Indian Journal of Sexually Transmitted Diseases and AIDS最新文献

Human papillomavirus (HPV) infection is considered to be the most common sexually transmitted disease among both males and females, with an incidence of 14% in South-East Asia. Cervical cancer is one of the most prevalent types of cancer over the past years and the 3rd main cause of cancer-related mortality among adults. There is consensus that persistent high-risk HPV infection is necessary to cause cervical cancer. Vaccination is the best way to prevent HPV infection. Currently, bivalent, quadrivalent, and nonavalent vaccines are available. In this narrative review, information about different diseases caused by human papillomaviruses, role of HPV vaccines in prevention, and their role in the therapy of recalcitrant warts has been discussed. A systematic search of various databases and search engines such as Medline, PubMed, Embase, Scopus, Cochrane Library, and Science Direct was done. HPV vaccines play a preventive role against the HPV types present in the vaccine. Vaccinating girls and boys before sexual debut is anticipated to maximize disease control. The role of vaccines in older women is under evaluation. The role of HPV vaccines as therapeutic modality in recalcitrant warts has also been explored with encouraging results.

Venereophobia, even though a historically well-recognized entity, is often underdiagnosed in the modern era. Like any phobia, this condition presents with an intense and irrational fear of contracting a sexually transmitted infection (STI) often following a high-risk sexual encounter. Accurate prevalence data were lacking globally. This condition is very common in men, and there are various sociocultural factors contributing to the hesitation to report to a sexual health clinic by women especially in an Indian context. Venereophobia can present with physical and/or psychological symptoms where the patients seek repeated consultations even after repeated reassurances that they were cured of STIs. This is due to the fear that stems from previous high-risk encounters, misinformation, and social stigma. Diagnosing this condition requires expertise from both dermatologists and psychiatrists. In addition to treating the physical symptoms, the patients require reassurance and psychoeducation, extensive laboratory work-up to prove them that they have no STIs, and, in extreme cases, might require cognitive behavioral therapy and/or antipsychotic medications. It is recommended to set up psychodermatology liaison clinics, which help in improving the diagnosis, management and follow-up of these patients.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a variant of keratinocytic epidermal nevi. In contrast to noninflammatory epidermal naevi, ILVEN is less common, typically erythematous, and persistently pruritic. It usually appears at birth or in early childhood and follows a linear distribution along Blaschko's lines. Genital or perigenital involvement is relatively rare. We report a case of ILVEN on the labia majora of an 11-year-old female. ILVEN usually presents on extremities and trunk, but is uncommon on the genitalia.

Ocular syphilis is a significant manifestation of neurosyphilis that can occur at any stage of syphilis infection and may affect one or both eyes. The most common symptoms include reduced vision, pain, photophobia, and flashes of light. Uveitis and otic neuropathies are frequently observed ocular manifestations. If left untreated, ocular syphilis can result in permanent vision loss, highlighting the importance of thorough evaluation and timely treatment. We present the case of a 44-year-old woman, who exhibited symptoms including a maculopapular rash on the trunk and upper limbs, followed by cervical lymphadenopathy, tonsillitis, and decreased vision. Serological tests showed positivity for Venereal Disease Research Laboratory (1:32) and Treponema pallidum haemagglutination (1:10,240). An magnetic resonance imaging of the brain ruled out any pathological intracranial impregnations. Analysis of the cerebrospinal fluid revealed normal cellularity. An ocular ultrasound and a Doppler examination of the ophthalmic artery were conducted to assess the Ocular Assessment Rating Index (OARI). A retinal detachment was observed in the right eye, showing a significant increase in OARI compared to the left eye (0.82 vs. 0.68). A clinically significant increase in OARI was defined as a value >0.75 based on previous observations. The patient was treated with aqueous crystalline penicillin G for 10 days. This case highlights a potential link between damage to the ophthalmic and cerebral vascular systems and systemic manifestations in early syphilis. We propose that Doppler of the ophthalmic artery, with resistance index calculation, should be part of the diagnostic evaluation for patients with syphilis. An increased OARI may identify patients who should undergo lumbar puncture to confirm a diagnosis of neurosyphilis and initiate appropriate therapy.

Background: Syphilis diagnosis can be confirmed by two testing algorithms. In the traditional algorithm, a nontreponemal test is used as a screening test to rule out syphilis which, if reactive, is confirmed by a treponemal test. In the reverse algorithm, a treponemal test is used as a screening test, which, if positive, is confirmed by a nontreponemal test. If the nontreponemal is negative, a second treponemal assay of a different principle is performed to resolve the discordant result. The aim of this study was to compare the traditional and reverse algorithms for the diagnosis of syphilis in a National Referral Apex Centre for Sexually Transmitted Infections.

Materials and methods: A retrospective study was done on samples received from male and female sexually transmitted infection clinics for syphilis testing. All samples were tested simultaneously using the Venereal Disease Research Laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA), and fluorescent treponemal antibody absorption (FTA-Abs) test. The results of syphilis serological testing were interpreted using the traditional and reverse algorithms. The traditional algorithm used VDRL as the screening test and TPHA as the confirmatory test. In the reverse algorithm, TPHA was the screening test, and reactive results were confirmed with VDRL. Discordant samples were confirmed with the FTA-Abs test.

Results: The reverse algorithm showed a significantly higher seroprevalence of syphilis than the traditional algorithm (62.4% vs. 40.8%, P < 0.0001). The traditional algorithm had a high missed serodiagnosis rate (34.6%) and showed a higher false-positive rate of the screening test (6.8%) as compared to the reverse algorithm (0.6%).

Conclusions: This study supports the use of reverse algorithms for diagnosing syphilis in high-prevalence populations.

Genital tuberculosis (TB) in females is a chronic disease with low-grade symptoms. It commonly occurs secondary to extragenital TB and rarely occurs primarily by inoculation from male partners. Owing to its rarity and variability of clinical presentation, along with its ability to mimic many other common conditions, its clinical diagnosis poses a challenge for practitioners. Histopathological examination plays a pivotal role in diagnosing such cases. One such rare case of TB, reveling in the vulva, masquerading as a tumor is presented here.

Genital psoriasis rarely presents as isolated pustular lesions confined to the glans penis, often leading to misdiagnosis as sexually transmitted infections such as herpes genitalis. We report a 36-year-old male with recurrent pruritic lesions on the glans over four months, with seasonal exacerbations over the past three years, particularly in winter and summer. The patient, with no systemic comorbidities or extragenital lesions, was initially misdiagnosed and treated with antivirals without relief. Clinical examination revealed multiple erythematous papules with collarette of scale and pustules that ruptured to form non-scarring erosions. Histopathological examination confirmed pustular psoriasis. The patient responded completely to topical 2% tofacitinib within four weeks. Isolated genital pustular psoriasis is exceedingly rare, with limited cases reported in the literature. Diagnostic delay is common due to its overlap with other genital dermatoses and lack of typical psoriatic plaques. This case highlights the importance of considering non-venereal causes in persistent genital lesions and the role of histopathology in achieving accurate diagnosis.

Context: Human papillomavirus types 6 and 11 are the most prevalent strains that produce anogenital warts. Both cryotherapy and podophyllin have approved modalities in the treatment of anogenital warts.

Aim: The aim of this study was to determine the treatment outcome following cryotherapy compared to podophyllin in the treatment of anogenital warts.

Settings and design: This was an observational study conducted in a tertiary care hospital.

Materials and methods: All patients diagnosed clinically with anogenital warts were recruited after obtaining informed consent and with due consideration of the inclusion and exclusion criteria. A brief history taking and examination was done. Patients were segregated into two groups based on the treatment received, which was either cryotherapy or podophyllin once a week for 6-week duration. Treatment response was assessed every week based on various scoring systems.

Statistical analysis used: Results were analyzed using statistical software SPSS version 20.0.

Results: Both cryotherapy and podophyllin showed similar efficacy, with 92.3% of patients in each group showing complete resolution of the lesions at the end of this study. It was also found that participants in the podophyllin group required 3.50 ± 1.67 weeks for complete clearance, while the cryotherapy group required only 2.08 ± 0.99 weeks. Both groups exhibited an equal proportion of adverse effects, which were not statistically significant.

Conclusion: While both cryotherapy and podophyllin were equally effective in treating anogenital warts, cryotherapy showed a slightly faster resolution than podophyllin. Based on the overall findings, while both options can be provided to the patient, podophyllin still holds good in resource-poor settings where cryotherapy is not always available.