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Inamdar DP, Kulkarni A, Basavaraju A. Genital ulcer disease: Study of factors associated and utility of rapid diagnostic methods in current pandemic. J Family Med Prim Care 2024; 13:1473-1480. [PMID: 38827702 PMCID: PMC11141987 DOI: 10.4103/jfmpc.jfmpc_1729_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 06/04/2024] Open
Abstract
Background Genital ulcer disease (GUD) is regarded as the most difficult conundrum for clinicians, as valid and rapid methods to diagnose them are limited, especially in India. The sexual behavior of an individual plays a role in the causation of GUD, and it depends on psychological, behavioral, and social well-being, which was significantly affected during the COVID-19 pandemic. Hence, the present study was undertaken to determine the etiology of genital ulcers by using simple, rapid microbiological methods and to study various factors associated with them. Materials and Methods Various rapid tests like staining (Giemsa, Gram, and Diff Quick) and serology for antibody detection were used to diagnose agents causing genital ulcers among 71 suspected patients during the study period of 1 year. After due informed consent, sociodemographic and behavioral factors were recorded in proforma and analyzed. Results Rapid tests could aid in diagnosing 47.9% of cases of GUD. Turnaround time was less than 60 minutes for all tests carried out. Genital herpes was the most common GUD followed by syphilis. Male gender (74.6%), age group of more than 34 years old (62%), literate (71.8%), and earning (70.4%) constituted most of the population presenting with GUD. Behavioral factors like promiscuity with a known person (83.1%) had a significant association (P 0.04) with GUD. Conclusion Rapid diagnostic tests could assist in the early treatment of GUD cases. Factors like literacy, financial independence, and promiscuity with known individuals were associated with GUD in our study during the COVID-19 pandemic.
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Affiliation(s)
- Dhanashree P. Inamdar
- Department of Microbiology, Mamata Medical College and Hospital, Khammam, Telangana, India
| | - Arun Kulkarni
- Department of Microbiology, Mamata Medical College and Hospital, Khammam, Telangana, India
| | - Anuradha Basavaraju
- Department of Microbiology, Mamata Medical College and Hospital, Khammam, Telangana, India
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2
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Fernando I, K Edwards S, Grover D. British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021). Int J STD AIDS 2022; 33:422-432. [PMID: 35312417 DOI: 10.1177/09564624211070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.
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Affiliation(s)
| | - Sarah K Edwards
- GU Medicine, 215332Cambridgeshire Community Services NHS Trust, Bury St Edmunds, UK
| | - Deepa Grover
- GUM/HIV Medicine, 4954Central and North West London NHS Foundation Trust, London, UK
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Edwards S, Boffa MJ, Janier M, Calzavara-Pinton P, Rovati C, Salavastru CM, Rongioletti F, Wollenberg A, Butacu AI, Skerlev M, Tiplica GS. 2020 European guideline on the management of genital molluscum contagiosum. J Eur Acad Dermatol Venereol 2020; 35:17-26. [PMID: 32881110 DOI: 10.1111/jdv.16856] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/17/2020] [Accepted: 07/30/2020] [Indexed: 01/05/2023]
Abstract
Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed 'mollusca', seen as dome-shaped, smooth-surfaced, pearly, firm, skin-coloured, pink, yellow or white papules, 2 - 5 mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.
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Affiliation(s)
| | - M J Boffa
- Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta
| | - M Janier
- STD Clinic, Hôpital Saint-Louis AP-HP and Hôpital Saint-Joseph, Paris, France
| | | | - C Rovati
- Dermatology Department, University of Brescia, Italy
| | - C M Salavastru
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - A Wollenberg
- Dept. of Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - A I Butacu
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - M Skerlev
- Zagreb University Hospital and Zagreb University School Of Medicine, Zagreb, Croatia
| | - G S Tiplica
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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4
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Rubaihayo J, Tumwesigye NM, Konde-Lule J. Trends in prevalence of selected opportunistic infections associated with HIV/AIDS in Uganda. BMC Infect Dis 2015; 15:187. [PMID: 25879621 PMCID: PMC4408591 DOI: 10.1186/s12879-015-0927-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/08/2015] [Indexed: 11/12/2022] Open
Abstract
Background After more than a decade of establishing and expanding access to highly active antiretroviral therapy (HAART), empirical evidence on its impact on trends of opportunistic infections (OIs) associated with the deadly human immunodeficiency virus (HIV) in resource poor settings is scarce. The primary objective of this study was to assess the effect of HAART coverage on trends of five most common OIs in Uganda. Methods Observational data from January 2002 to December 2013 for 5972 HIV positive individuals attending the AIDS Support Organisation (TASO) HIV/AIDS care programme in Uganda were extracted and analysed. Trends were analysed using autoregressive moving average time series and mixed effects linear regression models adjusting for all available potential confounders. Results A total of 204,871 monthly medical reports were retrieved and analysed. Majority of the participants were female (73%) with a median age of 32 years (inter-quartile range 26–39). Overall, significant decreasing mean annual prevalence trends were observed for Mycobacterium tuberculosis, herpes zoster, genital ulcer and oral candidiasis (p < 0.05, X2trend). Non-significant declining mean annual prevalence trend was observed for cryptococcal meningitis (p = 0.181, X2trend). The largest impact of HAART was observed in Oral candidiasis and TB whose average annual prevalence reduced by 61% and 43% respectively following the introduction of HAART. Monthly series for TB, Herpes zoster and genital ulcers differed significantly by age and clinic but only genital ulcer series differed significantly by sex (p < 0.05, kruskal wallis). After controlling for the effects of age, sex and clinic (fixed) and monthly clustering (random effect) in a mixed effects linear regression model, all the five OIs showed a significant monthly change in prevalence (p < 0.001). Conclusion Overall, prevalence of most OIs declined especially after the introduction of HAART. However significant variations exist in the trends of different OIs in different geographical areas in Uganda. It is therefore important that site specific factors are properly identified to enable the development of targeted interventions.
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Affiliation(s)
- John Rubaihayo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. .,Department of Public Health, School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda.
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Joseph Konde-Lule
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
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Hochberg CH, Schneider JA, Dandona R, Lakshmi V, Kumar GA, Sudha T, Akbar M, Ahmed GMM, Ramgopal SP, Armbruster B, Alary M, Dandona L. Population and dyadic-based seroincidence of herpes simplex virus-2 and syphilis in southern India. Sex Transm Infect 2015; 91:375-82. [PMID: 25605970 PMCID: PMC4518737 DOI: 10.1136/sextrans-2014-051708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/24/2014] [Indexed: 11/11/2022] Open
Abstract
Objectives Herpes simplex virus-2 (HSV-2) and syphilis are associated with increased risk of HIV, highlighting the importance of understanding their transmission dynamics. In India, most studies of HSV-2 and syphilis incidence are in high-risk populations and may not accurately reflect infectious activity. In this study, we aim to define HSV-2/syphilis incidence and risk factors in a population sample. Methods We conducted a longitudinal population-based survey in Andhra Pradesh, India, in two rounds: 2004–2005 and 2010–2011. Sociodemographic and behavioural data were collected, and dried blood spots tested for HSV-2 and Treponema pallidum IgG. After calculating sexually transmitted infection (STI) incidence, associated factors were assessed using modified Poisson regression and within-couple transmission rates modelled using seroconcordance/discordance data. Results 12 617 adults participated at baseline with 8494 at follow-up. Incidence of HSV-2 and syphilis per 1000 person-years was 25.6 (95% CI 24.1 to 27.2) and 3.00 (95% CI 2.52 to 3.54). Incidence of HSV-2 was higher in women vs men (31.1 vs 20.2) and in rural vs urban residents (31.1 vs 19.0) (p<0.05 for both). STI seroincidence increased in a step-wise fashion with age and was associated with spousal seropositivity for both sexes (incidence rate ratio (IRR) 2.59 to 6.78). Within couples the rate of transmission per 1000 couple-years from men to women vs women to men was higher for HSV-2 (193.3 vs 119.0) compared with syphilis (27.6 vs 198.8), p<0.05 for both. Conclusions HSV-2 has higher incidence among subpopulations such as women, rural residents and older-aged individuals, suggesting a need for more generalised STI prevention approaches among populations traditionally considered low risk.
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Affiliation(s)
- Chad H Hochberg
- Pritzker School of Medicine, University of Chicago Chicago, Illinois, USA
| | - John A Schneider
- Department of Medicine and Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | | | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Talasila Sudha
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | | | | | - Michel Alary
- Département de médecine sociale et préventive, URESP, Centre de recherche du CHU de Québec, Université Laval, Québec, Canada
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Fernando I, Pritchard J, Edwards SK, Grover D. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS 2014; 26:687-95. [PMID: 25332225 DOI: 10.1177/0956462414554435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jill Pritchard
- Sexual Health Ashford and St Peter's Hospital, Chertsey, Surrey, UK
| | - Sarah K Edwards
- Sexual Health Cambridgeshire Community Services, Cambridgeshire, UK
| | - Deepa Grover
- Barnet General Hospital, Hertfordshire, UK Royal Free Hospital, London, UK
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Sethi S, Sarkar R, Garg V, Agarwal S. Squamous cell carcinoma complicating donovanosis not a thing of the past! Int J STD AIDS 2014; 25:894-7. [PMID: 24554002 DOI: 10.1177/0956462414524560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Donovanosis causes granulomatous ulceration of genitalia and neighbouring sites with little tendency to heal spontaneously. It is uncommonly seen nowadays in sexually transmitted infection clinics of north India. The present case is reported for its scarcity and to make clinicians aware of this disease which may rarely accompany carcinoma.
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Affiliation(s)
- Sumit Sethi
- Department of Dermatology and Venereology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Rashmi Sarkar
- Department of Dermatology and Venereology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Vijay Garg
- Department of Dermatology and Venereology, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
| | - Shipra Agarwal
- Deparment of Pathology, Maulana Azad Medical College and Associated Hospital, New Delhi, India
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8
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Muralidhar S, Talwar R, Anil Kumar D, Kumar J, Bala M, Khan N, Ramesh V. Genital Ulcer Disease: How Worrisome Is It Today? A Status Report from New Delhi, India. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:203636. [PMID: 26316954 PMCID: PMC4437428 DOI: 10.1155/2013/203636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/07/2013] [Accepted: 03/15/2013] [Indexed: 11/30/2022]
Abstract
Background and Objectives. Genital ulcer diseases represent a diagnostic dilemma, especially in India, where few STI clinics have access to reliable laboratory facility. The changing STI trends require that a correct diagnosis be made in order to institute appropriate treatment and formulate control policies. The objective of this study was to determine recent trends in aetiology of genital ulcers, by using accurate diagnostic tools. Methods. Specimens from 90 ulcer patients were processed for dark field microscopy, stained smears, culture for H. ducreyi, and real-time PCR. Blood samples were collected for serological tests. Results. Prevalence of GUD was 7.45 with mean age at initial sexual experience as 19.2 years. Use of condom with regular and nonregular partners was 19.5% and 42.1%, respectively. Sexual orientation was heterosexual (92.2%) or homosexual (2.2%). There were 8 cases positive for HIV (8.9%). Herpes simplex virus ulcers were the commonest, followed by syphilis and chancroid. There were no cases of donovanosis and LGV. Conclusions. A valuable contribution of this study was in validating clinical and syndromic diagnoses of genital ulcers with an accurate aetiological diagnosis. Such reliable data will aid treatment and better define control measures of common agents and help eliminate diseases amenable to elimination, like donovanosis.
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Affiliation(s)
- Sumathi Muralidhar
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Richa Talwar
- Department of Community Medicine, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi 110029, India
| | - Deepa Anil Kumar
- Department of Microbiology, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi 110025, India
| | - Joginder Kumar
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Manju Bala
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Nilofar Khan
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - V. Ramesh
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
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Choudhry S, Ramachandran VG, Das S, Bhattacharya SN, Mogha NS. Pattern of sexually transmitted infections and performance of syndromic management against etiological diagnosis in patients attending the sexually transmitted infection clinic of a tertiary care hospital. Indian J Sex Transm Dis AIDS 2010; 31:104-8. [PMID: 21716796 PMCID: PMC3122595 DOI: 10.4103/0253-7184.74998] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The availability of baseline information on the epidemiology of sexually transmitted infections (STIs) and other associated risk behaviors is essential for designing, implementing, and monitoring successful targeted interventions. Also, continuous analysis of risk assessment and prevalence-based screening studies are necessary to evaluate and monitor the performance of syndromic management. The aim of the present study was to document the pattern of common STIs and to evaluate the performance of syndromic case management against their laboratory diagnoses. MATERIALS AND METHODS Three hundred consecutive patients who attended the STI clinic of a tertiary care hospital at Delhi, with one or more of the complaints as enunciated by WHO in its syndromic approach for the diagnosis of STIs, were included as subjects. Detailed history, demographical data, and clinical features were recorded and screened for common STIs by standard microbiological methods. RESULTS The mean age was 24 years and most of the male patients were promiscuous and had contact with commercial sex workers (CSWs 63.9%). Majority came with the complaint of genital discharge (63 males; 54 females) followed by genital ulcer (61 males; 30 females). Genital herpes accounted for the maximum number of STI (86/300) followed by syphilis (71/300). The sensitivity of genital discharge syndrome (GDS) was high for Neisseria gonorrhoeae and Chlamydia trachomatis (96% and 91%, respectively) while specificity was low (76% and 72%, respectively). The sensitivity of genital ulcer syndrome for herpes simplex virus-2 (HSV-2) and Treponema pallidum was 82.65% and 81.2%, respectively, while specificity reached 99% approximately. CONCLUSIONS Viral STIs constitute the major burden of the STI clinic and enhance the susceptibility of an individual to acquire or transmit HIV through sexual contact. Syndromic algorithms have some shortcomings, and they need to be periodically reviewed and adapted to the epidemiological patterns of STI in a given setting.
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Affiliation(s)
- Shilpee Choudhry
- Department of Microbiology, UCMS & GTB Hospital, Dilshad Garden, Delhi, India
| | - V. G. Ramachandran
- Department of Microbiology, UCMS & GTB Hospital, Dilshad Garden, Delhi, India
| | - Shukla Das
- Department of Microbiology, UCMS & GTB Hospital, Dilshad Garden, Delhi, India
| | - S. N. Bhattacharya
- Department of Dermatology and STD, UCMS & GTB Hospital, Dilshad Garden, Delhi, India
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Schneider JA, Lakshmi V, Dandona R, Kumar GA, Sudha T, Dandona L. Population-based seroprevalence of HSV-2 and syphilis in Andhra Pradesh state of India. BMC Infect Dis 2010; 10:59. [PMID: 20214795 PMCID: PMC2848152 DOI: 10.1186/1471-2334-10-59] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 03/09/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Understanding the prevalence and risk factors for common causes of ulcerative genital disease in the general population would inform current STI syndromic management and HIV testing strategies in high HIV prevalence regions of India. METHODS Persons 15-49 years old from 32 rural and 34 urban clusters were sampled using a stratified random method to represent adults in the high HIV prevalence Guntur district in Andhra Pradesh state. Interviews were conducted and dry blood spots were collected on 12,617 study participants. Testing for HSV-2 and syphilis was performed. RESULTS Adjusted HSV-2 and syphilis seroprevalence rates were 4.70% and 2.08% for men and 7.07% and 1.42% for women. For men, tattooing, >3 lifetime sex partners, tobacco use, and sex with men in the past 6 months were associated with HSV-2 or syphilis (ORs, 1.66-2.95, p < 0.05). Male circumcision was positively associated with HSV-2 infection (OR, 1.37, p = 0.028) though this could be due to residual confounding. In women, greater than one lifetime partner remained significantly associated with HSV-2 in multivariate analysis (OR, 2.61; 95% CI, 1.39-4.87). Among all behavioral risk factors and other covariates in women and men, HIV infection exhibited the strongest association with HSV-2 and syphilis (ORs, 8.2-14.2, p < 0.001). The proportion of individuals with HSV-2 who were HIV infected was less than the proportion with syphilis who were HIV infected (11.8% vs. 22.7%; p = 0.001). CONCLUSIONS Nearly one in four persons surveyed in this population-based study that were seroprevalent for syphilis, were also HIV infected. Common population risk factors for syphilis, HSV-2 and HIV and high rates of co-seroprevalence suggest that HIV testing, STI testing and service strategies for these would benefit from direct linkage in India.
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Affiliation(s)
- John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Health Studies, University of Chicago, Chicago, IL, USA
| | - Vemu Lakshmi
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
- School of Public Health and George Institute for International Health, University of Sydney, Sydney, Australia
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
| | - Talasila Sudha
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- George Institute for International Health - India, Hyderabad, India
- School of Public Health and George Institute for International Health, University of Sydney, Sydney, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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11
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Al-Mutairi N, Joshi A, Nour-Eldin O, Sharma AK, El-Adawy I, Rijhwani M. Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait. Int J Dermatol 2007; 46:594-9. [PMID: 17550558 DOI: 10.1111/j.1365-4632.2007.02843.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait. METHODS All patients seen over a 1-year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients. RESULTS One thousand and ninety-six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21-40-year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%. CONCLUSIONS Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.
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Affiliation(s)
- Nawaf Al-Mutairi
- Department of Dermatology, Farwaniya Hospital, Farwaniya, Kuwait.
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12
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Abstract
Donovanosis, a chronic cause of genital ulceration, has recently been the subject of renewed interest after a long period of relative obscurity. The causative organism, Calymmatobacterium granulomatis, has been cultured for the first time in many years and a polymerase chain reaction diagnostic using a colorimetric detection system has been developed. Phylogenetic analysis confirms close similarities with the genus Klebsiella and a proposal made that C granulomatis be reclassified as Klebsiella granulomatis comb nov. Azithromycin has emerged as the drug of choice and should be used if the diagnosis is confirmed or suspected. In donovanosis endemic areas, syndromic management protocols for genital ulceration may need to be adapted locally. A significant donovanosis epidemic was reported in Durban from 1988-97 but the current status of this epidemic is unclear. The donovanosis elimination programme among Aboriginals in Australia appears successful and is a model that could be adopted in other donovanosis endemic areas. Overall, the incidence of donovanosis seems to be decreasing. Increased attention would undoubtedly be paid to donovanosis if policy makers recognised more readily the importance of genital ulcers in fuelling the HIV epidemic.
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