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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   2013| January-June  | Volume 34 | Issue 1  
    Online since June 4, 2013

 
 
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ORIGINAL ARTICLES
Pattern of mucocutaneous manifestations in human immunodeficiency virus-positive patients in North India
Sachin D Kore, Amrinder J Kanwar, Keshavamurthy Vinay, Ajay Wanchu
January-June 2013, 34(1):19-24
DOI:10.4103/0253-7184.112865  PMID:23919050
Background: Mucocutaneous diseases are among the first-recognized clinical manifestations of acquired immune deficiency syndrome. They function as visual markers in assessing the progression of human immunodeficiency virus (HIV) infection. Given the relative ease of examination of skin, its evaluation remains an important tool in the diagnosis of HIV infection. Objective: To determine the pattern of mucocutaneous manifestations in HIV-positive patients and to correlate their presence with CD4 counts. Materials and Methods: This cross-sectional study included 352 HIV-infected patients seen at PGIMER, Chandigarh, India, over a period of 1 year. The patients were screened for mucocutaneous disorders by an experienced dermatologist. The patients were classified into different stages according to the World Health Organization clinical and immunological staging system. Results: The most prevalent infection was candidiasis, seen in 57 patients (16.2%). Prevalence of candidiasis, dermatophytosis, herpes simplex, herpes zoster, molluscum contagiosum (MC), seborrheic dermatitis, adverse drug reaction, nail pigmentation, xerosis and diffuse hair loss differed statistically according to the clinical stages of HIV infection. There was a statistically significant association between immunological stages of HIV infection and dermatophytosis. Conclusion: Results of our study suggest that mucocutaneous findings occur throughout the course of HIV infection. Dermatoses like MC and dermatophytosis show an inverse relation with CD4 cell count, and these dermatoses can be used as a proxy indicator of advanced immunosuppression to start highly active anti-retroviral therapy in the absence of facilities to carry out CD4 cell count.
  2 4,287 180
CASE REPORTS
Congenital syphilis, still a reality
Rajat Gupta, Rita V Vora
January-June 2013, 34(1):50-52
DOI:10.4103/0253-7184.112941  PMID:23919058
Congenital syphilis is a potentially serious pathology affecting newborns of infected mothers. Even one case of congenital syphilis is a sentinel public health event, since timely diagnosis and treatment of syphilis infected pregnant woman should prevent transmission almost entirely. Here, we are reporting a case of early symptomatic congenital syphilis presented with severe desquamating papulosquamous lesions over multiple body parts along with erosive lesions around oral cavity and nostrils.
  1 9,011 99
Late onset Warfarin induced skin necrosis in human immunodeficiency virus infected patient with pulmonary tuberculosis
Sanjiv Vijay Choudhary, Amrita Madnani, AL Singh
January-June 2013, 34(1):47-49
DOI:10.4103/0253-7184.112940  PMID:23919057
The incidence of Warfarin-induced skin necrosis (WISN) is very low 0.01-0.10%. The majority of the WISN cases appear between day 3 and 6 of onset of Warfarin therapy. The cases of late onset WISN are rarely seen. We report a case of late onset WISN in a young human immunodeficiency virus positive female patient with thrombotic pulmonary embolism and reactivation of pulmonary tuberculosis.
  1 3,142 34
LETTERS TO EDITOR
Nine years' follow-up of successful implementation of PPTCT program in Government Medical College, Dhule, Maharashtra
Mrudula N Dravid, Arun Moray, Ravindra K Khadse, Suwarna U Phute
January-June 2013, 34(1):61-62
DOI:10.4103/0253-7184.112949  PMID:23919061
  1 1,815 38
ORIGINAL ARTICLES
Profile of HIV seroconcordant/discordant couples a clinic based study at Vadodara, India
Yogesh S Marfatia, Eknath Naik, Priyanka Singhal, Smriti Naswa
January-June 2013, 34(1):5-9
DOI:10.4103/0253-7184.112862  PMID:23919047
Background: Heterosexual transmission of HIV among married couples is the commonest mode of transmission seen in India. Intramarital transmission is associated with several challenges which need to be further researched. Aim: To study level of seroconcordance and serodiscordance among HIV positive couples and factors affecting intramarital sexual transmission in terms of safe sexual practice, and the presence of Sexually transmitted infections (STI)/circumcision. Materials and Methods: Ninety-one monogamous married cohabiting HIV-positive cases (index cases) attending Department of Skin and Venereology, Medical College Baroda, from January 2009 to August 2009 were studied. Their spouses were tested for HIV. A structured proforma was used to study various factors like condom use, circumcision, and the presence of sexually transmitted infections. Results: Ninety-one monogamous married cohabiting HIV-positive cases were included in the study and considered as index cases. There were 51 males and 40 females. On testing their spouses for HIV, both the spouses were positive in 55 couples giving rise to 60% seroconcordance rate. Out of 55 seroconcordant couples, male spouses used condom in 16 cases (29%). Out of 36 serodiscordant couples 17 male spouses (47%) used condom. Evidence of STD was observed in one of the spouses in 6 out of 55 seroconcordant couples and 6 out of 36 serodiscordant couples. Thus, out of 91 couples one of the partners was having STI in 12 couples. Overall rate of circumcision was 12.2%. Conclusion: The prevention of transmission of HIV to the HIV negative partner is of paramount importance. Serodiscordant couples, specially the HIV negative female partner is at higher risk. Less acceptability of condoms among married couples may be one of the factors responsible in transmission. Further studies are needed to explore other risk factors associated with HIV transmission in discordant couples.
  1 3,257 146
ABSTRACTS
Abstracts from current global literature: ART resistance in reference to Indian population
Sonia Jain
January-June 2013, 34(1):53-55
  - 1,534 46
Abstracts from the current global iterature: Discordant virological and immunological response in anti-retroviral therapy
Ankit H Bharti, Kiran Chotaliya, YS Marfatia
January-June 2013, 34(1):56-58
  - 2,204 46
BOOK REVIEWS
DYP Survival Guide for Post Graduate Dermatology Examination
Yogesh S Marfatia
January-June 2013, 34(1):68-68
  - 6,167 222
Sexually Transmitted Infections
Chitra S Nayak
January-June 2013, 34(1):69-69
  - 2,881 73
CASE REPORTS
Observance of Kassowitz law-late congenital syphilis: Palatal perforation and saddle nose deformity as presenting features
Govindan Balaji, Subramanian Kalaivani
January-June 2013, 34(1):35-37
DOI:10.4103/0253-7184.112869  PMID:23919053
Late congenital syphilis refers to the people with syphilis from the age of 2 to 30 years. We report a case of late congenital syphilis in a 9 year old girl with perforation of palate and saddle nose deformity. Kassowitz law was also observed (if a woman with untreated syphilis has series of pregnancies, the likelihood of infection of the fetus in later pregnancies becomes less).Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination (TPHA) were reactive. Computed tomography (CT) scan of paranasal sinus showed maxillary and nasal polyps. The case reported here is a rare presentation of late congenital syphilis with perforation of palate and saddle nose deformity.
  - 4,046 67
Pseudoepitheliomatous keratotic and micaceous balanitis with malignant transformation
Vidyadhar R Sardesai, Trupti D Agarwal, Avinash B Dalal, Madhulika A Mhatre
January-June 2013, 34(1):38-40
DOI:10.4103/0253-7184.112871  PMID:23919054
Pseudoepitheliomatous, keratotic and micaceous balanitis (PKMB) is a non-venereal and extremely rare pre-malignant condition characterized by silvery white plaque with micaceous scaling on glans seen in elderly uncircumcised men. Symptoms include phimosis, pain, and interference with sexual activity.Herein we present a young, 40-year-old male with PKMB of 5 years duration with deviation of urinary stream and histology showing acanthosis, hyperkeratosis with features of cellular atypia and abnormal mitosis suggestive of malignant transformation.
  - 4,857 57
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.
  - 13,184 56
Perianal pseudoverrucous papules and nodules
Ameet Dandale, Rachita Dhurat, Smita Ghate
January-June 2013, 34(1):44-46
DOI:10.4103/0253-7184.112939  PMID:23919056
Perianal pseudoverrucous papules and nodules (PPPN) is a rare entity attributed to chronic irritation. We came across this entity in a case of spina bifida. A 14 year old girl having spina bifida at L3 presented with complaints of multiple asymptomatic whitish lesions on the inner aspect of thighs and labia majora since early childhood. She had incontinence of stool and urine since birth. Cutaneous examination revealed multiple 3-12 mm flat topped moist papules, few verrucous nodules, some of these lesions coalesced to form plaques at the perianal area extending upto the labia majora. On histology marked epidermal hyperplasia and pale keratinocytes in the epidermis was seen. This confirmed the diagnosis of PPPN. This rare condition can be mistaken with sexually transmitted diseases leading to unnecessary investigations and treatment.
  - 6,993 85
LETTERS TO EDITOR
Assessment of oral health status and Treatment needs of HIV/AIDS patients visiting Government Hospitals and Rehabilitation centers in Banglore city
Hemamalini Rath, Subash Chandra Raj
January-June 2013, 34(1):59-60
DOI:10.4103/0253-7184.112944  PMID:23919059
  - 1,947 53
Father to child transmission of human immunodeficiency virus disease while sero-discordant status of the mother is maintained
Sankaranantham Murugan, Rajanayagam Anburajan
January-June 2013, 34(1):60-61
DOI:10.4103/0253-7184.112945  PMID:23919060
  - 1,798 37
Behcet's disease simulating secondary syphilis in an HIV-infected patient
Vidya Kharkar, Sachin Yeole, Sunanda Mahajan, Rameshwar Gutte, Uday Khopkar, M. R. L. Sujatha
January-June 2013, 34(1):62-64
DOI:10.4103/0253-7184.112950  PMID:23919062
  - 3,553 42
Genital tract infection of women in Southern Orissa with special reference to pelvic inflammatory disease
Sarita Mohapatra, Pritilata Panda, Banojini Parida
January-June 2013, 34(1):64-66
DOI:10.4103/0253-7184.112971  PMID:23919063
  - 1,985 67
Assessing the preparedness of the community for rendering home-based care for HIV/AIDS patients by a using a qualitative tool
R Shankar, S Sangeetha Balamurugan
January-June 2013, 34(1):66-67
DOI:10.4103/0253-7184.112973  PMID:23919064
  - 1,549 26
ORIGINAL ARTICLES
Trichomoniasis: How do we diagnose in a resource poor setting?
R Sivaranjini, TJ Jaisankar, Devinder Mohan Thappa, Rashmi Kumari, Laxmisha Chandrasekhar, M Malathi, Subhash Chandra Parija, Syed Habeebullah
January-June 2013, 34(1):25-31
DOI:10.4103/0253-7184.112866  PMID:23919051
Background: Diagnosis of Trichomonas vaginalis vaginalis infection based solely on clinical symptoms and signs is unreliable because the spectrum of infection is broad and other sexually transmitted pathogens cause similar signs and symptoms. Aims: Our study was undertaken to study the frequency of T. vaginalis infection in women presenting with vaginal discharge, to characterize the clinical features, and to study the sensitivity and specificity of microbiological investigations in the diagnosis of the same. Materials and Methods: This was a hospital-based descriptive study done on 400 female patients with vaginal discharge attending the Gynecology out-patient department (OPD) of JIPMER, Puducherry, from May 2010 to July 2011. Women of age between 20 years and 50 years presenting with vaginal discharge irrespective of marital status, were included, and detailed history was elicited and thorough examination was performed. Results: In 400 women presenting with vaginal discharge from Gynecology out-patient department (OPD) included in the study, T. vaginalis infection was found in 27 (6.75%) women. The risk factors for trichomoniasis included history of pre- or extramarital sexual contact in the woman or her partner, symptomatic partner, and alcohol consumption. A positive association with pelvic inflammatory disease was also observed. The most frequent symptoms included lower abdominal pain, dysuria, and dyspareunia. Combining of Whiff test, pH > 4.5, and pus cells in Gram-stained smear, the specificity in diagnosing the infection (97.3%) approached that of the reference standard, i.e., culture. On combining wet mount with Papanicolaou smear, the sensitivity increased to 92.6%, which was higher than that individually done. Conclusion: To conclude, diagnosis of T. vaginalis infection based solely on clinical symptoms and signs is unreliable, and combination of simple laboratory tests increases the diagnostic performance close to the reference standard (culture), especially in resource poor settings.
  - 3,527 164
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.
  - 53,288 295
Partner notification and treatment Institute of Venereology-experience
S Arunkumar, Sushruth Guruputra Kamoji, Gajendran Kasatti
January-June 2013, 34(1):10-13
DOI:10.4103/0253-7184.112863  PMID:23919048
Introduction: There has been a significant increase in general awareness about Sexually transmitted diseases (STD's) among the general public. However, rates of partner notification and treatment which are an integral part of STD awareness is still questionable. Methodology and Results: We analyzed the statistics for prevalence of partner notification (which is about 52%) as well as the possible reasons for non-compliance. An overview of various ways of partner notification has been given as patient delivered partner medication (PDPM) and patient based partner referral (PBPR) of which PDPM is the most acceptable and effective method worldwide.
  - 2,696 93
Study of sexual behavior and prevalence of STIs/RTIs and HIV among female workers of textile industries in Surat city, Gujarat, India
Binita Desai, JK Kosambiya, Summaiya Mulla, Ragini Verma, Bharat Patel
January-June 2013, 34(1):14-18
DOI:10.4103/0253-7184.112864  PMID:23919049
Background: Surat city is vulnerable to transmission of sexually transmitted infections (STIs)/HIV due to its huge migratory population in diamond and textile industries. Females working in textile industries were not receiving focused intervention although they were at high risk of acquiring STIs/HIV. Objective: The present study was conducted to know the prevalence of various STIs and HIV among the group of female textile workers in Surat city. The findings of the study will be helpful for policy decision makers to address the issues of a specific vulnerable group. Materials and Methods: A total 257 female workers in various textile markets were enrolled in the present study. Data were collected by the help of a pre-tested questionnaire and analysis was done by using Microsoft Excel and the EPI Info software. Result: Overall prevalence of various STIs/RTIs (reproductive tract infections) was 16.73%, whereas HIV positivity was 1.17%. Bacterial vaginosis and candidiasis were the most common infections. Conclusion: Groups such as female textile workers need to be taken care of especially to enhance the HIV prevention and control activities in Surat city, which would help in breaking the chain of transmission.
  - 3,095 128
REVIEW ARTICLE
Getting to zero: Possibility or propoganda?
Suneela Garg, Ritesh Singh
January-June 2013, 34(1):1-4
DOI:10.4103/0253-7184.112861  PMID:23919046
The world is now in the fourth decade of a pandemic that united all the nations more than any other calamities or policies. The numbers with relation to HIV are falling consistently. Unfortunately the funding is also decreasing. In the current uncertain economic environment, the Joint United Nations Programme on HIV and AIDS (UNAIDS) has set a very ambitious target of reducing HIV to zero by 2015. There are strategies that are good and cost-effective and, if used appropriately, will give remarkable results. No new innovations have recently been discovered related to HIV. More molecular level studies are needed besides strengthening the existing strategies. We need money for all these activities and it should not stop coming. The paper reviews the success of HIV program in India and also foresees the challenges lying ahead of us in "getting to zero."
  - 3,063 119
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