Indian Journal of Sexually Transmitted Diseases and AIDS最新文献

Context: The number of men who have sex with men (MSM) seeking health care has increased in recent years, but the research comparing sexually transmitted infections (STI) prevalence and risk behaviors between homosexual and bisexual MSM is limited, particularly postpandemic.

Aims: To compare the profile of STIs and risk behaviors between homosexual and bisexual MSM attending our STI clinic.

Methodology: In this comparative cross-sectional study, we analyzed the records of all male STI patients who reported at least one male partner who attended our STI clinic from January 2015 to December 2023 for demographic details, sexual history, clinical examination, and laboratory findings.

Statistical analysis: Chi-square test and logistic regression were utilized.

Results: The number of MSM attending STI clinics showed a rising trend, with a sharp decline during the pandemic followed by a significant rebound. Bisexuals outnumbered homosexuals until the lockdown, after which the trend reversed. About 42.6% of homosexuals and 26.7% of bisexuals reported first sexual exposure before the age of 16 (odds ratio (OR) = 2.04, 95% confidence interval (CI): 1.17-3.55, P = 0.01). Syphilis was the most prevalent STI (70.6%), followed by HIV (29.8%) and condyloma acuminata (16.6%). Homosexuals had a significantly higher prevalence of syphilis (adjusted OR 4.82, 95% CI 1.94-11.93, P < 0.01) than bisexuals. 51.4% of HIV cases were newly diagnosed on evaluation after attending the STI clinic.

Conclusions: There was a sharp rise in the number of MSM attending the STI clinic, especially homosexuals. Syphilis was the most prevalent STI, particularly among homosexuals, which frequently coexisted with HIV.

Bowenoid Papulosis (BP) is an uncommon, Human Papillomavirus (HPV) induced genital dysplasia, usually observed in younger, sexually active individuals. We report a case of a 37-year-old woman who presented with dark, itchy lesions over her external genitalia of 6 months duration. Clinical examination and histopathological evaluation confirmed the diagnosis of BP. The patient was managed with weekly cryotherapy sessions and was advised to undergo annual cytological screening.

Background: Syphilis screening methods in blood banks have recently transitioned from manual nontreponemal tests to automated treponemal-specific enzyme immunoassays and chemiluminescence immunoassays (CIA). Although convenient and highly sensitive, this has led to increased false-positive rates leading to the wastage of blood resources.

Aims and objectives: This study aimed to evaluate the positive predictive value (PPV) of Treponema pallidum (TP)-CIA as a screening tool in healthy blood donors and determine optimal cutoff values to improve specificity, thereby reducing unnecessary blood wastage and donor exclusion.

Patients and methods: It was a retrospective observational study that collected data from July 2019 to May 2023 on blood bank donors referred to the sexually transmitted disease clinic, in view of testing reactive on the Abbott ARCHITECT Syphilis TP CMIA (relative light unit [RLU] >1). Clinical details, Venereal Disease Research Laboratory (VDRL) titers, and confirmatory TP hemagglutination (TPHA) test records were corroborated.

Results: A total of 1791 patients were referred over 4 years as per blood bank records. Only 271 (15.13%) of these presented to the sexually transmitted infection clinic, indicating a high referral loss. Of patients with CIA titers available, 119/202 (58.9%) were diagnosed as confirmed syphilis based on VDRL and TPHA positivity, out of which majority (92.4%) were latent syphilis. PPV of TP-CIA rapid test at RLU >1 (manufacturer recommendation) was 64.3%, with an area under the receiver operating characteristic curve of 0.86. Setting the cutoff at RLU ≥2.5 improved sensitivity to 100% (patients with RLU <2.5 could be safely returned to the donor pool), while a cutoff of ≥24.63 achieved 100% specificity (confirmed syphilis).

Conclusion: The manufacturer cutoff for syphilis CMIA rapid test (RLU >1) maintains high sensitivity but generates high false positives, causing nearly one-third of patients to be referred unnecessarily, as well as blood wastage. Reflexive confirmatory testing with a second treponemal assay can minimize the psychological impact on healthy donors and prevent unnecessary donor exclusion. Large-scale studies are required to establish population-based cutoffs for ensured blood safety without wastage.

Genital beading or pearling, the practice of implanting small beads under the penile skin for sexual enhancement, is a cultural tradition in certain regions of Nepal, East Asia, Southeast Asia, the Pacific islands, some parts of Africa, and Eastern Europe. This case report discusses the presentation of a couple in Nepal who migrated to India and was diagnosed with latent syphilis of unknown duration, highlighting the clinical and cultural implications of genital modifications.