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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CASE REPORTS
Cutaneous lymphangiectasia of the vulva secondary to tuberculosis
Ramesh M Bhat, Celia S Saldanha, Srinath M Kambil, S Dandakeri
January-June 2012, 33(1):35-37
DOI:10.4103/0253-7184.93817  PMID:22529452
Cutaneous lymphangiectasia, also called as acquired lymphangioma, is a benign cutaneous disorder involving the dermal and subcutaneous lymphatic channels. It can rarely occur on the vulva. We describe a 35-year-old woman who came with multiple raised lesions over the vulva and left upper thigh of 1 year duration. She gave history of getting treated for multiple swellings that developed over right side of the neck and inguinal regions on both sides three decades ago. On local genital examination, the patient had a large polypoidal growth involving both sides of the vulva, left upper thigh, and over pubic area. Multiple linear scars were present over the upper thighs and groin bilaterally. The patient underwent simple vulvectomy and left thigh growth excision. Histopathological examination of the vulvectomy specimen confirmed our diagnosis.
  50,862 63 1
REVIEW ARTICLES
Prostitution in India and its role in the spread of HIV infection
Devinder Mohan Thappa, Nidhi Singh, Sowmya Kaimal
July-December 2007, 28(2):69-75
DOI:10.4103/0253-7184.39007  
Prostitution describes sexual intercourse in exchange for remuneration. The legal status of prostitution varies in different countries, from punishable by death to complete legality. The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female). Brothels are establishments specifically dedicated to prostitution, often confined to special red-light districts in big cities. The devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure of temple priests and pilgrims, was an established custom in India by 300 AD. An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance, and acceptance of prostitution. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be major vectors of HIV transmission. The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street brothel, and escort prostitution. So long as men want to buy sex, prostitution is assumed to be inevitable.
  48,930 845 3
ORIGINAL ARTICLES
Herpes genitalis - Topical zinc sulfate: An alternative therapeutic and modality
BB Mahajan, Mohit Dhawan, Rajwinder Singh
January-June 2013, 34(1):32-34
DOI:10.4103/0253-7184.112867  PMID:23919052
Background: Herpes genitalis is one of the commonest sexually transmitted infections in the world caused by herpes simplex virus (HSV) 1 and 2. All herpes viruses show latency. Herpes genitalis caused by HSV-1 and HSV-2 is recurrent in 55 and 90% of case respectively. Aims: To comparatively evaluate the therapeutic efficacy of topical zinc sulfate (ZnSO 4 ) in varying concentrations in herpes genitalis. Materials and Methods: Ninety patients clinically diagnosed as herpes genitalis and confirmed by Tzanck test were taken up for study and divided into 3 groups of 30 patients each which were applied topical ZnSO 4 in concentrations of 1%, 2% and 4% respectively for 3 months. Ten patients of herpes genitalis were kept as control in whom only distilled water was applied. Patients were followed up for a total period of 6 months for any recurrences. Results: Ten patients of group 1 (1% ZnSO 4 ) showed recurrence, 6 patients in group 2 (2% ZnSO 4 ) and only one patient in group 3 (4% ZnSO 4 ) showed recurrence. In the control group, 8 out of 10 patients showed recurrence. No serious side effects were seen in all 3 groups. Conclusion: Topical ZnSO 4 has been found to be an effective therapeutic modality not only for treatment but also for prolonging remissions in herpes genitalis. Topical 4% ZnSO 4 has been found to be most efficacious out of the three concentrations, without any side effects.
  27,748 240 -
CASE REPORTS
Lipschutz ulcer
Ramesh M Bhat, Shireen Furtado
July-December 2007, 28(2):106-107
DOI:10.4103/0253-7184.39017  
LipschŁtz first identified an acute disease with ulceration of the external genital organs of young women. The syndrome has been termed acute vulvar ulcer or ulcus vulvae acutum. The following typical case history of a 19-year-old girl is a good illustration of this interesting clinical entity.
  16,397 376 -
RESIDENTíS PAGE
Laboratory diagnosis of HIV
Archana Sharma, YS Marfatia
January-June 2008, 29(1):42-45
  15,101 1,025 -
Clue cells
Kaleem J Khan, Rajul Shah, Manjyot Gautam, Sharmila Patil
July-December 2007, 28(2):108-109
DOI:10.4103/0253-7184.39018  
  15,549 474 -
REVIEW ARTICLES
Homosexuality in India
Devinder Mohan Thappa, Nidhi Singh, Sowmya Kaimal
July-December 2008, 29(2):59-62
DOI:10.4103/0253-7184.48725  
Homosexuality can be described as the orientation and inclination of a person to have sexual relations with a person of his or her own sex. The clustering of Acquired immune deficiency syndrome (AIDS) cases among male homosexuals in the initial phase of the HIV epidemic in the USA and a few other Western countries led to a misleading notion that the disease afflicted only "reckless" male homosexuals and it was often referred to as the 'gay plague' or 'gay cancer', 'gay' being the current vogue word for homosexuals. Very little is known about the practice of homosexuality in contemporary India. According to Ashok Row-Kavi, a self-acclaimed homosexual activist, the number of exclusively or predominantly homosexual men in India may be over 50 million. A vast majority of them are married and living with their wives. A culturally identifiable group known by the Urdu term "hijra" lives in most parts of India and are known to depend, at least partly, for their livelihood on working as male prostitutes. Most hijras are castrated males and dress as females. In addition to a large section of the hijra community, there are many full-time or part-time male prostitutes in India. Some of them live in red-light areas of metropolitan cities; many seek male clients by offering massage services in parks, beaches, hotels, and houses. Male prostitution is increasingly visible in India. In Delhi there are as many as twenty "agencies" offering "handsome masseurs" in the classifieds of the newspapers (Hindustan Times).
  15,245 591 -
REVIEW ARTICLE
Vesicobullous disorders of female genitalia
Taru Garg, Saurabh Mittal
January-June 2012, 33(1):1-8
DOI:10.4103/0253-7184.93786  PMID:22529446
Blistering over the vulval region can be due to multiple causes, each having nearly a similar presentation. Thus, a thorough understanding of the various etiologies is necessary to make a correct diagnosis. Clinically, there always remains some ambiguity as to the precise diagnosis, thus investigations, such as biopsy, play a very essential role in clinching the correct diagnosis. Most of these disorders are amenable to treatment and thus an early intervention is a must to prevent morbidity associated with these diseases.
  14,753 394 -
CASE REPORTS
Rare sweat gland tumors of vulva: Report of two cases
Rashmi Mahajan, Damodar Bang, Amit Nagar, Freny Bilimoria
July-December 2012, 33(2):124-127
DOI:10.4103/0253-7184.102128  
Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination of genitalia in these disorders.
  14,929 66 -
PHOTO QUIZ
What is your diagnosis?
Khozema Saify, PK Saraswat, Dinesh Mishra, Pulak Jeswani
January-June 2010, 31(1):63-64
DOI:10.4103/0253-7184.69010  PMID:21808443
  14,796 116 -
REVIEW ARTICLES
Post-exposure prophylaxis for HIV
Archana Sharma, YS Marfatia, Ragini Ghiya
July-December 2007, 28(2):61-68
DOI:10.4103/0253-7184.39006  
Post-exposure prophylaxis (PEP) is a medical response given to prevent the transmission of pathogens after potential exposure. The PEP for HIV refers to a set of comprehensive services to prevent HIV infection in exposed individuals where the exposure can be occupational or non-occupational (nPEP) and the provision of short-term (28 days) antiretroviral drugs depending on risk assessment with follow-up. High concentration of free infectious virus and virus-infected cells have been reported in blood, genital fluids and cerebrospinal fluid. The average risk of HIV infection after percutaneous exposure to HIV-infected blood is 0.3%. The nPEP can be offered for cases like unprotected sexual exposure, sexual assault survivors, injecting drug users (IDUs) sharing equipment, etc. While considering PEP, evaluation of exposure, exposure source and exposed person is to be done and 2 or 3 drug PEP (depending upon the type of exposure) can be started within 72 h and need to be continued for 28 days. Drugs preferred are zidovudine + lamivudine. If needed, a boosted protease inhibitor can be added.
  14,095 797 -
An update on Trichomonas vaginalis
Seema Sood, Arti Kapil
January-June 2008, 29(1):7-14
Trichomonas vaginalis is a parasitic protozoan that is the cause of trichomoniasis, a sexually transmitted disease (STD) of worldwide importance. Recent data have shown that the annual incidence of trichomoniasis is more than 170 million cases worldwide. In fact, the World Health Organization (WHO) has estimated that this infection accounts for almost half of all curable sexually transmitted infections. The actual burden of the disease remains unknown in India. As per the published literature, the prevalence of T. vaginalis ranges from 0.4-27.4% in women and 0.0-5.6% in men. Although T. vaginalis is the most common cause of nonviral STD, the exact mechanism of its pathogenesis has not been clearly elucidated. Standard teaching is that trichomoniasis is an important cause of vaginitis in women. The prevalence and spectrum of disease in males are less well characterized; the infection appears to usually be asymptomatic, but it has been suggested as an increasingly important cause of nongonococcal urethritis. The laboratory plays a key role in the diagnosis of this infection. The time-honored approach has been microscopic evaluation by wet mount method. The broth culture method is the 'gold standard' for diagnosis of trichomoniasis and detects twice as many infections as the wet mount method. The drug of choice is metronidazole or tinidazole. For long it has been considered a 'minor' STD. Recent literature documents that women infected during pregnancy are predisposed to premature rupture of membranes, premature labor, and low-birth-weight infants. Further, it may amplify HIV transmission. Therefore, the identification of this common treatable sexually transmitted infections offers a precious and much needed additional strategy for AIDS prevention.
  13,607 944 -
CASE REPORTS
Amoebic ulcer of the male genitala: A rare case report
Indrani Mohanty, Prasenjeet Mohanty, Satyadarshi Patnaik, Pritilata Panda
July-December 2010, 31(2):116-117
DOI:10.4103/0253-7184.75009  PMID:21716788
Amoebic ulcer of the penis is a very rare clinical entity. We report a case of amoebic ulcer of the glans penis in a 47-year-old male homosexual, symptomatic with severe pain and foul-smelling hemopurulent discharge of acute onset. He had received systemic antibiotics like ciprofloxacin and azithromycin prior to presentation with no improvement. Diagnosis was confirmed by wet mount microscopic examination of the discharge. The patient responded well to a course of metronidazole.
  12,149 63 2
RESIDENTíS PAGE
Specific investigations in a case of sexually transmitted disease
Kaleem Khan, Manjyot Gautam, Sharmila Patil
January-June 2007, 28(1):43-47
DOI:10.4103/0253-7184.35714  
  11,244 828 -
REVIEW ARTICLE
Adolescent HIV/AIDS: Issues and challenges
Smriti Naswa, YS Marfatia
January-June 2010, 31(1):1-10
DOI:10.4103/0253-7184.68993  PMID:21808429
Adolescence (10- 19 years) is a phase of physical growth and development accompanied by sexual maturation, often leading to intimate relationships. Adolescent HIV/AIDS is a separate epidemic and needs to be handled and managed separately from adult HIV. The adolescents can be subdivided into student, slum and street youth; street adolescents being most vulnerable to HIV/AIDS. Among various risk factors and situations for adolescents contracting HIV virus are adolescent sex workers, child trafficking, child labor, migrant population, childhood sexual abuse, coercive sex with an older person and biologic (immature reproductive tract) as well as psychological vulnerability. The most common mode of transmission is heterosexual, yet increasing number of perinatally infected children are entering adolescence. This is due to "bimodal progression" (rapid and slow progressors) among the vertically infected children. Clinically, the HIV infected adolescents present as physically stunted individuals, with delayed puberty and adrenarche. Mental illness and substance abuse are important co-morbidities. The disclosure and declaration of HIV status to self and family is challenging and guilt in sexually infected adolescents and tendency to blame parents if vertically affected need special consideration and proper counseling. Serodiscordance of the twins and difference in disease progression of seroconcordant twins are added causes of emotional trauma. Treatment related issues revolve around the when and what of initiation of ART; the choice of antiretrovirals and their dosages; issues related to long term ADRs; sense of disinhibition following ART commencement; adherence and resistance.
  11,057 416 2
CASE REPORTS
Squamous cell carcinoma of penis with bullous pemphigoid masquerading as lymphogranuloma venereum
V Venugopal, Pushpa Gnanaraj, SD Fernandes, Murali Narasimhan, Subashini Karthikeyan, Shwetha Rahul
January-June 2013, 34(1):41-43
DOI:10.4103/0253-7184.112938  PMID:23919055
We report a case of a 60-year old unmarried male who presented with multiple ulcers and foul smelling discharge from the groin since 4 months and multiple tense bullae over the trunk of 1 month duration. Groove sign was present. Investigations for lymphogranuloma venereum (LGV) and other sexually transmitted diseases were negative. Histopathology from the ulcer in the groin and growth in the penis revealed squamous cell carcinoma (SCC). Skin biopsy of bulla was diagnostic of bullous pemphigoid (BP). We report a rare case of SCC masquerading as LGV with BP occurring as a paraneoplastic phenomenon.
  11,318 53 -
RESIDENTíS PAGE
Formulating a researchable question: A critical step for facilitating good clinical research
Sadaf Aslam, Patricia Emmanuel
January-June 2010, 31(1):47-50
DOI:10.4103/0253-7184.69003  PMID:21808439
Developing a researchable question is one of the challenging tasks a researcher encounters when initiating a project. Both, unanswered issues in current clinical practice or when experiences dictate alternative therapies may provoke an investigator to formulate a clinical research question. This article will assist researchers by providing step-by-step guidance on the formulation of a research question. This paper also describes PICO (population, intervention, control, and outcomes) criteria in framing a research question. Finally, we also assess the characteristics of a research question in the context of initiating a research project.
  11,112 153 3
REVIEW ARTICLE
Overview of HIV/AIDS in India
YS Marfatia, Archana Sharma, Megha Modi
January-June 2007, 28(1):1-5
DOI:10.4103/0253-7184.35702  
Globally there are 40 million people living with human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS). According to latest estimates based on National Family Health Survey (NFHS), released by National AIDS Control Organization (NACO), the National adult HIV prevalence in India is approximately 0.36% which corresponds to an estimated 2 to 3.1 million people living with HIV in the country. The new lower estimates are due to difference in surveillance method and do not mean a sharp decline in the epidemic. HIV prevalence has begun to decline in Tamil Nadu and other southern states with high HIV burden. There has been feminization of epidemic with an estimated 38.4% of infected adults being female. Eighty-six percent of the Indian population is unaware of their HIV status with only 57% population being aware of the preventive methods. There are more than 4000 integrated counseling and testing centers (ICTCs) in the country. About 80,000 patients are accessing free antiretroviral treatment (ART) in 127 centers. PPTCT program has been scaled up in the county with Nevirapine as the regimen of choice. It has an efficacy rate of 48% in prevention of HIV transmission in the mother baby pair; there are chances of increased drug-resistance to ART in mothers who were treated with prophylactic single-dose Nevirapine. These patients face a lot of stigma and discrimination. A 2006 study found that 25% of people living with HIV in India had been refused medical treatment on the basis of their HIV-positive status.
  9,933 943 -
ORIGINAL ARTICLES
A clinical study of vulval lichen sclerosus at a tertiary care hospital in South India
Nidhi Singh, Devinder Mohan Thappa, Telanseri J Jaisankar, Syed Habeebullah
July-December 2007, 28(2):87-90
DOI:10.4103/0253-7184.39011  
Lichen sclerosus (LS) is a chronic inflammatory dermatosis that causes substantial discomfort and morbidity, most commonly in adult women. The objective of our study is to study the pattern of vulval LS and to correlate LS with various clinical parameters. The study included 26 female patients with vulval LS presenting over a period of 22 months, starting from September 2005 to June 2007. Demographic characteristics and clinical findings were recorded. The mean age of LS patients was 44 years (range 3-65 years). Lichen sclerosus was most commonly observed in postmenopausal women (18, 69.2%), followed by women in reproductive age group (5, 19.23%), and prepubertal girls (3, 11.5%). All patients presented with ivory white atrophic plaque. Surface of the plaque showed telangiectasia in one patient; both erosions and fissuring in two patients, ≠erosions in four patients, fissuring in two patients, and wrinkling in all patients. Introitus was stenosed in five (19.2%) patients, out of which three (11.5%) patients also had perianal involvement leading to "figure of 8" appearance. Three patients had atrophy of labia minora and clitoris to an extent that labia minora appeared merged with labia majora and clitoris was buried. This study highlights the importance of diagnosing LS as it is associated with considerable morbidity.
  10,494 257 -
Sexual behaviour in adolescents and young people attending a sexually transmitted disease clinic, Ile Ife, Nigeria
Olayinka Abimbola Olasode
July-December 2007, 28(2):83-86
DOI:10.4103/0253-7184.39010  
WHO estimates that 20% of persons living with HIV/AIDS are in their 20s and one out of twenty adolescents contract a sexually transmitted disease (STD) each year. A total of 303 adolescents and youths (10-24 years of age) attending an STD clinic were subjected to a questionnaire to assess sexual behavioural patterns that predisposed them to STD. Scope of the questions included age at initiation of sexual intercourse, partner at first exposure, number of sexual partners, use of condoms, exposure to commercial sex workers (CSWs), previous infection with STDs and role of alcohol. Their diagnosis was based on history, clinical findings and laboratory confirmation. Adolescents and youths accounted for 30% of the total number of patients attending the STD clinic during this period. The male to female ratio was 1:0.95. Ninety-six percent (290) were single while 4% (13) were married. Seventy-two percent (217) were students. Age at onset of sexual activity was 10-20 years in 80%, 85% practiced risky sexual behaviour, patronising casual partners was frequent especially after alcohol use, 10% had been exposed to CSWs, condom use was poor, number of sexual partners varied between 1 and 5 and previous infections were not professionally treated. Adolescents and young people are sexually active and practice risky sexual behavioural patterns. Adolescents and youths account for a high percentage of patients patronising the STD clinic. Sexual education and youth friendly reproductive health services are urgently needed to curb the spread of HIV/AIDS/STDs.
  10,252 349 1
CASE REPORTS
Chronic genital herpes
Kishan Kumar Agarwal, Devinder Mohan Thappa
July-December 2007, 28(2):97-99
DOI:10.4103/0253-7184.39014  
A 30-year-old, previously healthy, nulliparous married woman presented with painful genital ulceration of 1 month duration. She was admitted with a diagnosis of chronic genital herpes with oral thrush and pulmonary tuberculosis. ELISA test for antibodies against HIV was positive for both the partners. She was treated in isolation ward with four-drug regimen of antituberculous therapy (ATT), oral cloxacillin oral fluconazole and acyclovir 400 mg three times daily. The genital lesions completely resolved after treatment with acyclovir.
  10,205 294 -
Oral squamous papilloma and condyloma acuminatum as manifestations of buccal-genital infection by human papillomavirus
Helena Lucia B dos Reis, Priscila C Rabelo, Maria Rubia F de Santana, Dennis Carvalho Ferreira, Antonio C Filho
January-June 2009, 30(1):40-42
DOI:10.4103/0253-7184.55484  PMID:21938114
Genital infection by human papillomavirus (HPV), a sexually transmitted disease (STD), has increased considerably due to the changes in sexual behaviour and an increase in the practice of oral sex. HPV, in a parallel manner, has been closely studied due to its oncogenic potential. We present the case of a 27-year-old patient, with a multi-partner sexual history and frequent practice of oral sex, who suffered from warts lesions on the genitalia and tongue. Squamous papilloma was diagnosed from a tongue biopsy. The treatment of the oral lesion was by way of surgery, without relapse in the first two years. Our discussion in this report is regarding the HPV infection in the oral cavity.
  8,959 353 2
ORIGINAL ARTICLES
Quality of life in HIV/AIDS patients: A cross-sectional study in south India
B Nirmal, KR Divya, VS Dorairaj, K Venkateswaran
January-June 2008, 29(1):15-17
With developing countries on the wave of a HIV epidemic, issues like quality of life (QOL) have come to fore. We aimed to assess the quality of life in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients at antiretroviral therapy (ART) clinic in a tertiary healthcare centre in South India. The study was conducted on 60 HIV/AIDS patients attending ART clinic at a tertiary health hospital, Chennai, South India. QOL was evaluated using the WHO QOL-BREF (Field trial version) instrument using 26 items grouped under 4 domains, namely physical health, psychological well-being, social relationships, and environment on 60 HIV/AIDS patients. Standard error of the difference between means was employed to find out significant difference between domain scores and clinical categories. QOL scores were highest for environmental domain which is 46.19 (0-100 scale). QOL scores were significantly lower among persons with lower CD4 counts ( P < 0.001). Women had lower QOL scores than men despite having less advanced disease. Patients with better educational background had significantly higher psychological domain scores. Also, a supportive family kept environmental domain scores better ( P < 0.001). A need for good healthcare support system was perceived. Better education helps the patient to cope with the disease well. Family support is essential for healthier environment.
  8,665 611 -
PHOTO QUIZ
Warty lesion over external genitalia
Roshni Vora, YS Marfatia
July-December 2007, 28(2):116-117
DOI:10.4103/0253-7184.39024  
  8,308 262 -
CASE REPORTS
Genital elephantiasis as a complication of chromoblastomycosis: A diagnosis overlooked
Nidhi Sharma, YS Marfatia
January-June 2009, 30(1):43-45
DOI:10.4103/0253-7184.55486  PMID:21938115
Over the decades, causes of genital elephantiasis have changed only to become elusive to etiological diagnosis. This is a case of 20 year old male who presented with genital elephantiasis occurring due to lymphatic obstruction caused by chromoblastomycosis and super added erysipelas. The diagnosis of chromoblastomycosis was clenched by biopsy. We describe this case for the rarity of its occurrence.
  8,334 213 3
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