870
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IJSTD quiz based on articles in volume 40 issue 1 p. 84
Donborlang Byrsat, Yogesh S Marfatia
DOI:10.4103/ijstd.IJSTD_24_19  PMID:31143871
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