Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
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   Table of Contents - Current issue
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January-June 2020
Volume 41 | Issue 1
Page Nos. 1-138

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REVIEW ARTICLES  

Anogenital lichen sclerosus p. 1
Manjyot Manish Gautam, Vasundhara Singh, Nitin J Nadkarni, Sharmila P Patil
DOI:10.4103/ijstd.IJSTD_49_17  
Lichen sclerosus (LS) was first described by Hallopeau in 1887. It is a chronic inflammatory condition most commonly involving the anogenital region with a relapsing course and a potential for destruction, functional impairment, atrophy, and malignant changes. LS affects both sexes with a female preponderance of 5:1. The exact prevalence of the disease is difficult to predict as the lesions are asymptomatic in the initial phase and later when the complications arise patients might visit the surgeon, pediatrician, gynecologist, or urologist. The etiology of LS has a complex interplay of genetic factors, autoimmunity, infections, and trauma. Physical examination to assess the extent of the disease and decide the line of management is the most crucial step in the management. Corticosteroids, calcineurin inhibitor, retinoids, phototherapy, and surgery can be helpful. Self-examination and long-term follow-up are necessary.
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Genital scabies: Haven of an unwelcome guest p. 10
Hima Gopinath, Kaliaperumal Karthikeyan
DOI:10.4103/ijstd.IJSTD_69_17  
The itch mite Sarcoptes scabiei var. hominis has been a menace to humanity for ages. Diagnosing scabies can be a challenge in view of the varied presentations of the disease. The male genitalia are an important area of predilection of the mite. Examination of this often overlooked area is essential as it may reveal both characteristic and atypical manifestations of scabies. Genital involvement also attains special relevance in view of the possible sexual transmission of the mite. In addition to the morbidity caused by itching, patients may have to deal with myths, stigma, and embarrassment.
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ORIGINAL ARTICLES Top

Profile of HIV and multidrug-resistant tuberculosis in orphans living in orphanages in Mumbai, Maharashtra, India p. 17
Ira Shah, Khushnuma Mullanfiroze
DOI:10.4103/ijstd.IJSTD_108_13  
Aims: The aim was to study the clinical profile of HIV-infected orphans living in orphanages in Mumbai, Maharashtra, India and determine the prevalence of multidrug-resistant (MDR) tuberculosis (TB) in them. Materials and Methods: Seventy-four HIV-infected orphans from two orphanages (orphanage A taking antiretroviral therapy [ART] as per our prescription, whereas orphanage B taking ART from an ART center) were included in the study. Detailed history and examination was carried out in each patient. CDC class prior to ART, age at presentation, CD4 count/percent, opportunistic infections (OIs) prior to and after ART, co-infections with hepatitis B virus (HBV) and hepatitis C virus, growth, ART regimes, and treatment failure were noted in each patient. Results: Of 18 HIV-infected children in orphanage A, boys constituted 11 (61.1%) and girls were 7 (38.9%), whereas orphanage B had all girls (n = 56). TB was the most common OI in orphanage A prior to the start of ART seen in 15 (83.3%), whereas it was seen in 18 (32.1%) in orphanage B. In contrast, TB was seen in eight (14.2%) orphans in orphanage B after the start of ART, of which two (3.5%) were MDR-TB and another two (3.5%) were suspected to have MDR-TB, whereas one (5.5%) in orphanage A had MDR-TB. Age of presentation was 4.7 ± 3.2 years for orphanage A and 12.9 ± 2.5 years for orphanage B. On ART, malnutrition was seen in one child in orphanage A as compared to nine in orphanage B. ART was started at 6.1 ± 3.1 years in orphanage A and 10.1 ± 2.8 years in orphanage B. Zidovudine, lamivudine (3TC), and nevirapine (NVP)/efavirenz (EFV) constituted the baseline ART regimen in 13 (72.1%) orphans in orphanage A, whereas stavudine (d4T) + 3TC + NVP constituted the baseline ART in 17 (30.3%) orphans in orphanage B. Three (5.3%) orphans had HBV co-infection in orphanage B. Conclusion: Children in orphanage A came to us at a younger age, in more advanced stage of disease, and were more malnourished. Orphanage A was started on ART earlier in life. The prevalence of TB was higher in orphanage A prior to ART. MDR-TB was seen in both orphanages, with prevalence ranging from 3.5% to 5.5%.
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Prevalence and trends of hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus 1, 2 and syphilis infections among blood donors in a regional transfusion center in Punjab, India: A 3 years study Highly accessed article p. 22
Sonam Kumari
DOI:10.4103/0253-7184.196887  
Background: Accurate estimates of the risk of transfusion-transmitted infectious diseases are essential for monitoring the safety of blood supply and evaluating the potential effects of new screening tests. Objective: The aim was to determine changes over time in blood donor population infection rates of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV-1, 2) and syphilis. Materials and Methods: Changes in rates of HBV, HCV, HIV-1, 2, and syphilis infections were evaluated by comparing yearly prevalence rates for blood donors over 3 years, that is, between January 1, 2012 and December 31, 2014. Serological tests were done according to the standard operating procedures and manufacturer's instructions and included the following: tests for hepatitis B surface antigen; antibodies to HCV and HIV-1, 2 and rapid plasma reagin test for syphilis. Results: Nearly 2.54 of the total screened blood donors were reactive for one of the four transfusion transmitted infections (TTIs) with higher prevalence in replacement (3%) than voluntary donors (2.3%) and in male (2.54%) than female (2.3%) donors. TTI tend to be more (54.7%) in younger population of 18–30 years. HCV infection is the most common of all TTI (50%). Conclusion: The rising prevalence rates of HIV; HBV; HCV and syphilis among different groups suggests that blood transfusion is still very unsafe in this community and emphasis should be laid on donor education and donor self-exclusion, implementation of strict donor screening criteria, pre-donation counseling, and more sensitive screening methods. Furthermore, donors with a history of sexually transmitted infections should be totally excluded from all donations.
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Childhood sexual abuse perceptions and experience among college students of Panchkula p. 30
Amandeep Chopra, Amarpreet Kaur, Satpreet Singh, Rupandeep Kaur, Achyutha Valli Rallapali
DOI:10.4103/ijstd.IJSTD_110_15  
Background and Objective: Child sexual abuse (CSA) is a global public health and human rights concern. Hence, the present study was conducted to assess childhood sexual abuse perception and experience among college students of Panchkula. Methodology: A self-administered anonymous questionnaire which assessed perception and experiences of childhood sexual abuse was given to a convenient sample of 1000 college students. Using descriptive statistics and Chi-square test, perception and the experience of childhood sexual abuse were calculated. Results: The study showed that 18% (boys = 20%, girls = 16%) of the students were exposed to CSA, with boys more often affected than girls. The student's perception about abuse was not very clear. Myths and cultural beliefs justified abuse. Conclusion: Although preliminary in nature, the present findings are among the first to demonstrate the nature of CSA among students of Panchkula. Further, the study revealed that CSA manifests both as contact and noncontact forms. More boys than girls are exposed to most forms of abuse.
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Attitudes, beliefs, and norms about sex and sexuality among young Indian male adults: A qualitative study p. 35
Tirajeh Zohourian, Nader Hakim, Patricia Moise Dorcius, Reshma Shaheen, Indira Rama Rao, Rona Carter, Karl Krupp, Purnima Madhivanan
DOI:10.4103/ijstd.IJSTD_133_15  
Objective: Little is known about the risky sexual behaviors, attitudes, beliefs, and sources of information regarding sexual health among young adult Indian males. Currently, students in Indian secondary schools do not receive a structured comprehensive sexual health education. This qualitative study explored the sources of information, knowledge, and attitudes around sexual behaviors among young men in Mysore, India. Materials and Methods: Between May and June 2011, 23 semi-structured qualitative in-depth interviews with males aged 18–25 years were conducted to explore their views on sexual norms, attitudes, and their sources of information to gain knowledge about sexual health. Interviews were audio recorded and transcribed verbatim. Thematic analyses were conducted. Results: Participants shared a desire for quality sex education in schools but described their current sexual health curriculum as inadequate. Since social taboos dictated the space in which students gained awareness on sexual topics, the participants resorted to the outside information from both reliable and unreliable sources. Conclusions: These findings have important implications for laying the groundwork for culturally specific sexual health education interventions to meet the needs of a growing youth population in India.
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What are the most common sexually transmitted bacteria in women with cervico-vaginitis nowadays? p. 39
Elie Nkwabong
DOI:10.4103/ijstd.IJSTD_143_15  
Introduction: Cervico-vaginitis is usually the initial infection which, when undiagnosed, can evolve to salpingitis with tubal infertility, ectopic pregnancy, and chronic pelvic pain as consequences. This study aimed at identifying the sociodemographic profile and clinical presentation of women diagnosed with cervico-vaginitis, as well as the microorganisms isolated. Materials and Methods: This cross-sectional, descriptive study was carried out between October 1, 2013, and March 31, 2014. Women diagnosed with cervico-vaginitis were recruited. The main variables recorded were maternal age, occupation, marital status, number of sexual partners, clinical presentation, and microorganisms identified. Data were analyzed using SPSS 20.0. Results: The mean maternal age was 25.5 ± 5.6 years. Students were more represented (41.1%), 66% were single, and 69.6% had ≥2 sexual partners. The most frequent symptom was abnormal vaginal discharge (100%). The most frequent microorganisms isolated were genital tract mycoplasmas (67.9%) and Chlamydia trachomatis (55.3%). Discussion: Acute cervico-vaginitis is common among young, single women with multiple sexual partners. Genital tract mycoplasmas were the commonest germs isolated followed by Chlamydia trachomatis. Conclusion: Cervico-vaginitis is very common in our setting. Screening for genital tract mycoplasmas should be the first to be requested to women with cervico-vaginitis.
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Seroprevalence of syphilis by VDRL test and biological false positive reactions in different patient populations: Is it alarming? Our experience from a tertiary care center in India Highly accessed article p. 43
Vrushali Vishwas Patwardhan, Sonali Bhattar, Preena Bhalla, Deepti Rawat
DOI:10.4103/0253-7184.194317  
Introduction: Many centers for sexually transmitted infections in India perform only a single screening assay for diagnosis of syphilis which may yield biological false positive (BFP) reactions. Aims and Objective: The aim of this study was to determine the true picture of seroprevalence of syphilis and BFP reactions in different patient groups. Materials and Methods: A total of 57,308 serial serum samples obtained over a period of 5 years from different patient groups were screened by venereal disease research laboratory (VDRL) test both qualitatively and quantitatively. VDRL reactive sera were confirmed by Treponema pallidum hemagglutination (TPHA) test. Results: The overall seroprevalence of syphilis by VDRL test was 1.27%, and BFP rate in test population was 0.14%. The rate of BFP reactions among total tested male (0.44%) and female (0.1%) patients differs significantly. Out of 733 VDRL reactive samples, 81 were BFP, i.e., BFP reaction is occurring at a frequency of 11% of the total VDRL reactive samples (ratio of 8:1 for true positives/BFP). Similarly, among antenatal cases, almost 24% of the total VDRL reactive samples were BFP, or for every 116 true positives, there were 37 (almost one-third) BFP. Conclusion: Although the overall seroprevalence of syphilis is low; the frequency of occurrence of BFP reactions is quite alarming. Hence, treponemal test must be used for confirmation of VDRL reactive sera.
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Study of mucocutaneous manifestations of HIV and its relation to total lymphocyte count Highly accessed article p. 47
PK Ashwini, Jayadev Betkerur, Veeranna Shastry
DOI:10.4103/2589-0557.229947  
Introduction: HIV is associated with various mucocutaneous manifestations which may be the first pointers toward HIV and can also be prognostic markers for disease progression. This study was done to note the different mucocutaneous lesions present in HIV and their relation to total lymphocyte count (TLC). Methodology: Three hundred and seventy-nine HIV patients attending the Department of Dermatology, Venereology, and Leprosy were included in the study. They were screened for the presence of any mucocutaneous lesions. TLC in patients presenting with mucocutaneous lesions was done and also CD4 count was done wherever possible. Results: Among 379 patients, 53.8% developed mucocutaneous manifestations. Male: female ratio was 2.2:1. Majority of patients belonged to 20–39 years age group. Among mucocutaneous manifestations, oral candidiasis was the most common, followed by herpes zoster and dermatophytoses. Adverse drug reactions were noted in few. The majority of patients had TLC <1500/mm3 and CD4 <200. Conclusion: Mucocutaneous manifestations are common and have varied presentation in HIV/AIDS. Patients with mucocutaneous manifestations were clustered at lower TLC and CD4 count. Like CD4 count, TLC can be considered as a marker for disease progression.
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Pre- and post-HIV test knowledge, attitude, behavior, and practice of people living with HIV and AIDS by questionnaire pattern p. 53
Narmadha Selvaraj, R Amudha, S Vasuki
DOI:10.4103/ijstd.IJSTD_78_16  
Context: In spite of intensive information, education, and communication (IEC) activities, the incidence of new HIV cases is also increasing. Its incidence for the past 3 years was 375, 385, and 457 at our tertiary care center. Aims: The impact of IEC activities on the society was assessed in this study. Settings and Design: This was a retrospective, epidemiological study conducted by a questionnaire pattern. Subjects and Methods: The questionnaire pattern was issued to 100 newly diagnosed PLWHA, which evaluated the knowledge, attitude, behavior, and practice pre- and posttesting. Every month, follow-up was done for 3 months for further assessment. Statistical Analysis Used: One-way ANOVA test was used for the statistical analysis. Results: Out of the 100 patients, 37 were male, 60 were female, and 3 were transgender. Academic education had a significant association, while occupation had no association with the awareness. Nearly 80% of the new cases were identified by the government institutions. Around 33% of the study group were first identified on sexually transmitted infection screening and 20% by skin problems. Nearly 79% of the married couples revealed their status to their spouse. Out of 79% of single individuals willing to get married, 50% were willing to reveal their status to their future partner. Almost 94% of the participants were willing to undergo antiretroviral treatment. Acceptance by family and society was reflected by 87% and 68%, respectively. Conclusions: Although this study reveals the success of IEC activities, the subtle population who are still undergoing high-risk behavior after knowing their status should be targeted for achieving zero new case identification. This study gives hope to reach that day in the near future.
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Rapid Assessment of low utilisation of sexually transmitted infection services amongst high risk groups in designated sexually transmitted infection clinics of Bhopal” – A Qualitative Study p. 58
Devendra Gour, Manju Toppo, Dinesh K Pal, Angelin Priya, Daneshwar Singh, Nisha Singh
DOI:10.4103/ijstd.IJSTD_109_16  
Introduction: High-risk groups (HRGs) have limited access to appropriate information and sexual and reproductive health services. They are a highly marginalized subgroup and their social stigma is a barrier for the use of health care and treatment. Objectives: (1) To assess the knowledge regarding sexually transmitted infection (STI) infections among HRGs. (2) To identify the reasons and barriers associated with low utilization of services among HRGs. Materials and Methods: Qualitative study conducted in three HRGs of Bhopal for 3 months. Six focus group discussions were done among three HRGs namely intravenous drug users (IDUs), commercial sex workers (CSWs), and men having sex with men (MSM). Issues related to STIs were asked to all the respondents and detailed responses were recorded by the voice recorders and noted down. The audio recordings were translated and transcribed into English. Transcribed data content were analyzed manually in various themes. Results: Knowledge regarding STI/reproductive tract infection: The knowledge of HRGs regarding STDs was assessed. Almost all the CSWs of the group were having considerable knowledge regarding signs and symptoms about STI. MSM were having good knowledge about STIs. Most of the IDUs had a very limited and scarce knowledge about STI. Most of the CSWs shared their problems regarding STI with family members followed by doctor. Almost all the MSMs approached the counselor first before approaching a doctor and preferred to consult a doctor in a government hospital. Majority of IDUs said that they prefer to go to government hospital for getting treated for such conditions while a few prefer for private hospitals. Conclusion: Majority of HRGs are seeking health care from government health facilities while the MSMs and transgender faced discrimination at these facilities and nongovernmental organizations (NGOs) played a major role in promoting better health-seeking behavior among them. The HRGs freely discussed their problems with the NGOs.
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A study on satisfaction level among patients attending sexually transmitted infections clinic Highly accessed article p. 63
Bela B Padhiar, Umesh K Karia
DOI:10.4103/2589-0557.229946  
Introduction: Patient satisfaction has become a favourite debate for enhancing quality of OPD services, however it still needs a lot of improvement for the better delivery of health care services. Aim: The aim was to study the satisfaction level among STI (Sexually transmitted infection) patients regarding quality of care and services provided in STI clinic. Materials and methods: The present study was a cross sectional study conducted on 88 patients with ages ranging from 16-65 years attending STI clinic at the department of Dermatology, Venereology and Leprology of a tertiary care hospital in Gujarat, India from December 2016 to april 2017. An effort was made to bring into focus significant areas to target for improvement. Satisfaction was assessed using 13 questions modified from patient satisfaction questionnaire by Wirral Community NHS Trust.Patients were asked to give rating to these questions. Likert's 5 point rating scale was used. Results: It was noticed that total satisfaction in present study was 82.9%. Most of the questions of patient satisfaction were statistically highly significant (p <0.0001). Conclusion: Overall patient satisfaction with services provided at our STI Clinic was high (93.2%) except length of waiting time (<30 minutes), waiting area & other amenities of the hospital.
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Sociodemographic profile of patients attending the integrated counseling and testing center at a government super-specialty hospital in Central India p. 68
Prabha Desikan, Aseem Rangnekar, Karuna Tiwari, Nikita Panwalkar, Manoj Pateriya, Virendra Singh Rajput
DOI:10.4103/ijstd.IJSTD_52_17  
Context: The HIV epidemic continues to be a matter of concern worldwide. Integrated counseling and testing center (ICTC) is an opening wedge for HIV diagnosis and support services, especially to the high-risk groups. Counseling and testing is a cost-effective and simple way of reducing HIV transmission. Aims: The aim of the study was to analyze the sociodemographic profiles of the ICTC attendees to evaluate the changing trends of HIV seropositivities over a period of 7 years. Settings and Design: This was a retrospective study done in the ICTC housed in a tertiary care hospital at Bhopal. Materials and Methods: All attendees in the period of 7 years were included. Statistical analysis used: percentages and proportions were calculated. Results: There were 24,853 ICTC attendees from January 2009 to January 2016, of which 183 (6.41%) attendees were tested seropositive. There were 15,555 (62.5%) males and 9298 (37.5%) female attendees. Among 15,555 males, 151 (0.97%) were seropositive, and of 9298 females, 32 (0.34%) were seropositive. Of 151 seropositive males, 62 (41%) were in the age group of 19–30 years and 48 (31.7%) were in the age group of 31–40 years. Among the seropositive females, 9 (28.1%) were in the age group of 19–30 years and 10 (31.2%) were in the age group of 31–40 years. We observed a rise in total number of ICTC attendees from January 2009 to January 2016. The number of attendees increased to 4655 in 2013, of which 27 (0.58%) were seropositive, and by 2015, there were 4982 attendees with only 6 (0.12%) seropositives. Conclusion: Such rising trends of attendees and a steady decline in the seropositivity rates are encouraging signs, reflecting the contribution of the ICTC in creating awareness, and reducing the transmission of HIV among the population served.
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Effectiveness of structured teaching programme on transmission and prevention of human immunodeficiency virus/acquired immune deficiency syndrome among adolescent girls in Lowry Memorial High School, Bengaluru Highly accessed article p. 73
Nanbur Stephen, Nanle Joseph Gusen, Patience Ringkat Kumzhi, Bonji Gaknung, Dauda Abimiku Auta, Lydia B Bulndi, Champion Mbursa, Vasantha P Kumari, Nannim Nanvyat
DOI:10.4103/ijstd.IJSTD_102_17  
Background: Adolescence is a critical stage in human development. Most young people become sexually active during adolescence and are more likely to have multipartner and unprotected sex with high-risk behavior that predisposes them to sexually transmitted infections such as human immunodeficiency virus (HIV). Objectives: The objective of the study was to evaluate the effectiveness of a structured teaching programme on transmission and prevention of HIV/acquired immune deficiency syndrome (HIV/AIDS) among adolescent girls. Methods: An evaluative research approach was adopted, in which a preexperimental, one group pre- and post-test research design was used to evaluate the effectiveness of the structured teaching programme on transmission and prevention of HIV/AIDS among adolescent girls studying at Lowry Memorial High School, Bengaluru. A self-administered structured questionnaire was used for data collection. Data were presented in frequency tables and statistical graphs (bar charts) and analyzed using descriptive statistics (mean, standard deviation) and inferential statistical methods (Chi-square and paired “t”-tests) using SPSS version 21. Results: The findings of the study revealed that the mean percentage difference in the pre- and post-test knowledge scores was statistically significant at 5% level (P < 0.05). The overall mean post-test knowledge score of adolescent girls on transmission and prevention of HIV/AIDS was 88.83%. It is apparently higher compared to the pretest knowledge score, which was 67.67% with enhancement of 21.16%. This implies that the structured teaching programme was effective in gaining knowledge of adolescent girls regarding transmission and prevention of HIV/AIDS. Conclusion: Our study suggests that structured teaching programme enhanced the knowledge of the adolescent girls on transmission and prevention of HIV/AIDS. We, therefore, recommend that structured teaching programmes on transmission and prevention of HIV/AIDS should be encouraged among adolescents and youths to reduce the spread of HIV infection.
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Effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in Human Immunodeficiency Virus -(HIV) positive pregnant women p. 83
Osime Odaburhine Evarista, Tijani Paul Ezimokhai, Blessing Airiagbonbu
DOI:10.4103/ijstd.IJSTD_107_17  
Background: In many developing countries with a significant proportion of human immunodeficiency virus (HIV)-positive patients are women of child-bearing age and would require antiretroviral therapy. This study aimed at evaluating the effect of highly active antiretroviral therapy (HAART) on some specific clotting profile in HIV-positive pregnant women. Subjects and Methods: This study comprised 150 patients consisting of 50 blood samples from pregnant women on HAART as test subjects, 50 pregnant HIV-positive women that were not on HAART as test subjects, and 50 pregnant HIV-negative women which served as controls. The test subjects were attending the prevention of mother-to-child transmission Clinic at the Central Hospital, Benin City. Specific clotting factors assayed were factors 11, V, V11, V111, 1X, X, X1, and X11. All were done using ELISA methods. Results: Factors 11 and V were reduced significantly in HIV-infected pregnant women on HAART and those not on HAART (P < 0.05) when compared with HIV-negative pregnant women. A significant increase in factors V11, V111, 1X, X, and X11 were observed in HIV-positive patients on HAART and those not on HAART when compared with HIV-negative pregnant women (P < 0.05). However, when HIV-positive patients on HAART were compared to HIV-positive women not on HAART, no statistical difference were observed (P > 0.005). Conclusion: There are changes in clotting profile of HIV-positive women on HAART and on those not on HAART and these changes are not due to the administration of antiretroviral therapy.
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Is there any perceptiveness about the mode of transmission of human immunodeficiency virus/acquired immune deficiency syndrome? An analysis among the adolescent tribal students in Tamil Nadu Highly accessed article p. 88
J John Britto, J Yuvaraj
DOI:10.4103/2589-0557.229942  
Background: Cognizance about human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) among the community is still lacking. Seldom studies done in tribal area and to indentify the awareness about HIV/AIDS among the adolescent tribal students in Jawadhu hills of Tamil Nadu, with the objectives includes on social, demographical, and knowledge about HIV/AIDS were taken. For primary data, survey method and secondary data from various literatures gathered. Materials and Methods: Schedule tribe adolescent students, between the age groups of 13–21 years, from 8th to 12th standard, exclusively from Vellore and Tiruvannamalai educational districts, were taken, by applying STRATA method. Results: A total of 938 students from various tribal schools participated. Amongst them, 507 (54%) were males and 431 (46%) were females. Half of the respondents (50%) agreed that blood transfusion, intravenous drug use, and sharing infected needles are the major modes of transmission. Nearly 35% agreed that HIV/AIDS is transmitted by hugging, tattooing, dirty hands, breastfeeding, kissing on cheeks, shaving at the barber shop, shaking hands with AIDS patients, homosexuality and are food and waterborne. Conclusions: Formal HIV/AIDS education should be mandatory in their curriculum, where teachers get an opportunity to deliver the scientific information about HIV/AIDS. To acquire better knowledge about HIV/AIDS, sex education should be included in the mainstream of curriculum with the assistance of educational consultants, professional social workers, and also local non-governmental organizations to conduct further mindfulness camps about the HIV/AIDS.
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Profile of intestinal parasitic infections in human immunodeficiency virus/acquired immunodeficiency syndrome patients in Northeast India p. 93
Mohammed Ashraf Ali S Namaji, Sifa Harun Pathan, Anil Madhukar Balki
DOI:10.4103/ijstd.IJSTD_115_17  
Introduction: Diarrhea is one of the major complications occurring in over 90% of human immunodeficiency virus (HIV)-infected individuals in developing countries. Coccidian group of parasitic infections remain the standout opportunistic pathogens in many parts of the world. Aim: The objective was to understand the profile of diarrheagenic parasites in HIV/AIDS patients along with analysis of the changing trends in the profile of parasitic diarrhea with special context to coccidian parasitic infections. Methodology: A cross-sectional study was performed at “ID CENTRE FOR NORTHEAST,” Shillong, from January 2014 to October 2017. Stool samples collected were observed microscopically for parasites both on direct and concentrated stool samples under ×10 and ×40 magnification. Modified acid-fast staining was used for the detection of coccidian parasites. All statistical analyses were performed using IBM SPSS software, Version 24.0. Results: The prevalence of intestinal parasitic infections was 40.99%, coccidian parasitic infection accounted for 85.13% of total intestinal parasitic infections. Cryptosporidium parvum was the most common cause of diarrhea (70.64%), followed by Cystoisospora belli (23.81%) and Cyclospora spp. (5.55%). Trend analysis of coccidian etiology during the study revealed a significant rise in the positivity of Cryptosporidium spp. and a decrease in the Cystoisosporiasis belli infection. The common noncoccidian parasites identified include hookworm (8.1%) followed by Ascaris lumbricoides (4.7%). Conclusion: The magnitude of parasitic infections is considerably high among the HIV/AIDS patients in Northeast India, and it is essential for screening and periodic monitoring of all the HIV patients for coccidian parasites by stool microscopy.
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Sexual behavior pattern in the young attending sexually transmitted infection clinic in a tertiary health-care center Highly accessed article p. 97
Chitralekha Keisham, Zamzachin Guite, Heisnam Kulabidhu
DOI:10.4103/2589-0557.229943  
Introduction: Half of all new HIV infections occur in young people(15-24years). Unfortunately, the study on the sexual behaviour pattern in these age group is lacking. Materials and methods: It is retrospective, cross sectional study assessing adolescent and youth between 10 to 24 years presenting to STD clinic in a tertiary health care centre as a part of their risk assessment. Results: Adolescent and youth were a total of 17.13%(165) amongst 963 STD clinic attendees. The male to female ratio was 84:81. The mean age for male±1SD was 21.17±2.26 years and for female±1SD was 20.54±2.37 years. Around 47.27% (78) were students at various levels of education. Earliest onset of sexual activity was at 14 years. Risky sexual behaviour was reported in 75.75% clients. Onset of sexual activity was earlier in females with 24.6% having sex before the age of 18 years as compared to 15.4% in males. Condom use was poor. Around 63% had heard of HIV or AIDS. Conclusion: The young being a vulnerable age group, education on safe sex, condom use and other protective measures should be strengthened.
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CASE REPORTS Top

Pityriasis rubra pilaris type 6: A case report in an AIDS patient p. 100
Abhilasha Williams, Anisha George, Emy Abi Thomas, Jency Maria Koshy
DOI:10.4103/ijstd.IJSTD_120_15  
A 24-year-old woman, known to be human immunodeficiency virus positive for 6 years, presented with an itchy rash on the body. She had dull erythematous to hyperpigmented scaly plaques over the body, with extensor predominance. Inflammatory papules and nodules were noted on the face. Follicular hyperkeratotic papules were seen on the shins, giving a “nutmeg grater” feel. All her nails were dystrophic. Histopathology was consistent with the clinical diagnosis of pityriasis rubra pilaris. CD4 counts had dropped to 192 cells/μl, so she was started on antiretroviral therapy along with acitretin to which she responded well within 2 months.
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Disseminated Kaposi's sarcoma as a presenting sign of HIV in an Indian male: A case report with dermoscopic findings p. 102
Nagendran Prabhakaran, Divya Gupta, Laxmisha Chandrashekhar, Devinder Mohan Thappa, Nachiappa Ganesh Rajesh
DOI:10.4103/ijstd.IJSTD_53_16  
Kaposi's sarcoma (KS) is one of the AIDS-defining illnesses, which tends to occur at low CD4 count. It is the most common malignancy associated with HIV disease. Yet, there is a paucity of Indian case reports of KS in the English literature. We report the case of a 45-year-old HIV-positive heterosexual male with an unusual presentation of KS in the form of unilateral lymphedema mimicking cellulitis. We also describe the dermoscopic findings of the same.
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Epidermodysplasia verruciformis with plane warts over lower abdomen and genitals p. 105
Rochit Rajesh Singhal, Niral Ketan Sheth, Pragya Ashok Nair
DOI:10.4103/ijstd.IJSTD_110_16  
Epidermodysplasia verruciformis (EDV) may clinically vary from pityriasis versicolor-like macules to wart-like flat papules, psoriasiform red papules, or pigmented keratotic lesions resembling seborrheic keratosis. Sun-exposed areas are commonly affected with genital areas rarely involved. It is associated with more than 30 human papillomaviruses (HPVs). In 90% cases of squamous cell carcinomas, HPV5 and HPV8 is isolated. A case of EDV with plane warts involving the genital area in a 35-year-old male is reported here.
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Human immunodeficiency virus encephalitis p. 108
Nitin Sinha, Sahil Sareen, Ashwini Kumar Malhotra, Sanchit Singh
DOI:10.4103/ijstd.IJSTD_112_16  
Here, we present a case of pyrexia with altered sensorium in a young healthy male individual. On evaluation, he was detected to have human immunodeficiency virus infection with low CD4. He had no opportunistic infection or any other acquired immunodeficiency syndrome-defining illnesses although his magnetic resonance imaging brain showed features of encephalitis. He recovered tremendously within 3 months of antiretroviral therapy.
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Refractory cutaneous Crohn's disease of the external genitalia in a female p. 110
Pallavi Goyal, Shivi Nijhawan, Manisha Nijhawan, Savita Agrawal
DOI:10.4103/ijstd.IJSTD_32_17  
Cutaneous lesions as a part of Crohn's disease (CD) may occur as a totally separate entity without the involvement of the gastrointestinal tract, in which case it is termed as metastatic CD. A 23-year-old female presented with complaints of vulvar swelling and multiple, oval-linear, typical knife cutting deep ulcers on the perineal folds. Biopsy showed epithelioid cell granuloma in the dermis. Differential diagnosis included cutaneous tuberculosis, sarcoidosis, deep fungal infection, and CD of the vulva. A diagnosis of CD was made by the exclusion. The patient was earlier treated with oral steroids, antibiotics, antituberculosis treatment, and azathioprine but showed only mild improvement. Therefore, the condition was regarded as a refractory one. The patient showed significant improvement after six cycles of adalimumab.
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Treatment non-responsiveness in depression following Efavirenz administration p. 113
Subhash Das, Priyanka Bhatia
DOI:10.4103/ijstd.IJSTD_38_17  
Depression is found as a comorbid condition in patients with human immunodeficiency virus (HIV) infection. Antiretroviral drugs used for the treatment of such infection may result in emergent depression. One such antiretroviral drug is efavirenz (EFV). Induction or exacerbation of depression with EFV has been reported in studies, which resolved after stopping EFV. We report a case of a 23-year-old male patient suffering from HIV for 5 years with treatment nonresponsive depressive symptoms due to EFV which improved after stopping it.
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Hypertrophic lichen planus of the vulva – A missed diagnosis p. 116
Rashmi Mahajan, Varun Jain, Kishan Ninama, Yogesh S Marfatia
DOI:10.4103/ijstd.IJSTD_51_19  
Lichen planus (LP) is an inflammatory dermatosis which can affect the skin, nails, and all mucous membranes, including the genitalia. Lichen planus on vulvar keratinized skin can manifest with diverse clinical features, probably due to higher temperature, PH, humidity, and bacterial flora which may modify typical cutaneous features. While lichen planus (LP) may affect the vulva in isolation, it may also be part of generalized outbreak in up to 20% cases. Herein, a case of a 53 year-old female who presented with a severely pruritic plaque over labia majora Since 6 -7 months, with no response to potent topical corticosteroids is reported. Provisional diagnosis of lichen simplex chronicus was considered however, histopathology was suggestive of hypertrophic lichen planus.
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Cytomegalovirus retinitis associated with high CD4 counts and DHEA abuse p. 119
Gan Yuen Keat, Syed Shoeb Ahmad, Suresh Subramaniam, Shuaibah Abdul Ghani, Amir Samsudin
DOI:10.4103/ijstd.IJSTD_90_15  
The most frequent ocular manifestation of acquired immunodeficiency syndrome (AIDS) is cytomegalovirus retinitis (CMVR). This infection is reportedly inversely proportional to the CD4 counts. Usually CMVR develops once the CD4 counts fall below 50/mm3. Our case report documents an AIDS patient who developed CMVR despite CD4 counts being persistently >200/mm3. The patient was self-administering dehydroepiandrosterone, high dose Vitamin C, testosterone and hydrocortisone. This case report describes a unique case of pharmacologically induced elevated CD4 counts, which however, did not prevent the development of CMVR in the patient.
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Metabolic acidosis and encephalopathy in an HIV-exposed infant on breastfeeding and maternal antiretroviral therapy p. 122
Ira Shah, Jagdish Kathwate
DOI:10.4103/ijstd.IJSTD_83_16  
Zidovudine (AZT) treatment during pregnancy, delivery, and the postnatal period is associated with adverse effects in the neonate such as bone marrow suppression, elevation in aspartate aminotransferase activity, and lactic acidosis. With antiretroviral therapy (ART) now being recommended for life in HIV-infected pregnant women, infants born to these mothers and on breastfeeds are going to be exposed to antiretrovirals for a longer duration. We report a rare case of an HIV-exposed infant who received AZT prophylaxis for 6 weeks after birth and was on exclusive breastfeed while the mother was on ART and presented with unexplained severe metabolic acidosis and encephalopathy.
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LETTERS TO EDITOR Top

Recent onset pruritic papular eruptions in apparently healthy Indian adults: A clue to suspect AIDS p. 125
Chandra Sekhar Sirka, Swetalina Pradhan, Baijayantimala Mishra
DOI:10.4103/ijstd.IJSTD_38_16  
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Penile strangulation: A case report of a potentially serious emergency condition in a young male p. 127
Rajesh Kumar Mandal, Sudip Kumar Ghosh, Sharmila Sarkar
DOI:10.4103/ijstd.IJSTD_87_16  
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CD4+ count after arabinoxylan supplementation: An observation p. 129
Kamon Chaiyasit, Viroj Wiwanitkit
DOI:10.4103/ijstd.IJSTD_93_16  
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The impact of education, family income, and occupation on CD4 count among HIV infected adults p. 130
Shesh Prakash Maurya, Ravinder Singh, Neema Negi, Madhu Vajpayee, Arti Kapil, Bimal Kumar Das
DOI:10.4103/ijstd.IJSTD_11_17  
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Donovanosis in a human immunodeficiency virus-positive female p. 131
Tasleem Arif, Mohammad Adil
DOI:10.4103/ijstd.IJSTD_18_17  
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Combating HIV-related stigma: An experience from Eastern India p. 133
Sandeep Lahiry, Ayan Mukherjee, Anindya Mukherjee, Shouvik Choudhury, Rajasree Sinha
DOI:10.4103/ijstd.IJSTD_29_17  
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To study the incidence of anemia in HIV-infected children on zidovudine-based highly active antiretroviral therapy regimen p. 135
Manisha Maurya, Shruthi Badrinath, Dharmendra K Singh, Ruchi Rai
DOI:10.4103/ijstd.IJSTD_79_17  
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PHOTOFEATURE Top

Crusted scabies with scalp involvement in an institutionalized elderly p. 137
Hsiu-Hui Chiu, Cheng-Che E Lan
DOI:10.4103/ijstd.IJSTD_101_17  
Scabies is a common disease and typically described as a skin condition with sparing of face and scalp in adults. However, crusted scabies is not conventional scabies. It can also affect the scalp. Herein, we report an unusual case of crusted scabies with scalp infestation and suggest that for cases with suspicious lesions on scalp, immunocompromised patients or relapse cases, crusted scabies, special age groups, such as infant, young children, and the elderly, topical treatment of the scalp should be included.
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