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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  Citation statistics : Table of Contents
   2014| July-December  | Volume 35 | Issue 2  
    Online since October 9, 2014

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Congenital syphilis: The continuing scourge
Prachi G Agrawal, Rajesh Joshi, Vidya D Kharkar, MV Bhaskar
July-December 2014, 35(2):143-145
DOI:10.4103/0253-7184.142411  PMID:26396451
Congenital syphilis is a severe, disabling infection that occurs due to the transmission of Treponema pallidum across the placenta during pregnancy or from contact with an infectious genital lesion during delivery. However, its early diagnosis is often difficult because more than half of the affected infants are asymptomatic, and the signs in symptomatic infants may be subtle and nonspecific. Although its incidence is declining, this long-forgotten disease continues to affect pregnant women, resulting in considerable perinatal morbidity and mortality. We hereby report a case of a 2-month-old infant with early congenital syphilis presenting with joint swellings and Parrot's pseudoparalysis, a comparative rarity in the present scenario. The report also stresses upon the importance of implementing the Centres for Disease Control and Prevention recommendation that all the pregnant women should be screened for syphilis in the first antenatal visit in the first trimester and again in late pregnancy.
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Abstracts from the current global literature: Chlamydia and Infertility in Men
Ankit H Bharti, YS Marfatia
July-December 2014, 35(2):158-160
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Abstracts from the current global literature: Psoriasis and human immunodeficiency virus
Ipsa Pandya, Sheethal K Jose, YS Marfatia
July-December 2014, 35(2):161-163
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Principles of perinatal and pediatric HIV/AIDS
Yogesh S Marfatia
July-December 2014, 35(2):173-173
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Genital donovanosis with malignant transformation: An interesting case report
K Navya Sri, A Swetha Chowdary, B. S. N. Reddy
July-December 2014, 35(2):135-137
DOI:10.4103/0253-7184.142409  PMID:26396449
Donovanosis is a chronic indolent sexually transmitted granulomatous ulceration of genito-inguinal region, caused by Calymmatobacterium granulomatis. It became uncommon due to indiscriminate use of broad spectrum antibiotics. In recent years, much interest is being focused on this condition because genital ulcers facilitate HIV infection. We report an interesting episode of genital donovanosis complicated with squamous cell carcinoma in a middle aged female for its rarity and clinical interest.
  - 1,660 71
Human immunodeficiency virus in a tribal family: Issues and challenges
Dimpal Patel, Ankit Bharti, Ipsa Pandya, Eknath Naik, Yogesh S Marfatia
July-December 2014, 35(2):138-142
DOI:10.4103/0253-7184.142410  PMID:26396450
A 35-year-old married tribal female presented with well-defined crusted ulcers with purulent exudates on the right side of the face involving both lips and right forearm since last 6 months. On investigation, she turned out to be human immunodeficiency virus (HIV) positive with CD4 count of 7 cell/mm 3 and also having probable abdominal tuberculosis (TB) as suggested by ultrasonography abdomen. Her husband and son were also found to be HIV positive. Her skin lesions were suggestive of cutaneous TB. She was started on antituberculosis treatment (ATT), antiretroviral treatment (ART), and injectable antibiotics. As her skin lesions failed to respond after 1 month, herpes simplex virus infection was suspected as a cause of ulceration, and she was given oral acyclovir therapy to which she responded well and later she was discharged. She stopped both ART and ATT and came with recurrence of skin lesions after 1½ month. Her husband left her for another woman. The purpose of reporting this case is to discuss the issues related to HIV infection affecting all the members of a tribal family.
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Annular lichenoid syphilis: A rare entity
Ananta Khurana, Archana Singal, Seema Gupta
July-December 2014, 35(2):146-148
DOI:10.4103/0253-7184.142412  PMID:26396452
Syphilis is a disease known for centuries, but still continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders. Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era. We present the case of a 32-year-old woman presenting with localized annular lichenoid lesions on the neck.
  - 1,445 75
Sweet's syndrome in human immune deficiency virus-infected patient
Adarsh Rajendran, George Sarin Zacharia, Sue Ann Zacharia, KC George
July-December 2014, 35(2):149-151
DOI:10.4103/0253-7184.142413  PMID:26396453
Sweet's syndrome is an uncommon dermatosis and can be associated with a wide variety of illnesses including infections and malignancies. Sweet's syndrome as a dermatological manifestation in human immunedeficiency virus (HIV) infection is rarely reported. Furthermore, called acute febrile neutrophilic dermatosis is characterized by fever and skin lesions, which are often erythematous papules and pseudovesicles. Diagnosis is based on clinical features and histology. The gold standard for treatment is systemic steroids although many other medications have been tried with variable success. We here report a case of Sweet's syndrome in an HIV-infected patient.
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Pyoderma gangrenosum masquerading as Donovanosis
Varadraj V Pai, Naveen Narayanshetty Kikkeri, SB Athanikar, Anil Myageri, Vijetha Rai
July-December 2014, 35(2):152-154
DOI:10.4103/0253-7184.142414  PMID:26396454
Pyoderma gangrenosum (PG) is a rare inflammatory disorder of unknown etiology characterized by neutrophilic infiltration of the dermis and destruction of tissue. PG is diagnosed after excluding more commonly occurring condition presenting with similar manifestation. Though PG has been reported to occur over the genitalia, it rarely presents with concurrent involvement of the groin. Herein, we present a case of PG masquerading as Donovanosis.
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Whither venereology training in India?
N Asokan
July-December 2014, 35(2):164-165
DOI:10.4103/0253-7184.142420  PMID:26396456
  - 1,076 46
Control of HIV: Role of female sex workers in risk of HIV transmission
S Ganesh Kumar
July-December 2014, 35(2):165-166
DOI:10.4103/0253-7184.142421  PMID:26396457
  - 1,048 41
Trichomoniasis: Is it always sexually transmitted?
Subitha Kandamuthan, Renu Thambi, Jyotsna Yeshodharan
July-December 2014, 35(2):166-167
DOI:10.4103/0253-7184.142422  PMID:26396458
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Sequential development of psoriasis, alopecia universalis, and vitiligo vulgaris in a human immunodeficiency virus seropositive patient: A unique case report
Sudarshan P Gaurkar, Kirti S Parmar, Bela J Shah
July-December 2014, 35(2):167-169
DOI:10.4103/0253-7184.142424  PMID:26396459
  - 1,127 44
Toll like receptors: Sensors for herpes simplex virus infection
Balaji Govindan
July-December 2014, 35(2):170-171
DOI:10.4103/0253-7184.142425  PMID:26396460
  - 1,044 71
Genital pyoderma gangrenosum
Ramesh M Bhat, Celia Soni Saldanha, Sukumar Dandakeri, Srinath M Kambil
July-December 2014, 35(2):171-172
DOI:10.4103/0253-7184.142426  PMID:26396461
  - 1,074 40
Metabolic abnormalities in human immunodeficiency virus patients with protease inhibitor-based therapy
Tumnyak Ete, Salam Ranabir, Narmada Thongam, Biplab Ningthoujam, Narendra Rajkumar, Bhimo Thongam
July-December 2014, 35(2):100-103
DOI:10.4103/0253-7184.142399  PMID:26396442
Context: Several studies have reported metabolic abnormalities in patients taking protease inhibitor (PI) based therapy from several parts of the world. But there is no prospective study in India after switching from PI sparing regimen to PI based regimen. Aims: To assess whether North-East Indian Human Immunodeficiency Virus (HIV) patients also develop similar metabolic abnormalities to PI. Settings and Design: This prospective study was conducted in Anti-retroviral therapy (ART) Centre of Excellence, at a tertiary care Medical Institute. Materials and Methods: Fifty-five patients taking PI based ART were taken for the study. These patients were started on Ritonavir based therapy, after treatment with first line drugs had failed according to National AIDS Control Organization (NACO) guidelines 2008. Glucose and lipid profiles were evaluated. American Diabetes Association (ADA) and NCEP ATP III criteria were used to categorize glucose and lipid abnormalities. International Diabetes Federation (IDF) 2006 cut-off was used for waist circumference and blood pressure. Statistical Analysis Used: Paired t-test was done whenever applicable. Results: There was a significant increase in waist circumference after 6 months of 2 nd line ART from 78.0 cm to 80.2 cm (P value < 0.001). There was significant increase in both systolic and diastolic blood pressure after 6 months. In 29.8% of patients blood pressure rose to hypertensive level after 6 months. Total cholesterol, triglyceride and low density lipoprotein cholesterol also rose significantly after 6 months but not high density lipoprotein cholesterol. Conclusions: Our study showed that North-Eastern Indian patients also develop metabolic abnormalities to protease inhibitors similar to people of other races.
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Status of prevention of parent to child transmission services among HIV-positive mothers from rural South India
Anbarasi Subramaniyan, Sonali Sarkar, Gautam Roy, Subitha Lakshminarayanan
July-December 2014, 35(2):104-108
DOI:10.4103/0253-7184.142400  PMID:26396443
Background: Tamil Nadu comes under group I high-prevalence state, with <1% prevalence of HIV infection in ante-natal women but above 5% prevalence in high-risk group. One of the ways to control HIV/AIDS in India is through prevention of parent to child transmission (PPTCT), the success of which lies in the utilization of services. Materials and Methods: A descriptive qualitative study was conducted to explore the status of utilization of PPTCT services by rural HIV-positive mothers, in the Gingee Block of Villupuram district, Tamil Nadu. All the mothers who tested positive between June 2006 and May 2010 were interviewed in-depth using an interview guide. Results: There were 21 HIV-positive mothers during this period, 19 of whom gave consent for the study. Thirteen out of 19 mothers (68%) received Nevirapine prophylaxis, while 15 out of 20 infants born to these mothers (75%) received Nevirapine syrup. During the study period, it was found that 61% of the mothers were not compliant to antiretroviral therapy (ART). Conclusion: Poor access to the ART centers was reflected in majority of the cases (79%). There is a pressing need to improve access to quality PPTCT services especially during the intranatal period.
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Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant
Sangeeta Trivedi, Anjali Modi, Silky Modi, JK Kosambiya, VB Shah
July-December 2014, 35(2):109-113
DOI:10.4103/0253-7184.142404  PMID:26396444
Background: Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program. Methods: At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters. Results: Anthropometric parameters (weight, length and head circumference) were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight <50 kg compared to mothers in HIV Clinical stage I and II and weight >50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm 3 and not at established cut-off of CD4 350 cells/mm 3 . This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively. Conclusions: Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.
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Co-infection of human immunodeficiency virus and sexually transmitted infections in circumcised and uncircumcised cases in India
Charu Nayyar, Ram Chander, Poonam Gupta, BL Sherwal
July-December 2014, 35(2):114-117
DOI:10.4103/0253-7184.142405  PMID:26396445
Background: Acquired Immunodeficiency Syndrome (AIDS), is now one of the greatest challenges facing the world. Sexual transmission is the primary route of human immunodeficiency virus infection worldwide. Male circumcision is being considered as strategy to reduce the burden of HIV/AIDS. Material and Methods: The present study was conducted on 200 HIV positive clients. They were screened for bacterial causes of STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Gardnerella vaginalis). Results: There were 138 males and 62 females. The males were examined and the circumcision status was observed. In the females, circumcision status of their male partners was observed. The coinfection of HIV and STIs in circumcised and uncircumcised cases was found out. Diagnosis was made using standard tests. A total of 23% cases were diagnosed to have HIV -STI coinfection. Most common diagnosed diseases were Chlamydia (10%), Gonorrhoea (9%), Bacterial Vaginosis (4.8%) and Syphilis (2.5%). The coinfection rate in uncircumcised cases was found to be higher (29.2% in males and 39.2% in females) as compared to the circumcised cases (14.2% in males and 13.6% in females). Conclusion: The present study suggests that circumcision is a protective factor for acquisition of STIs in HIV positive clients but other factors like sexual behaviours, use of barrier contraceptives, drug abuse etc also play a role.
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Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India
Maitri Shah, Shetal Deshmukh, Sangita V Patel, Kedar Mehta, Yogesh Marfatia
July-December 2014, 35(2):118-123
DOI:10.4103/0253-7184.142406  PMID:26396446
Introduction: Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy. Aims and Objectives: Validation of syndromic management for vaginal discharge syndrome in pregnancy. Materials and Methods: A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests. Results: A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing. Conclusion: Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.
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Retention of antiretroviral naïve patients registered in HIV care in a program clinic in Pune, India
Manisha V Ghate, Sunil S Zirpe, Nilam P Gurav, Bharat B Rewari, Raman R Gangakhedkar, Ramesh S Paranjape
July-December 2014, 35(2):124-128
DOI:10.4103/0253-7184.142407  PMID:26396447
Background: Retention in HIV care ensures delivery of services like secondary prevention, timely initiation of treatment, support, and care on a regular basis. The data on retention in pre antiretroviral therapy (ART) care in India is scanty. Materials and Methods: Antiretroviral naοve HIV-infected adult patients registered between January 2011 and March 2012 in HIV care (pre-ART) were included in the study. The follow-up procedures were done as per the national guidelines. Patients who did not report to the clinic for 1 year were considered as pre-ART lost to follow-up (pre-ART LFU). They were contacted either telephonically or by home visits. Logistic regression analysis was done to find out factors associated with pre-ART loss to follow-up. Results: A total of 689 antiretroviral naοve adult patients were registered in the HIV care. Fourteen (2%) patients died and 76 (11%) were LFU till March 2013. The multivariate analysis showed that baseline CD4 count >350 cells/mm 3 (P < 0.01) and illiteracy (P = 0.044) were significantly associated with LFU. Of the total pre-ART LFUs, 35 (46.1%) informed that they would visit the clinic at their convenient time. NGOs that referred 16 female sex workers (FSWs) who were LFU (21.1%) informed that they would make efforts to refer them to the clinic. Conclusion: Higher CD4 count and illiteracy were significantly associated with lower retention in pre-ART care. Developing effective "retention package" for patients and strengthening linkage strategies between key sub-population such as FSWs and ART programming will help to plug the leaky cascade in HIV care.
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Mitochondrial toxicities of nucleoside analogue reverse transcriptase inhibitors in AIDS cases
Yogesh S Marfatia, Mahima Talwar, Meetesh Agrawal, Ajay Sharma, Kajal Mehta
July-December 2014, 35(2):96-99
DOI:10.4103/0253-7184.142395  PMID:26396441
The development of antiretroviral therapy (ART) has been one of the most dramatic progressions in the history of medicine. Concomitant with this momentous therapeutic advance, the mitochondrial toxicities of ART were recognized as an important clinical entity. Aim: The aim was to study the mitochondrial toxicities in terms of peripheral neuropathy (PN), lipodystrophy (LD), hepatic steatosis, lactic academia (LA), and pancreatitis developing in AIDS cases on nucleoside analog reverse transcriptase inhibitors (NRTIs) based ART regimens. Materials and Methods: An observational study, which included 90 AIDS cases, receiving first line ART regimens containing two NRTIs (zidovudine [AZT]/stavudine [d4T] with lamivudine [3TC]) and one nonNRTIs (nevirapine/efavirenz) was conducted at Skin-VD outpatient department of a tertiary care hospital attached to a Medical College. Thorough history was taken, and clinical examination was done. Cases were subjected to measurements of abdominal girth and mid-arm circumference, liver function tests, blood sugar, lipid profile, serum lactate, and amylase levels. Results: Of 90 cases on ART, 66% were males and 34% were females. Mitochondrial toxicities developed in 26 (30%) cases out of 90, which included 3 (7%) out of 42 cases on AZT + 3TC and 23 (48%) out of 48 cases on d4T + 3TC. Most common toxicity was PN seen in 20 (22%) cases; male cases developed PN at a lower CD4 count than female cases. LD was observed in total of 13 (14.5%) cases; deposition of fat in the abdomen in seven cases and at the nape of the neck (buffalo hump) in one case while loss of fat from extremities was seen in seven cases and loss of buccal fat in seven cases. Women presented more with fat accumulation (breast and abdomen), while men with loss of fat (limbs and buttocks). Both PN and LD were more common in d4T based regimen. LA was reported in one case on d4T. Hepatic steatosis was seen in three cases and pancreatitis in one case receiving AZT. Conclusion: Regular monitoring and early diagnosis of mitochondrial toxicities with timely switch to safer alternatives is of utmost importance.
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Approach to balanitis/balanoposthitis: Current guidelines
Ipsa Pandya, Maulik Shinojia, Dipali Vadukul, YS Marfatia
July-December 2014, 35(2):155-157
DOI:10.4103/0253-7184.142415  PMID:26396455
  - 2,554 414
Reviewing literature for research: Doing it the right way
Shital Amin Poojary, Jimish Deepak Bagadia
July-December 2014, 35(2):85-91
DOI:10.4103/0253-7184.142387  PMID:26396439
In an era of information overload, it is important to know how to obtain the required information and also to ensure that it is reliable information. Hence, it is essential to understand how to perform a systematic literature search. This article focuses on reliable literature sources and how to make optimum use of these in dermatology and venereology.
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Premature ejaculation: A review
Sukumar Reddy Gajjala, Azheel Khalidi
July-December 2014, 35(2):92-95
DOI:10.4103/0253-7184.142391  PMID:26396440
Premature ejaculation (PE) is a common male sexual disorder. It is defined by the Diagnostic and statistical manual of mental disorders as "ejaculation occurring, without control, on or shortly after penetration and before the person wishes it, causing marked distress or interpersonal difficulty. [1] Although the timing of intravaginal ejaculatory latency time (IELT) (i.e., time from penetration to ejaculation) is not included in this definition, an IELT of <2 min, or ejaculation occurring before penetration, has been considered consistent with PE. [2] Management involves both the patient and his partner. Therapeutic options should suit both partners and be appropriate to their habit in planning and frequency of intercourse. Follow-up at appropriate intervals to judge efficacy, titrate dosage of pharmacological treatments and ascertain side effects is mandatory.
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A study of pattern of nonvenereal genital dermatoses of male attending skin OPD at a tertiary care center
PK Saraswat, Anubhav Garg, Dinesh Mishra, Sushma Garg
July-December 2014, 35(2):129-134
DOI:10.4103/0253-7184.142408  PMID:26396448
Background: Nonvenereal dermatoses tend to create confusion from venereal dermatoses. This may be responsible for considerable concern to the patient as well as may cause diagnostic dilemma to the physicians. Nonvenereal dermatoses may not be restricted to genitalia alone; it may affect skin and mucous membrane also. Most of the patients with genital lesions had apprehension of suffering from some venereal disorders. Aim: The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia. Materials and Methods: This was a descriptive study of 100 consecutive adult male patients with nonvenereal genital dermatoses attending skin and STD OPD at J A Group of Hospitals, Gwalior. Cases having any venereal dermatoses were excluded from this study. Results: The study included 100 male patients with nonvenereal genital lesions. A total of sixteen nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (18%), pearly penile papule (16%), fixed drug eruptions (12%), scabies (10%), scrotal dermatitis (9%) and lichen planus (9%). Other dermatoses included sebaceous cyst, psoriasis, lichen sclerosus, plasma cell balanitis or Zoon's balanitis, granuloma annulare, lichen nitidus, lymphangioma circumscriptum, papulo-necrotic tuberculid, squamous cell carcinoma and tinea infections. The age ranged from 18 years to 65 years with majority in the age group of 21-30 years (40%). Conclusion: This study highlights the importance of diagnosing common nonvenereal genital dermatoses. It also helps in avoiding the general misconception that all genital lesions are sexually transmitted.
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