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.

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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.

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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.

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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.

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Lipschütz 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.

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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.

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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.

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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).

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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.

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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.

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The diagnosis and management of nonvenereal diseases are always a tough challenge for the dermatologist due to lack of studies on its diagnostic criteria and standard treatment guidelines. Zoon balanitis (ZB) is one of the benign nonvenereal dermatoses, which presents as a solitary, persistent erythematous plaque usually on the glans penis primarily in the uncircumcised, middle-aged to old-aged men. Although it was described by Zoon in 1952, its etiopathogenesis still remains hypothetical. This article provides an overview of the epidemiology, clinical presentation, histopathological features, and diagnostic criteria and diagnostic methods of ZB. In addition to this, it is rather very important to differentiate this lesion from its clinical equivocal lesions such as erythroplasia of Queyrat, infective and other inflammatory penile dermatoses, which has been discussed in this review. The treatment modalities have also been reviewed in details, and the importance of circumcision as the treatment of choice has been emphasized.

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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.

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Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV.

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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.

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Studies follow a hierarchy in terms of the quality of evidence that they can provide. Randomized double blind placebo control (RDBPC) studies are considered the "gold standard" of epidemiologic studies. And the same is discussed at length in this paper taking example of a real journal article employing this study design to answer the research question; "Does once daily dose of Valacyclovir reduce the risk of transmission of genital herpes in a susceptible partner?" RDBPC studies remain the most convincing research design in which randomly assigning the intervention can eliminate the influence of unknown or immeasurable confounding variables that may otherwise lead to biased and incorrect estimate of treatment effect. Also, randomization eliminates confounding by baseline variables and blinding eliminates confounding by co-interventions, thus eliminating the possibility that the observed effects of intervention are due to differential use of other treatments. The best comparison is placebo control that allows participants, investigators and study staff to be blinded. The advantage of trial over an observational study is the ability to demonstrate causality. Hope, this will be useful to neophyte researchers to understand causal hierarchy when critically evaluating epidemiologic literature.

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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.

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The spectrum of conditions affecting the penile skin is varied and ranges from simple, benign dermatoses to premalignant and malignant conditions. Anogenital malignancies and premalignancies are an important personal/public health problem due to their effects on individuals' physical, mental, and sexual health. Furthermore, due to their etiological association with human papillomavirus infection, anogenital malignancies, and premalignancies constitute an immense public health burden. Bowen's disease, Bowenoid papulosis, and erythroplasia of Queyrat are the most widely seen premalignancies of anogenital region and are all forms of squamous intraepithelial neoplasia. Histopathologically, these conditions share identical histologic features of squamous cell carcinoma in situ, but their clinical features differ. In this article, we explore the common precancerous states that can lead to penile carcinoma.

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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.

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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.

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