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Jama M, Owen EM, Nahal B, Obasi A, Clarke E. Twenty years of herpes simplex virus type 2 (HSV-2) research in low-income and middle-income countries: systematic evaluation of progress made in addressing WHO prioritiesfor research in HSV-2 epidemiology and diagnostics. BMJ Glob Health 2024; 9:e012717. [PMID: 38964879 PMCID: PMC11227754 DOI: 10.1136/bmjgh-2023-012717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 02/22/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Low-income and middle-income countries (LMICs) have a high burden of herpes simplex virus type 2 (HSV-2) infection, which has been strongly associated with HIV. In 2001, the WHO hosted a workshop to set research priorities for HSV-2 in LMICs. Periodic re-evaluation of research priorities is essential to ensure effective allocation of resources. This study describes the progress made between 2000 and 2020 in addressing the priorities identified in two of the five thematic areas that were the workshop's focus: HSV-2 epidemiology and diagnostics. The remaining areas are addressed in a companion paper. METHODS A systematic search of MEDLINE, CINAHL, Global Health and Cochrane databases was carried out. Relevant primary and secondary research studies conducted in LMICs, written in English and published from 2000-2020 were included. Two independent researchers screened, identified papers and extracted preidentified variables from study texts. Data were organised into an Excel spreadsheet and analysed using IBM SPSS V.26. RESULTS Overall, 4445 discrete papers were identified, of which 165 publications were eligible for inclusion. The highest general population HSV-2 prevalence was reported in South and West Africa. Prevalence was higher among women than men and increased with age. HSV-2 prevalence studies among key populations were few, and the majority were in East and South Asia. Cohort studies of HSV-2 incidence among younger populations (mean age=25 years) and HSV-2 infection prevalence in North Africa and the Middle East were few. The most researched topic in HSV-2 diagnostics addressed serological techniques and direct molecular biology. Studies of point-of-care testing were also few. CONCLUSION HSV-2 research identified in LMICs has mainly addressed the epidemiology and diagnostics priorities identified by the 2001 WHO workshop. Unaddressed priorities include point-of-care testing, antiviral resistance and exploration of HSV-2 epidemiology in neglected geographical settings and population subgroups.
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Affiliation(s)
- Muna Jama
- Liverpool School of Tropical Medicine, Liverpool, UK
- International Rescue Committee, Mogadishu, Somalia
| | - Ela Mair Owen
- Liverpool School of Tropical Medicine, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Belinder Nahal
- University of Liverpool, Liverpool, UK
- London School of Hygiene & Tropical Medicine, London, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Emily Clarke
- University of Liverpool, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Sureram S, Arduino I, Ueoka R, Rittà M, Francese R, Srivibool R, Darshana D, Piel J, Ruchirawat S, Muratori L, Lembo D, Kittakoop P, Donalisio M. The Peptide A-3302-B Isolated from a Marine Bacterium Micromonospora sp. Inhibits HSV-2 Infection by Preventing the Viral Egress from Host Cells. Int J Mol Sci 2022; 23:947. [PMID: 35055133 PMCID: PMC8778767 DOI: 10.3390/ijms23020947] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Herpesviruses are highly prevalent in the human population, and frequent reactivations occur throughout life. Despite antiviral drugs against herpetic infections, the increasing appearance of drug-resistant viral strains and their adverse effects prompt the research of novel antiherpetic drugs for treating lesions. Peptides obtained from natural sources have recently become of particular interest for antiviral therapy applications. In this work, we investigated the antiviral activity of the peptide A-3302-B, isolated from a marine bacterium, Micromonospora sp., strain MAG 9-7, against herpes simplex virus type 1, type 2, and human cytomegalovirus. Results showed that the peptide exerted a specific inhibitory activity against HSV-2 with an EC50 value of 14 μM. Specific antiviral assays were performed to investigate the mechanism of action of A-3302-B. We demonstrated that the peptide did not affect the expression of viral proteins, but it inhibited the late events of the HSV-2 replicative cycle. In detail, it reduced the cell-to-cell virus spread and the transmission of the extracellular free virus by preventing the egress of HSV-2 progeny from the infected cells. The dual antiviral and previously reported anti-inflammatory activities of A-3302-B, and its effect against an acyclovir-resistant HSV-2 strain are attractive features for developing a therapeutic to reduce the transmission of HSV-2 infections.
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Affiliation(s)
- Sanya Sureram
- Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand; (S.S.); (S.R.)
| | - Irene Arduino
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (I.A.); (M.R.); (R.F.); (D.L.)
| | - Reiko Ueoka
- Institute of Microbiology, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland; (R.U.); (J.P.)
| | - Massimo Rittà
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (I.A.); (M.R.); (R.F.); (D.L.)
| | - Rachele Francese
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (I.A.); (M.R.); (R.F.); (D.L.)
| | | | - Dhanushka Darshana
- Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand;
| | - Jörn Piel
- Institute of Microbiology, ETH Zurich, Vladimir-Prelog-Weg 4, 8093 Zurich, Switzerland; (R.U.); (J.P.)
| | - Somsak Ruchirawat
- Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand; (S.S.); (S.R.)
- Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand;
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, Ministry of Higher Education, Science, Research and Innovation, Bangkok 10210, Thailand
| | - Luisa Muratori
- Department of Clinical and Biological Sciences, Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Turin, 10043 Orbassano, Italy;
| | - David Lembo
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (I.A.); (M.R.); (R.F.); (D.L.)
| | - Prasat Kittakoop
- Chulabhorn Research Institute, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand; (S.S.); (S.R.)
- Program in Chemical Sciences, Chulabhorn Graduate Institute, Chulabhorn Royal Academy, Kamphaeng Phet 6 Road, Laksi, Bangkok 10210, Thailand;
- Center of Excellence on Environmental Health and Toxicology (EHT), OPS, Ministry of Higher Education, Science, Research and Innovation, Bangkok 10210, Thailand
| | - Manuela Donalisio
- Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy; (I.A.); (M.R.); (R.F.); (D.L.)
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Gupta E, Singh M, Saini S, Goyal P, Goswami S. Prevalence and risks of reproductive tract infections among women of urban slums in North India: A cross-sectional study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2022. [DOI: 10.4103/2305-0500.361221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Roy A, Dadwal R, Yadav R, Singh P, Krishnamoorthi S, Dasgupta A, Chakraborti A, Sethi S. Association of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Ureaplasma species infection and organism load with cervicitis in north Indian population. Lett Appl Microbiol 2021; 73:506-514. [PMID: 34089202 DOI: 10.1111/lam.13520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
Cervicitis is predominantly caused by Neisseria gonorrhoeae and Chlamydia trachomatis, which accounts for almost half of all the cases of cervicitis. The role of newer organisms like Mycoplasma genitalium and Ureaplasma sp. and association of bacterial load with cervicitis are also not well established. So the study aimed to determine the relative frequency of these organisms and their load in association with cervicitis cases from north India. A case-control study involving 300 women was conducted using quantitative real-time PCR from endocervical swabs for identification of organisms and quantification of bacterial load. Among 150 cervicitis cases, C. trachomatis, N. gonorrhoeae, M. genitalium and Ureaplasma parvum were detected in 5 (3·3%), 10 (6·6%), 37(24·6%) and 47 (31·3%) respectively. Old age (<0·001, chi-squared test) and irregular menstrual cycles (<0·001, chi-squared test) were significantly associated with cervicitis. M genitalium was the only organism to be associated significantly with cervicitis with regard to age (<0·031) and symptoms like discharge (P < 0·033, chi-squared test) and dysuria (P < 0·044, chi-squared test) in multivariate analysis. Our finding suggests that the bacterial load of these organisms is not significantly associated with cervicitis. However, we found significant association of M. genitalium infection with clinical characteristics of cervicitis cases.
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Affiliation(s)
- A Roy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Dadwal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - R Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P Singh
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - S Krishnamoorthi
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bathinda, Punjab, India
| | - A Dasgupta
- Department of Biochemistry, Sharda University, Greater Noida, Uttar Pradesh, India
| | - A Chakraborti
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh S, Saha R, Suneja A, Das S. A hospital-based study on the prevalence of trichomoniasis and evaluation of accuracy of various diagnostic techniques. Trop Parasitol 2021; 10:124-129. [PMID: 33747880 PMCID: PMC7951069 DOI: 10.4103/tp.tp_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The sexually transmitted infections (STIs) caused by Trichomonas vaginalis have been associated with adverse pregnancy outcomes and increased risk of HIV transmission. Trichomoniasis remains underreported despite being easy to diagnose and treat. Moreover, availability of battery of diagnostic tools causes dilemma on the most appropriate techniques to be used. Aims and Objectives: The purpose of this study was to determine the prevalence of T. vaginalis and its diagnostic accuracy employing various diagnostic techniques in women presenting with vaginal discharge in gynecological outpatient department (GOPD) of our tertiary care hospital. Materials and Methods: Five vaginal swabs were collected from 204 patients with symptomatic vaginal discharge attending GOPD. Wet mount microscopy, Giemsa and acridine orange staining, culture in Kupferberg media and InPouch™ TV culture system, and polymerase chain reaction (PCR) were performed and compared. Results: The prevalence of T. vaginalis was 1.96% in the present study. Wet mount microscopy, staining method, and culture detected 1.96% of cases, whereas PCR detected 2.45% of cases. Conclusion: The prevalence of T. vaginalis was <3% among symptomatic vaginal discharge patients from GOPD. Although PCR had a higher detection rate, there was no significant difference in sensitivity and specificity between other diagnostic methods (direct wet mount, Giemsa/acridine orange staining, and InPouch™ TV culture system). Hence, the availability in a particular setting would determine the methods of choice to be used for the diagnosis of T. vaginalis.
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Affiliation(s)
- Sweety Singh
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
| | - Rumpa Saha
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
| | - Amita Suneja
- Department of Gynaecology and Obstetrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi University, Delhi, India
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Goel S, Chopra D, Choudhary V, Riyat A, Chopra S. Changing trends of sexually transmitted infections and estimation of partner notification at a tertiary care center in North India. Indian J Sex Transm Dis AIDS 2020; 41:176-180. [PMID: 33817590 PMCID: PMC8000662 DOI: 10.4103/ijstd.ijstd_10_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/20/2019] [Accepted: 01/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background Sexually transmitted infections (STIs) are dynamic and show a variable prevalence in different parts of the country. Moreover, the prevalence changes with time in the same geographical area. It is important to have the knowledge of current trend of STIs and partner notification (PN) rate in a particular area for the effective implementation of preventive and control measures. Aims This study aimed to assess the changing demographic and clinical trends of STIs in the patients attending a tertiary care center in North India. Materials and Methods This study was conducted at STI clinic located at a tertiary care center in North India. All the patients visiting STI clinic over a 5-year period from January 1, 2013, to December 31, 2017, were included in our study. Diseases were diagnosed on the basis of detailed history, clinical examination, and relevant investigations, and PN was done using the patient-oriented notification method. Results The most common STI affected age group was 25-44 years (45.11%), and the most common STI noted was candidal balanoposthitis in males (19.49%) and candidal vaginal discharge in females (20.54%), followed by herpes genitalis (15.04%) and condylomata acuminata (14.66%) in both the genders. Bacterial STIs such as syphilis (1.58%), lymphogranuloma venereum (0.45%), and chancroid (0.39%) were less common. The average PN rate was 42.48%. Conclusion In the present study, fungal and viral STIs showed an upward trend, whereas bacterial STIs such as syphilis and chancroid demonstrated a declining trend. The measures to improve PN are urgently required for both cure and the prevention of STIs.
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Affiliation(s)
- Seema Goel
- Department of Dermatology Venereology and Leprology, Government Medical College, Patiala, Punjab, India
| | - Dimple Chopra
- Department of Dermatology Venereology and Leprology, Government Medical College, Patiala, Punjab, India
| | - Vivek Choudhary
- Department of Dermatology Venereology and Leprology, Government Medical College, Patiala, Punjab, India
| | - Amandeep Riyat
- Department of Dermatology Venereology and Leprology, Government Medical College, Patiala, Punjab, India
| | - Siddharth Chopra
- Department of Dermatology Venereology and Leprology, Government Medical College, Patiala, Punjab, India
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Mallik A, Das N, Mukherjee S, Datta S. A systematic review and meta-analysis of different diagnostic procedures to detect gonococcus infection in resource-limited scenario. Indian J Med Microbiol 2020; 38:299-306. [PMID: 33154239 DOI: 10.4103/ijmm.ijmm_20_312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Neisseria gonorrhoeae is a Gram-negative diplococcus, an obligate human pathogen, and the etiologic agent of the sexually transmitted infection (STI), gonorrhoea. culture is the standard procedure for diagnosis, which may be supported by nucleic acid tests and microscopy. Aims To determine the best possible method of diagnosis for Gonococcus infection in resource-limited settings. Settings and Design The meta-analyses were designed to determine the difference in diagnosis between Culture and nucleic acid amplification tests (NAATs) and also between the different Amplification Tests and widely available Roche COBAS AMPLICOR test. Subjects and Methods Databases searched were Pubmed, Medline, Google Scholar and Cochrane reviews. Risk ratio (RR) with 95% confidence intervals was estimated for the dichotomous outcomes. The random-effect model was applied for all the studies in the analysis. Statistical Analysis Used The meta-analysis was computed in RevMan Version 5.3, Copenhagen, Denmark. Results In the first analysis, NAATs significantly improved the chances of detection in comparison to the standard culture and final RR was 1.24 (1.05-2.51), which put the diamond on the right of no-effect axis, indicating more positives by NAATs. In the second analysis, AMPLICOR had the more positive results, which may have indicated better detection rate, as well as less specificity and final RR was 0.809 (0.737-0.888), which put the diamond on the left of the non-effect axis, indicating more positives by AMPLICOR. Conclusions In a resource-limited scenario like India, the syndromic management of STIs are considered to be the norm. A positive diagnosis is only given if the tests are confirmed by Culture, as it is still considered to be the gold standard of diagnosis. However, in many cases, due to suboptimal transportation and lack of proper handling, culture in unable to grow even if the patient is infected. In such cases, Nucleic Acid Tests should be able to detect an infection.
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Affiliation(s)
- Aromita Mallik
- Department of Biotechnology, Amity University, Kolkata, West Bengal, India
| | - Nibedita Das
- Regional STI Laboratory, Institute of Serology, Kolkata, West Bengal, India
| | - Swati Mukherjee
- Regional STI Laboratory, Institute of Serology, Kolkata, West Bengal, India
| | - Shibani Datta
- Department of Health Promotion and Education, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
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Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Men in Moshi District of Tanzania. AIDS Res Treat 2020; 2020:7607834. [PMID: 32089879 PMCID: PMC7029278 DOI: 10.1155/2020/7607834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022] Open
Abstract
The syndromic diagnosis of sexually transmitted infections (STIs) is widely recognized as the most practical, feasible, and cost-effective diagnostic tool in resource-limited settings. This study assessed the diagnostic accuracy of syndromic versus laboratory testing of STIs among 794 men randomly selected from the Moshi district of Tanzania. Participants were interviewed with a questionnaire that included questions on history of STIs symptoms. Blood and urine samples were taken from the participants for laboratory testing. Only 7.9% of the men reported any symptoms of STI; however, 46% of them tested positive for at least one STI. There was little agreement between syndromic and laboratory-confirmed diagnoses, with low sensitivity (0.4%–7.4%) and high specificity (96%–100%) observed for each individual symptom. The area under the receiver-operating curve was 0.528 (95% CI: 0.505–0.550), indicating that the syndromic approach has a 52.8% probability of correctly identifying STIs in study participants. In conclusion, whenever possible, laboratory diagnosis of STI should be favored over syndromic diagnosis.
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Chaudhary N, Kalyan R, Singh M, Agarwal J, Qureshi S. Prevalence of reproductive tract infections in women attending a tertiary care center in Northern India with special focus on associated risk factors. Indian J Sex Transm Dis AIDS 2020; 40:113-119. [PMID: 31922100 PMCID: PMC6896375 DOI: 10.4103/ijstd.ijstd_17_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Reproductive tract infections (RTIs) continue to present major health, social, and economic problems worldwide, and their complications are the most important causes of morbidity and mortality for women, especially in developing countries. Interest in RTIs and their management has increased tremendously because the presence of a RTI in the sexual partner increases the risk of acquisition of HIV. Aims: The aim of this study is to know the prevalence of RTIs, its correlation with clinical features and associated risk factors in women of reproductive age group attending a tertiary care center in Lucknow. Materials and Methods: The present study was conducted on 318 women of the reproductive age group (18–45 years) attending the RTI/sexually transmitted infection clinic at our center; they were evaluated for the prevalence of following RTIs: Chlamydia, gonorrhea, syphilis, bacterial vaginosis, trichomoniasis, and candidiasis; their correlation with clinical features and associated risk factors. Results: The prevalence of reproductive tract infections in women attending our centre reported 9.7%. The prevalence of candidiasis was maximum (11.5%) followed by chlamydia (4.1%), syphilis (4.1%), bacterial vaginosis (1.73%), and trichomoniasis (0.57%). None of the women were found positive for gonorrhea. The most common presentation was genital discharge (52.8%) followed by lower abdominal pain (45.2%). Conclusion: The factors found to be significantly associated with RTI were illiteracy (P < 0.05), unemployment (P < 0.05), history of RTI in patient (P = 0.001), and the presence of RTI in their partner (P < 0.05). The genital discharge was the most common presentation.
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Affiliation(s)
- Nisha Chaudhary
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rajkumar Kalyan
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mastan Singh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jyotsna Agarwal
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sabuhi Qureshi
- Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Tarrahi MJ, Kianersi S, Nasirian M. Latent class analysis of symptoms for sexually transmitted infections among Iranian women: Results from a population-based survey. Health Care Women Int 2019; 41:461-475. [PMID: 30689520 DOI: 10.1080/07399332.2019.1566335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A preliminary symptom-based screening test would lower the financial burden of sexually transmitted infections (STIs) caused by clinical testing. To develop such a screening method, we should first identify the most specific STI symptoms. We aim to distinguish the specific STI symptom(s) that are most likely to be found in the truly infected individuals. We used data from a population-based survey that was conducted in Iran, in 2014. Using Latent Class Analysis (LCA) in R software, we classified 3049 Iranian women, 18-60 years old, with reference to seven self-reported STI-associated symptoms. Using LCA, we categorized nearly 1% of women as "probably STI-infected". Above 70% of participants reported the "seven symptoms" that are associated with STIs, except for genital ulcer. These symptoms could be used to distinguish healthy participants from infected ones. The "probably healthy" class incorporated about 77% of the participants. Lower abdominal pain and abnormal vaginal discharge were the most frequently reported symptoms of this class. The LCA determined classes along with the WHO syndromic guidelines for STI diagnosis can help physicians to make a more accurate diagnosis. Hence, cost-effectively, only patients who are classified as probably infected need to be referred to medical laboratories for further investigations.
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Affiliation(s)
- Mohammad Javad Tarrahi
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Nasirian
- Epidemiology and Biostatistics Department, Health School, Isfahan University of Medical Sciences, Isfahan, Iran
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Okoboi S, Castelnuovo B, Moore DM, Musaazi J, Kambugu A, Birungi J, Nanfuka M, Van Rie A. Incidence rate of sexually transmitted infections among HIV infected patients on long-term ART in an urban and a rural clinic in Uganda. BMC Public Health 2019; 19:87. [PMID: 30658611 PMCID: PMC6339266 DOI: 10.1186/s12889-019-6417-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/08/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND HIV immunosuppression increases susceptibility to other STIs and STIs can enhance HIV transmission, reduce CD4 cell count and increase viral load. Co-infections of HIV and STIs may thus reduce the preventive benefits of ART. Little is known about the incidence rate of STIs among long-term patients on ART. METHOD We conducted a secondary data analysis of all patients enrolled in a rural and an urban longitudinal cohort studies who initiated ART between April 2003 and July 2007 followed up to 2016. Patients were screened for STI every three months using "a syndromic and case management approaches". STI incidence rate, was defined as the number of new cases per population at risk over the follow-up review period. We performed a time-to-event and Kaplan Meier analysis. We used a multivariable Cox proportional hazards regression model to assess for factors associated with STI incidence. RESULT Of 1012 participants, 402 (39.8%) were urban and 610 (60.2%) rural residents. Mean age was 42.8 years (SD 8.5). The total number of follow up time was 44,304 person years. We observed STI incidence rate of 2.1 per 1000 person-years after follow-up. Rural residence (adjusted hazard ratio [aHR] 3.53, 95% CI: 1.95-6.39), younger age (aHR 2.05, 95% CI: 1.02-4.12 for 18-34 years and aHR 1.65, 95% CI: 1.00-2.72 for 35-44 years) were factors associated with higher incidence of STIs. Being male (aHR 0.51, 95% CI: 0.27-0.93) was associated with a lower incidence of STIs. CONCLUSION We found STIs incidence rate of approximately 3 per 1000 person-years among patients on long-term (≥ 4 years) ART followed up-to 3.5 years. Rural and younger persons on ART should be routinely screened for STIs because high incidence of STIs may undo the preventative effects of ART for all.
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Affiliation(s)
- Stephen Okoboi
- Infectious Diseases Institute; College of Health Sciences, Makerere University, P.O BOX 22418, Kampala, Uganda
- Global Health Institute; University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Barbara Castelnuovo
- Infectious Diseases Institute; College of Health Sciences, Makerere University, P.O BOX 22418, Kampala, Uganda
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Joseph Musaazi
- Infectious Diseases Institute; College of Health Sciences, Makerere University, P.O BOX 22418, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute; College of Health Sciences, Makerere University, P.O BOX 22418, Kampala, Uganda
| | | | | | - Annelies Van Rie
- Global Health Institute; University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Ghosh I, Paul B, Das N, Bandyopadhyay D, Chakrabarti MK. Etiology of Vaginal/Cervical Discharge Syndrome: Analysis of Data from a Referral Laboratory in Eastern India. Indian J Dermatol 2018; 63:484-489. [PMID: 30504977 PMCID: PMC6233047 DOI: 10.4103/ijd.ijd_296_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) constitute important public health problem worldwide. Syndromic diagnosis of vaginal/cervical discharge (VCD) is often inaccurate leading to over- or under-treatment. Aims This study aimed to ascertain the laboratory-confirmed diagnosis of VCD and their relative frequency in a group of patients presenting to a STI clinic in eastern India and to determine the sensitivity and specificity of clinical diagnosis. Settings and Design This was a cross-sectional study. Materials and Methods Data of 5301 consecutive patients with VCD were analyzed for etiological diagnosis and the findings were compared with laboratory data of 3110 asymptomatic cases. Statistical Analysis Used Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical diagnosis of vaginal discharge syndrome were obtained considering the results of the laboratory diagnosis as gold standard. The strength of agreement was computed using Kappa statistic. Results Of 5301 cases of VCD, 90.83% had STI/RTIs. The most prevalent infection was trichomoniasis (35.23%), followed by bacterial vaginosis (33.05%) and vulvovaginal candidiasis (19.67%). Sensitivity, specificity, PPV, and NPV of vaginal discharge as an indicator of STI/RTI were 85.5%, 99.0%, 99.3%, and 80%, respectively, with agreement of 90.49% and kappa value of 0.8, indicating "almost perfect" agreement. Many cases with VCD also suffered from other STIs such as herpes simplex virus-2, hepatitis B, human immunodeficiency syndrome, and syphilis and some asymptomatic cases suffered from one or more STIs. Conclusions All patients with VCD with high-risk behavior should preferably undergo laboratory evaluation of the VCD syndrome to avoid over- or under-treatment.
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Affiliation(s)
- Ishita Ghosh
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Bandhan Paul
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Nibedita Das
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology and Leprosy, Medical College, Kolkata, West Bengal, India
| | - Manas Kumar Chakrabarti
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
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Sachdev D, Wasnik K, Patel AL, Sonkar SC, Desai P, Mania-Pramanik J, Kerkar S, Sethi S, Sharma N, Mittal P, Ghope P, Khandhari A, Saluja D. Multi-centric validation of an in-house-developed beacon-based PCR diagnostic assay kit for Chlamydia and Neisseria and portable fluorescence detector. J Med Microbiol 2018; 67:1287-1293. [PMID: 30051801 DOI: 10.1099/jmm.0.000803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The development of an accurate, sensitive, specific, rapid, reproducible, stable-at-room-temperature and cost-effective diagnostic kit, and a low-cost portable fluorescence detector to fulfil the requirements of diagnostic facilities in developing countries. METHODS We developed the 'Chlamy and Ness CT/NG kit' based on molecular beacons for the detection of Chlamydia trachomatis (CT) and Neisseriagonorrhoeae (NG). Multi-centric evaluation of the CT/NG kit was performed using the commercially available nucleic acid amplification test (NAAT)-based FTD Urethritis basic kit for comparison from December 2014 to November 2016. The stability of the kit reagents at 4 and 37 ˚C and the inter-day reproducibility of results were also analysed. RESULTS The sensitivity and specificity of the kit were found to be 95.83 and 100.00 % for the detection of C. trachomatis and 93.24 and 99.75 % for N. gonorrhoeae, respectively, when tested against the commercial kit. The positive predictive value (PPV) was 100.00 and 98.57 %, whereas the negative predictive value (NPV) was 99.54 and 98.79 % for C. trachomatis and N. gonorrhoeae, respectively. Analysis of the kappa statistics enhanced the 'inter-rater' κ=0.976 for Chlamydia and κ=0.943 for Neisseria. CONCLUSION Our kit was found to be as sensitive and specific as commercially available kits. Its low cost and ease of use will make it suitable for the routine diagnosis of C. trachomatis and N. gonorrhoeae in the resource-limited settings of developing countries.
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Affiliation(s)
- Divya Sachdev
- 1Dr B. R. Ambedkar Center for Biomedical research (ACBR), University of Delhi, Delhi 110007, India
| | - Kirti Wasnik
- 2DSS Imagetech Pvt Ltd, A5-Mohan Co-Op Industrial Estate, New Delhi 110044, India
| | - Achchhe Lal Patel
- 1Dr B. R. Ambedkar Center for Biomedical research (ACBR), University of Delhi, Delhi 110007, India
| | - Subash C Sonkar
- 1Dr B. R. Ambedkar Center for Biomedical research (ACBR), University of Delhi, Delhi 110007, India
- 3Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi 110029, India
| | - Parul Desai
- 2DSS Imagetech Pvt Ltd, A5-Mohan Co-Op Industrial Estate, New Delhi 110044, India
| | - Jayanti Mania-Pramanik
- 4Infectious Diseases Biology, ICMR National Institute for Research in Reproductive Health (NIRRH), Mumbai 400012, India
| | - Shilpa Kerkar
- 4Infectious Diseases Biology, ICMR National Institute for Research in Reproductive Health (NIRRH), Mumbai 400012, India
| | - Sunil Sethi
- 5Post Graduate Institute of Medical Education and Research (PGIMR), Chandigarh 160012, India
| | - Nandita Sharma
- 5Post Graduate Institute of Medical Education and Research (PGIMR), Chandigarh 160012, India
| | - Pratima Mittal
- 3Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi 110029, India
| | - Priti Ghope
- 3Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi 110029, India
| | - Ajay Khandhari
- 2DSS Imagetech Pvt Ltd, A5-Mohan Co-Op Industrial Estate, New Delhi 110044, India
| | - Daman Saluja
- 1Dr B. R. Ambedkar Center for Biomedical research (ACBR), University of Delhi, Delhi 110007, India
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Suvirya S, Shukla M, Pathania S, Singhal AK, Agarwal J. Clinico-epidemiological profile and high-risk sexual behavior among clients attending sexually transmitted infection clinic at a tertiary care hospital in North India. Indian J Sex Transm Dis AIDS 2018; 39:38-43. [PMID: 30187025 PMCID: PMC6111637 DOI: 10.4103/ijstd.ijstd_21_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Context: Sexually transmitted infections (STIs) are one of the most catastrophic events of health causing huge psychosocial and economic morbidity consequences. Aim: The study aims to study the clinico-epidemiological profile and high-risk sexual behavior among clients attending STI clinic at tertiary care hospital in North India. Materials and Methods: The present study was conducted at STI clinic, King George's Medical University, Lucknow, Uttar Pradesh. Data from 1283 clients attending STI clinic between August 2015 and July 2016 were compiled using master client register and STI/reproductive tract infection patient-wise register, and a final completed data set of these patients was analyzed according to the aims and objectives. Results: On analyzing the various factors associated with high-risk sexual behavior among clients attending STI clinic marital status, sexual preference and employment status were found to be significantly associated with high-risk sexual behavior (P < 0.05). On multivariate analysis, unmarried/divorced/widow/separated marital status (odds ratio [OR]: 14.72; 95% confidence interval [CI]: 1.89–114.17; P = 0.00) and unemployed status (OR: 6.10; 95% CI: 2.00–18.60; P = 0.02) were found to be independent predictors of high-risk sexual behavior (unprotected sex). Conclusions: Based on findings of study, it is highly recommended to provide periodic screening to these STI patients for assessment of their sexual behavior along with specific counseling session.
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Affiliation(s)
- Swastika Suvirya
- Department of Dermatology, Venereology and Leprosy, K.G. Medical University, Sitapur, Lucknow, Uttar Pradesh, India
| | - Mukesh Shukla
- Department of Community Medicine, Hind Institute of Medical Sciences, Sitapur, Lucknow, Uttar Pradesh, India
| | - Sucheta Pathania
- Department of Dermatology, Venereology and Leprosy, K.G. Medical University, Sitapur, Lucknow, Uttar Pradesh, India
| | | | - Jyotsana Agarwal
- Department of Microbiology, K.G. Medical University, Sitapur, Lucknow, Uttar Pradesh, India
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Das A, Ghosh P, Ghosh I, Bhattacharya R, Azad Sardar AK, Goswami S, Bandyopadhyay D, Das NK. Usefulness and Utility of NACO Regime in the Management of Sexually Transmitted Infections: A Pilot Study. Indian J Dermatol 2017; 62:630-634. [PMID: 29263538 PMCID: PMC5724312 DOI: 10.4103/ijd.ijd_114_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Treatment of sexually transmitted infections (STIs) has been made easy for field workers due to syndromic approach. The etiological agent responsible for different STI syndromes needs to be validated from time to time so as to guide the therapeutic regimen. Aims and Objectives The aim of this study was to evaluate the etiological agent for STI syndromes and correlate the syndromic diagnosis with etiological diagnosis. Materials and Methods The study was conducted over 9 months in all patients attending the STI and Gynaecology Outpatient Department. Syndromic diagnosis was done by STI-trained medical officer of respective clinic. Sample was collected for etiological diagnosis and subjected to relevant investigations. Data were analyzed by applying statistical methods. Results Among 308 patients (male:female = 1:3.5), no syndromic diagnosis could be made in 11 cases (all females and had premalignant changes on Pap smear). In 68 patients (22.08%), no etiological diagnosis could be arrived at (mostly genital ulcer disease [GUD]-herpetic [H] and vaginal discharge). In cervical discharge syndrome, six patients (16.7%) showed gonococcus. In GUD-H syndrome, 37 patients (27.027%) were tested positive. In GUD-nonherpetic syndrome, three patients (33.33%) were syphilis, granuloma inguinale, and chancroid (1 each). In urethral discharge syndrome, etiology could not be found in 33 cases (45.45%). In vaginal discharge syndrome (n = 217), etiologies were overlapping as follows: trichomonas vaginalis (76.04%), bacterial vaginosis (40%), gonococcus (24%), and undiagnosed (6.5%). Conclusion The present tool for validation of GUD-H can validate only 27% of cases. Overlap of etiologies is mostly common in vaginal discharge syndrome, wherein malignancies and premalignant conditions are overtreated with kits. Validation can be done only in two-third of cases with the available resources. However, syndromic approach provides the opportunity of treating STI without delay.
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Affiliation(s)
- Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Pramit Ghosh
- Department of Community Medicine, Medical College and Hospital, Kolkata, West Bengal, India
| | - Ishita Ghosh
- Institute of Serology, Kolkata, West Bengal, India
| | - Rittwika Bhattacharya
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, Kolkata, West Bengal, India
| | | | | | | | - Nilay Kanti Das
- Department of Dermatology, Bankura Sammilani Medical College, Bankura, West Bengal, India
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Sonkar SC, Wasnik K, Kumar A, Sharma V, Mittal P, Mishra PK, Bharadwaj M, Saluja D. Evaluating the utility of syndromic case management for three sexually transmitted infections in women visiting hospitals in Delhi, India. Sci Rep 2017; 7:1465. [PMID: 28469158 PMCID: PMC5431118 DOI: 10.1038/s41598-017-01422-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
Utility of syndromic case management (SCM) in women visiting obstetrics & gynecology department needs to be evaluated as it is subjective and imperfect. Consequently, antibiotic resistance has accelerated along with increased risk of infection to the partners. To understand the effectiveness and/or inadequacies of SCM, 11000 women were recruited and examined by clinicians for infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and others. Amongst these patients, 1797 (16.3%) reported vaginal discharge (VD). Other symptoms included: vaginitis (97%), cervicitis (75%), genital ulcers (60%), abnormal vaginal discharge (55%) and lower abdominal pain (48%). The patients were treated for single or co-infections using pre-packed National Aids Control Program III STI/RTI Kits. However, based on PCR diagnostics, 1453/1797 (81%) subjects were uninfected for NG/TV/CT. Amongst 344 (19%) infected patients, 257 (75%) carried infection with single pathogen (TV/NG/CT) while 87/344 (25%) were co-infected with multiple pathogens. Prevalence of TV, NG & CT was 4%, 7% and 8% respectively. Co-infection with CT + NG was highest, 51% (44/87), whereas, co-infection with CT + TV was 21% and NG + TV was 18% while co-infection with all three pathogens was 1.3%. We conclude that SCM is imprecise and successful intervention requires accurate and confirmatory diagnostic approach.
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Affiliation(s)
- Subash Chandra Sonkar
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Kirti Wasnik
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Anita Kumar
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vineeta Sharma
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Pratima Mittal
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Prashant Kumar Mishra
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Mausumi Bharadwaj
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Daman Saluja
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
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Chugh S, Garg VK, Sarkar R, Sardana K. Clinico-Epidemiological Profile of Viral Sexually Transmitted Infections in Seropositive Patients Attending a Tertiary Care Hospital in North India. J Int Assoc Provid AIDS Care 2017; 16:331-337. [PMID: 28043196 DOI: 10.1177/2325957416686196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sexually transmitted diseases are a major public health problem both in developing and in developed countries, and especially with the co-synergy with HIV infection, there is an increasing need to have a proper understanding of the clinicodemographic patterns of sexually transmitted infections (STIs) for planning and implementing control strategies. Worldwide, there is an increased preponderance of viral STIs. Increasing incidence and altered clinical presentation of viral STIs in patients with HIV pose a diagnostic challenge; thereby, we studied the demographic profile of HIV-seropositive patients and compared clinical manifestations of viral STIs in HIV-seropositive patients to those in seronegative individuals. Twenty-seven HIV-seropositive patients with viral STI (herpes/molluscum/warts) and same number of age-, sex-, and STI-matched seronegative patients were studied for variability in clinical profile. There were significant differences in the demographic factors (education, income, and migration) and sexual practices (number of contacts and source of infection) in the 2 groups. Lesional symptoms, increased extent of lesions, and resistance to treatment were significantly more common in HIV-seropositive patients.
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Affiliation(s)
- Shikha Chugh
- 1 Department of Dermatology, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Vijay Kumar Garg
- 1 Department of Dermatology, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Sarkar
- 1 Department of Dermatology, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India
| | - Kabir Sardana
- 2 Department of Dermatology, Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
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Nyati A, Gupta S, Jain SK, Yadav D, Patidar BL, Sharma M. A retrospective study of the pattern of sexually transmitted infections from a tertiary care hospital of Rajasthan. Indian J Sex Transm Dis AIDS 2017; 38:147-151. [PMID: 30148268 PMCID: PMC6085942 DOI: 10.4103/ijstd.ijstd_82_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Knowledge about the current patterns of sexually transmitted infections (STIs) is essential as they pose a major health problem worldwide and even more so in the developing countries like ours. Owing to the lack of advanced laboratory facilities at most of the centers, the cases are evaluated and managed as per the syndromic approach proposed by the National AIDS Control Organization. Aims: We aim to study the patterns of STIs seen over the past 4 years based on the syndromic approach. Materials and Methods: A retrospective analysis of the data of STI clinic over 4 years (April 2012–March 2016) was carried out. Showing all cases attending STI clinic are subjected to clinical examinations and investigated. Tests for HIV and venereal disease research laboratory were performed in all patients. STIs were categorized as per the syndromic approach. The proportions were calculated and data collected were analyzed. Results: A total of 4847 cases (1845 males and 3002 females) were studied. The most common STI overall was cervicovaginal discharge followed by genital herpes, warts, molluscum contagiosum, genital ulcerative disease-nonherpetic, lower abdominal pain, and urethral discharge in decreasing order of frequency. Genital herpes was the most common STI in males. Collectively, the proportion of viral STI was more as compared to nonviral STI. The number of newly diagnosed HIV cases was 19 (0.4%). Conclusion: The contemporary trend of STIs is relative rise in the proportion of viral STIs including genital herpes, warts, and molluscum contagiosum. Since STIs and HIV perpetuate each other, prompt diagnosis and adequate treatment of all cases of STIs is necessary to prevent HIV transmission.
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Affiliation(s)
- Asha Nyati
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Savera Gupta
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Suresh Kumar Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Devender Yadav
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - B L Patidar
- Department of Obstetrics and Gynecology, Government Medical College, Kota, Rajasthan, India
| | - Mukul Sharma
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
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Chauhan V, Shah MC, Patel SV, Marfatia YS, Zalavadiya D. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Indian J Sex Transm Dis AIDS 2016; 37:28-32. [PMID: 27190409 PMCID: PMC4857679 DOI: 10.4103/0253-7184.176215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. OBJECTIVE The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. MATERIALS AND METHODS A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. RESULTS 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. CONCLUSION Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.
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Affiliation(s)
- Vidyalaxmi Chauhan
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India
| | - Maitri C. Shah
- Department of Obstetrics and Gynecology, Government Medical College, Baroda, Gujarat, India
| | - Sangita V. Patel
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
| | - Yogesh S. Marfatia
- Department of Skin and VD, Government Medical College, Baroda, Gujarat, India
| | - Dhara Zalavadiya
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
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Diagnosis of Neisseria gonorrhoeae using molecular beacon. BIOMED RESEARCH INTERNATIONAL 2015; 2015:597432. [PMID: 25802857 PMCID: PMC4329845 DOI: 10.1155/2015/597432] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022]
Abstract
Neisseria gonorrhoeae is an important sexually transmitted diseases (STD) causing pathogen worldwide. Due to absence of an affordable diagnostic assay, routine screening of gonococcal infection becomes impossible in developing countries where infection rates are maximum. Treatment is given on the basis of symptoms alone which leads to spread of infection. Thus, development of a rapid, sensitive, specific, and PCR based visual diagnostic assay suitable for developing countries, required for better disease management, is aimed at in present study. Endocervical swabs were collected from patients visiting gynecology department of various hospitals in Delhi. In-house PCR based assay was developed and modified to visual assay using molecular beacon for end-point detection. It was evaluated against Roche AMPLICOR NG kit and rmp gene. Specificity of beacon was confirmed by competition experiments. Diagnostic test was 98.21% specific and 99.59% sensitive whereas negative and positive predicted value were 99.40% and 98.78%, respectively. We also observed that twice the concentration (2X) of premix was stable at 4°C for 4 months and dry swab samples gave concordant results with that of wet swabs. These features make the test best suitable for routine diagnosis of genital infections in developing countries.
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Chauhan V, Shah M, Thakkar S, Patel SV, Marfatia Y. Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome. Indian Dermatol Online J 2014; 5:S1-5. [PMID: 25506555 PMCID: PMC4252942 DOI: 10.4103/2229-5178.144498] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35%) followed by burning micturition (23.9%) were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.
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Affiliation(s)
- Vidyalaxmi Chauhan
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, Gujarat, India
| | - Maitri Shah
- Department of Obstetrics and Gynaecology, Government Medical College, Baroda, Gujarat, India
| | - Sejal Thakkar
- Department of Skin and VD, GMERS Medical College, Gotri, Baroda, Gujarat, India
| | - Sangita V Patel
- Department of Community Medicine, Government Medical College, Baroda, Gujarat, India
| | - Yogesh Marfatia
- Department of Skin and VD, Government Medical College, Baroda, Gujarat, India
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Prevalence of Trichomoniasis, Vaginal Candidiasis, Genital Herpes, Chlamydiasis, and Actinomycosis among Urban and Rural Women of Haryana, India. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2014; 2014:963812. [PMID: 26316979 PMCID: PMC4437425 DOI: 10.1155/2014/963812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/15/2014] [Accepted: 09/15/2014] [Indexed: 11/21/2022]
Abstract
Despite being curable reproductive tract infections (RTIs) including sexually transmitted infections continue to be a major health problem in developing countries. The present study was undertaken to know the prevalence of trichomoniasis, vaginal candidiasis, genital herpes, chlamydiasis, and actinomycosis in rural and urban women of Haryana by using wet mount, PAP smear, and fluorescent microscopic examination. Patients suspected of suffering from bacterial vaginosis were given treatment and were not included in the study. RTIs were seen in 16.6% of urban and 28.7% of rural women. The highest prevalence seen was that of trichomoniasis in both rural (24.2%) and urban (15.7%) women, followed by candidiasis (4.2% in rural and 0.6% in urban women), genital herpes (0.3% in rural and 0.2% in urban women), and chlamydiasis (0.02% in rural and 0.05% in urban women). Pelvic actinomycosis was seen in 1.4% of rural and 0.06% of urban women using intrauterine contraceptive devices. Mixed infection of Trichomonas vaginalis with Candida spp. was seen in 6.3% of rural women only. It is desirable to have a baseline profile of the prevalence of various agents causing RTIs in a particular geographic area and population which will help in better syndromic management of the patients.
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Souverein D, Euser SM, Ramaiah R, Narayana Gowda PR, Shekhar Gowda C, Grootendorst DC, Barot S, Jenniskens F, Kumar S, Kumar S, Den Boer JW. Reduction in STIs in an empowerment intervention programme for female sex workers in Bangalore, India: the Pragati programme. Glob Health Action 2013; 6:22943. [PMID: 24378194 PMCID: PMC3875344 DOI: 10.3402/gha.v6i0.22943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 11/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background/Objective The Pragati programme is an on-going empowerment programme for female sex workers (FSWs) working and living in Bangalore, India. Pragati aims to reduce transmission of HIV and sexually transmitted infections (STIs) among FSWs. This study describes the STI incidence rate, contact rate, and condom use during follow-up years. Design Between April 2005 and November 2010, 20,330 FSWs participated in the programme. Outcome measures were programme exposure (number of contacts per person-year), STI incidence rate, and condom use. All analyses were stratified by year of follow-up. STIs were diagnosed by syndromic case management in either programme or referral clinics. We restricted our analyses to the period between April 2005 and July 2008 (when the majority of STIs were diagnosed in programme clinics), in order to minimise the possible influence of differences in STI diagnosis between clinic types. Results Results showed a significant increase of programme exposure (p-value for trend < 0.001) and a significant decrease in the STI incidence rate (p-value for trend < 0.001) over the follow-up time (between April 2005 and July 2008). Reported condom use at last paid sex increased from 77.6% in year 1 to 100% in year 4 of follow-up (p-value for trend < 0.001). Conclusion Our data seem to suggest that the Pragati programme had a positive effect on the STI incidence rate and condom use, possibly as a result of increased programme exposure. We recommend for future studies to invest more in the study design, type of data collection, and recording mechanisms before starting with an intervention. Incorporation of empowerment strategies as an approach in HIV prevention programmes can have a beneficial effect on the lives and livelihoods of FSWs.
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Affiliation(s)
- Dennis Souverein
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands;
| | - Sjoerd M Euser
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
| | | | | | | | - Diana C Grootendorst
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
| | - Snehal Barot
- Swasti A Health Resource Center, Bangalore, India
| | | | - Sunil Kumar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Shiv Kumar
- Swasti A Health Resource Center, Bangalore, India
| | - Jeroen W Den Boer
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
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Stansfield SH, Patel P, Debattista J, Armitage CW, Cunningham K, Timms P, Allan J, Mittal A, Huston WM. Proof of concept: A bioinformatic and serological screening method for identifying new peptide antigens for Chlamydia trachomatis related sequelae in women. RESULTS IN IMMUNOLOGY 2013; 3:33-9. [PMID: 24600556 DOI: 10.1016/j.rinim.2013.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 12/30/2022]
Abstract
This study aimed to identify new peptide antigens from Chlamydia (C.) trachomatis in a proof of concept approach which could be used to develop an epitope-based serological diagnostic for C. trachomatis related infertility in women. A bioinformatics analysis was conducted examining several immunodominant proteins from C. trachomatis to identify predicted immunoglobulin epitopes unique to C. trachomatis. A peptide array of these epitopes was screened against participant sera. The participants (all female) were categorized into the following cohorts based on their infection and gynecological history; acute (single treated infection with C. trachomatis), multiple (more than one C. trachomatis infection, all treated), sequelae (PID or tubal infertility with a history of C. trachomatis infection), and infertile (no history of C. trachomatis infection and no detected tubal damage). The bioinformatics strategy identified several promising epitopes. Participants who reacted positively in the peptide 11 ELISA were found to have an increased likelihood of being in the sequelae cohort compared to the infertile cohort with an odds ratio of 16.3 (95% c.i. 1.65-160), with 95% specificity and 46% sensitivity (0.19-0.74). The peptide 11 ELISA has the potential to be further developed as a screening tool for use during the early IVF work up and provides proof of concept that there may be further peptide antigens which could be identified using bioinformatics and screening approaches.
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Affiliation(s)
- Scott H Stansfield
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Pooja Patel
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Joseph Debattista
- Metro North and Sunshine Health Service Districts, Sexual Health and HIV Service, Queensland Health, 270 Roma Street, Brisbane, Qld. 4000, Australia
| | - Charles W Armitage
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Kelly Cunningham
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - Peter Timms
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
| | - John Allan
- The Wesley Research Institute and The Wesley Reproductive Medicine and Gynaecological Surgery Unit, The Wesley Medical Centre, 40 Chasley Street, Auchenflower, Qld. 4066, Australia
| | - Aruna Mittal
- Institute of Pathology-ICMR, Safdarjung Hospital Campus, Post Box no. 4909, New Delhi 110029, India
| | - Wilhelmina M Huston
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld. 4059, Australia
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25
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Vora R, Anjaneyan G, Doctor C, Gupta R. Clinico-epidemiological study of sexually transmitted infections in males at a rural-based tertiary care center. Indian J Sex Transm Dis AIDS 2011; 32:86-9. [PMID: 22021968 DOI: 10.4103/0253-7184.85410] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) promote Human immunodeficiency virus (HIV) transmission by augmenting HIV infectiousness and susceptibility. In our society, especially in rural areas, males are common visitors to STI clinic than females who are generally traced as a contact. This difference may be due to the asymptomatic nature of infections in females, lower awareness among women of need for availing medical facilities, or their frequent consultation in gynecological clinics instead of STI clinics. AIM To determine the prevalence, clinical profile, and the pattern of STIs in males and the prevalence of HIV infection in them at a rural-based tertiary care center. MATERIALS AND METHODS A retrospective study of male cases attending STI clinic between January 2008 and December 2009 was carried out. Diseases were diagnosed on the basis of clinical morphology of the lesion, and HIV and Venereal disease research laboratory (VDRL) testing was done in all cases. RESULTS Of 23 433 male patients presenting at the Skin/VD department, 201 were diagnosed to have STI. Most common age group affected was 25 to 44 years (59.7%). Incidence of STI was high among married individuals (77.2%). Herpes genitalis was most common STI in 49 (24.37%) cases. Viral infections (herpes genitalis, genital warts, and molluscum contagiosum) accounted for 62.2% of cases. Prevalence of HIV in STI was 2.48%. CONCLUSIONS The persistent and recurrent nature of viral infections is responsible for their increasing trend in the current STI scenario. HIV and STIs are perfect examples of epidemiologic synergy as they are core transmitters of each other. STI being higher in married individuals further underlines the importance of contact tracing, counseling, and prompt management of the partners.
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Affiliation(s)
- Rita Vora
- Department of Dermatology, Pramukhswami Medical college, Karamsad, Gujarat, India
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