Indian Journal of Sexually Transmitted Diseases and AIDS最新文献

Introduction: The human immunodeficiency virus (HIV)/AIDS in India came into public view in 1986 with the detection of the first case of HIV in Chennai, Tamil Nadu, and the first AIDS case in Mumbai, Maharashtra in 1987. In acute phase response, iron distribution occurs in the liver and mononuclear phagocytic system. A high prevalence of elevated serum ferritin levels is reported in HIV infection and serum ferritin levels increase with the clinical worsening of infection and with decreasing CD4 lymphocyte counts. This study is designed to find the role of acute phase reactant serum ferritin in the progression of the disease of HIV which is complicated by opportunistic infections, by finding the correlation of serum ferritin with immunological stages of HIV.

Materials and methods: This cross-sectional study was conducted on 75 patients admitted to various wards of the Department of Medicine or attending medicine outdoor or ART Centre, Maharana Bhupal Government Hospital, RNT Medical College Udaipur. Serum ferritin, total iron binding capacity, and total serum iron were analyzed in Cobas^® analyzer. CD4 cells are measured using the flow cytometry technique. The results were tabulated and subjected to statistical analysis.

Results and conclusion: There was a negative correlation among serum ferritin and CD4 cells with r = -0.195 which was statistically significant (P < 0.05). As the CD4 cell count decreased incidence of serum ferritin increased. Elevation of serum ferritin levels is associated with a low count of the CD4+ in HIV-diagnosed patients. In a patient diagnosed with HIV, elevated serum ferritin indicates underlying inflammatory pathology. Serum ferritin can be used as a guide to further evaluation of underlying disease in HIV patients.

Background: A number of dermatoses affect the genitalia in a unique and distinct manner. Nonvenereal dermatoses may not be restricted to genitalia alone; it may affect other body sites and mucous membranes as well. Dermatoses involving genital areas are not necessarily sexually transmitted. Skin lesions of the genitalia may be physiological, venereal, or nonvenereal in origin. Studies on genital dermatoses of only nonvenereal and noninfectious origin among adults are not commonly documented in India.

Objectives: The objectives of this study were to determine the clinical pattern and frequency of noninfectious nonvenereal genital dermatoses.

Materials and methods: A total of 261 patients with noninfectious nonvenereal genital dermatoses attending tertiary care hospital were enrolled from August 2019-July 2020. Cases of more than 18 years of age who had given informed valid consent were included in the study, whereas venereal or infectious dermatoses were excluded from this study. The diagnosis was established based on a detailed history, examination, biopsy, and relevant investigations. Data collection was done using predesigned pro forma, and analysis was perfomed using MS Excel.

Results: Maximum participants were middle aged with a mean age of 43.38 ± 9.45 years. The most common nonvenereal genital dermatoses were vitiligo (23.37%), followed by physiological conditions (19%-92%), papulosquamous dermatosis (18.77%), lichen simplex chronicus (16.48%), premalignant conditions (6.51%), vesiculobullous conditions and benign conditions (4.98%) each, adverse cutaneous drug reactions (4.21%), and malignant conditions (0.77%). About 78.54% of participants had dermatosis over genitalia only. Focal vitiligo was the most common dermatosis involving only genitalia.

Conclusions: This study is novel as participants enrolled only of noninfectious, nonvenereal genital dermatoses among males.

Nevus comedonicus, an uncommon skin condition, was originally termed "comedo nevus" by Kofmann in 1895. It is characterized by the clusters of pits-containing black keratinous plugs resembling blackheads. Conventionally, nevus comedonicus manifests at birth (in 50% of cases) or during the first decade of life. The commonly affected areas include the head, neck, chest, upper, and lower limbs, with patterns ranging from unilateral, bilateral, linear, interrupted, segmental, to blaschkoid. While genital nevus comedonicus is rare, some cases have been reported. In this report, we present a case of nevus comedonicus on the glans, underscoring the importance of considering nonsexually transmitted disease-related causes for genital lesions.

Context: Economic burden imposed by sexually transmitted infections (STIs) is substantial in low-middle-income countries like India, in spite of the fact that national programs for controlling STIs are operational.

Aims: The aim of this study was to estimate the out-of-pocket expenses and catastrophic health expenditure (CHE) incurred by patients of STIs and analyze expenditure pattern in relation to various clinical and sociodemographic characteristics.

Settings and design: This was a hospital-based cross-sectional study among patients attending Suraksha Clinic.

Subject and methods: The study was conducted among patients aged ≥18 years. Data were collected regarding various direct and indirect expenses incurred, after adjusting any reimbursement or waive off. Total costs exceeding 10% of annual household income were considered catastrophic. Stepwise regression analysis was used to analyze predictors, and P < 0.05 was considered statistically significant.

Results: Out of 157 patients, most were suffering from herpetic ulcers (27.4%). The median and interquartile range (IQR) for total OOPE of STI management was ₹1950 (IQR 1035-5725). Direct expenditure constituted major expenses with a median of ₹1850 (IQR 787.50-5385.0). The cost of STI management was catastrophic in 15.2% of cases. Lower socioeconomic status, longer traveling distance, overnight stay as a part of seeking treatment at Suraksha Clinic, previous history of other than allopathic treatment, and quack consultation were found to be independent predictors of CHE.

Conclusions: Despite free diagnostic and treatment services to STI patients under the National AIDS Control Programme, many incurred considerable costs and catastrophic expenditure toward STI care. Better outreach of health services is required to maximize STI control and lower financial morbidity.

Background: There is a change in the pattern and prevalence of acquired syphilis due to better awareness, surveillance, laboratory diagnosis, and treatment in India in recent years. However, restrictive measures for COVID-19 may produce different effects on incidence.

Aims and objectives: We aimed to study the changing trend of acquired syphilis in relation to COVID-19 outbreak in a tertiary care hospital in North India.

Materials and methods: A retrospective analysis of all the cases of sexually transmitted infections (STIs) was done from January 2016 to June 2022. Demographic, clinical, and laboratory data of acquired syphilis were recorded and analyzed for changing trends in prevalence, clinical presentations, association with HIV and other sexually transmitted diseases (STDs), and its relation to COVID-19. Statistical analysis was done using SPSS software.

Results: A total of 1105 patients attended STD clinic from January 2016 to June 2022, of which 216 patients were venereal disease research laboratory and Treponema pallidum hemagglutination assay positive (19.5%). Before COVID-19, there was an increasing trend of acquired syphilis (late latent). Patients diagnosed with syphilis pre- and postlockdown did not differ significantly in their mean age, median age, male/female ratio, and HIV status. However, there is an increase in number of cases of primary and secondary syphilis postlockdown which was statistically significant.

Conclusion: Restrictive measures for COVID-19 during the lockdown produced a declining trend of syphilis. It is unclear whether the observed decrease in number of STI cases was due to true decline, inadequate testing, underreporting, or avoidance of high-risk sexual activities. The upsurge in the number of cases of acquired syphilis after lockdown suggests the possibility that lockdowns did not completely disrupt STI transmission.

Congenital syphilis (CS), once a forgotten disease, has now remerged. A 2-month-old male child presented with multiple discrete skin-colored papules over the trunk, back, bilateral lower limbs, and groin. He also had a deformity of bilateral lower limbs and a widening at the wrist. Radiological findings suggested syphilitic changes in long bones. Nontreponemal as well as treponemal tests were positive in the baby and both parents confirming the diagnosis of CS. The father had a history of multiple sex partners and untreated genital lesions in the past. The case emphasizes the importance of awareness regarding sexually transmitted infections and its timely treatment and judicious antenatal screening for the same.

Introduction: Dermatological manifestations are common manifestations of human immunodeficiency virus (HIV) disease, seen in 80% to 95% of HIV-infected patients. Dermatological manifestations are considered clinical indicators to predict and assess the underlying immune status.

Aim: This study aims to document the dermatological manifestations in relation to CD4 count in people living with HIV (PLHIV).

Materials and methods: Cross-sectional study in 250 PLHIV fulfilling inclusion-exclusion criteria was conducted. Variables including sociodemographic profile, recent CD4 count (data from antiretroviral therapy center), and dermatological manifestation (physical examination) were collected. Clinical diagnosis was established, and patients were grouped according to the World Health Organization immunological staging.

Results: Majority of PLHIV (39.6%) were in the age group of 31-40 years. Males were affected more than females (1.6:1). A total of 364 dermatoses were observed; dermatological manifestation per patient ranged from 1 to 4. 32.80%. PLHIV had CD4 count >500 cells/mm³, 15.60% had CD4 count between 200-349 cells/mm³. Majority of dermatosis had infectious etiology (77.6%), out of which dermatophytosis (27.2%) was the most common infectious condition, whereas pruritic papular eruption was the most common (11.6%) noninfectious condition. A statistically significant association of CD4 count was found with dermatophytosis (P ≤ 0.001) and candidiasis (P = 0.001).

Conclusion: The study showed a significant association between the number of dermatological manifestation and CD4 count as majority of study participants (67.2%) had CD4 <500 cells/mm³ at the time of episode of dermatosis.