Clinico-epidemiological study of sexually transmitted infections in males at a rural-based tertiary care center

A retrospective analysis of sexually transmitted infections among males presenting to a tertiary care hospital of India

Context

Sexually transmitted infections (STIs) are one of the most neglected diseases, leading to a high percentage of morbidity and mortality in India. The World Health Organization estimated that 20% of persons living with human immunodeficiency virus/acquired immunodeficiency syndrome are in their 20s and one out of twenty adolescents contract an STI each year.

Aims

The present study was conducted to study the characteristics of the pattern of STI in adult males and study the prevalence of various STIs among them.

Settings and Design

This retrospective study was conducted by retrieving records of males presenting to STI laboratory of our tertiary care hospital between (April 2018 and December 2019).

Subjects and Methods

The patients comprised high-risk group males, approached through nongovernmental organizations (NGOs) and slum population visiting the dispensary attached to our institute. The age group of the patient included was between 0 and 85 years.

Results

A total of 1023 males presented to our STI laboratory out of which 124 (12.12%) were symptomatic. The most common complaint was urethral irritation seen in 22.5%, followed by discharge in 9.6%. The most common sexually transmitted disease among symptomatic (34/124) as well as asymptomatic (172/899) men was syphilis showing a combined prevalence of 20% (206/1023). Out of 124 symptomatic patients, 29 (23.38%) complained of urethritis due to gonococcal infection. The association between the two was found to be significant (i.e., P < 0.05).

Conclusion

STIs are a serious health problem in our country. Approximately 6% of the adult population have one or the other STI amounting to 30-35 million cases per year. An intensive study is the need of the hour which could help clinicians as well as microbiologists to control the spread of these infections.

Clinical patterns of sexually transmitted diseases in human immunodeficiency virus-infected individuals in a tertiary care center in South India

Background:

Human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) synergize to aggravate the associated morbidity of each other in the human body.

Aims:

The aim was to study the pattern of presentations of STDs in patients with HIV.

Materials and Methods:

This study was conducted by selecting 100 consecutive cases of HIV infection with symptoms suggestive of co-existing STD attending the outpatient department in a tertiary care center in south India.

Results:

Most of the patients belonged to the age group of 26–30 years, with a slight male preponderance. Genital ulcer was the predominant presenting complaint (60%), followed by dysuria (32%) and genital growth (29%). Genital ulcer was the most common lesion (56%), followed by other genital lesions (37%) and extragenital lesions (18%). Among the investigations, Tzanck smear was most commonly seen positive (62.3% of 61 patients), followed by positive potassium hydroxide mount and Venereal Disease Research Laboratory. About 35.5% of the male patients and 60.53% of the female patients had multiple diagnoses. In males, herpes genitalis (29.76%) was the most common STD, followed by condyloma accuminata (23.08%). In females, candidal vulvovaginitis (28.12%) was the most common STD, followed by herpes genitalis (23.43%).

Conclusion:

Our study found genital ulcer as the most common symptom and sign of STD in HIV-infected patients. Herpes genitalis was the most common STD among males and candidal vulvovaginitis was the most common STD among females.

Estimating the Burden of Illness Related to Genital Warts in Russia: A Cross-Sectional Study

BACKGROUND

Human papillomavirus (HPV) infections are the etiologic agents of genital warts (GW). HPV is one of the most frequent sexually transmitted viral infections, and nearly 65% of individuals with partners who have GW also develop GW. In Russia, as in many other countries, overall GW prevalence data are scarce. Given the lack of Russian data, our study estimated GW prevalence in physician practices and GW-related health care resource use in Russia among male and female patients aged 18-60 years.

METHODS

Russian physicians recorded daily patient logs for a two-week period and conducted a 30-minute survey to estimate GW prevalence and related resource use between January and June 2012. Age, gender, and GW diagnosis status was recorded. Prevalence was obtained for each physician and calculated into a single estimate across all physician types. Overall prevalence estimate and 95% confidence interval were weighted by the estimated number of physicians in each specialty and the proportion of total patients visiting each specialist type. Health care resource use was reported and compared among different physician specialties.

RESULTS

The overall GW prevalence estimate was 9162 cases per 100 000 for male and female patients aged 18-60 years, with 9917 for obstetrician/gynecologists (OB/GYN), 8298 for urologists (URO), and 7833 for dermatologists (DERM). For males, GW prevalence was 8769 cases per 100 000, with the highest prevalence in the 30-34 age group. In females, GW prevalence was 9304 cases per 100 000, with the highest prevalence in the 18-24 age group. Among overall existing GW cases, 63.1% were recurrent and 34.2% were resistant. For all patients in our study, GW prevalence was higher in females. Male patients had the highest prevalence for those aged 30-34 years, and female patients for those aged 18-24 years. These results are consistent with data reported in other countries. Study limitations include estimates and results representative of the urban population of Russia. Despite its limitations, this study provides a GW prevalence estimate in Russia not previously available.

CONCLUSIONS

GW is a significant public health concern in Russia, and the GW prevalence was higher in female patients compared to male patients.

Changing trends of sexually transmitted infections and estimation of partner notification at a tertiary care center in North India

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.

Viewing the resurgence of early syphilis in light of increasing male homosexuality and childhood sexual abuse

Back Ground and Objectives:

A rising trend of syphilis has been documented worldwide recently. After decriminalization of homosexuality in India more and more males having sex with males (MSMs) have come out to seek medical advice.

Aim:

We evaluated sexual behavior of patients with syphilis attending our sexually transmitted infections (STIs) clinic focusing on the factors associated with the increasing MSM practices and rising trend of syphilis among MSM.

Materials and Methods:

This is a 10-year (2006–2015) descriptive study from among STI patients attending the dermatology outpatient department in a tertiary care center. Recognizing the rising homosexuality, from 2011 onward, we had given a questionnaire to assess their sexual behavior and sexual practices.

Results:

Analysis of data from 560 cases diagnosed as having STI revealed a rising trend of all STIs including syphilis from 2011 onward. The MSM cases reporting to our STI clinic showed a sustained rise from 2011 onward. The most common STI in MSM was syphilis that too early acquired. More than half of the MSM indulged in bisexual activities and the predominant mode was anoreceptive. Nearly 70% had unprotected contact and most had early sexual debut (<20 years). Thirty-six percent gave a history of childhood sexual abuse (CSA) by a close male acquaintance.

Conclusions:

After 2011, we have observed a resurgence of early acquired syphilis which coincided with an increase in promiscuous homosexuality. Many of the MSMs were bisexuals and homosexuality was an acquired behavior. An alarming increase in the incidence of CSA was observed in MSMs.

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

Background

This study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18-60 years in the Philippines.

Methods

Prevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.

Results

Overall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58-4.98%) for men and women aged 18-60 years. Genital warts prevalence was 3.39% (95% CI: 3.13-3.65%) and 8.0% (95% CI: 7.69-8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66-18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).

Conclusions

Genital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

The Current Status of Sexually Transmitted Infections/Reproductive Tract Infections in Vadodara City: Health-care Provider Perspective

Background

Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) are a major public health problem worldwide, affecting the quality of life and causing serious morbidity and mortality. STIs/RTIs have a direct impact on reproductive and child health through infertility, cancers and pregnancy complications, and they have an indirect impact through their role in facilitating the sexual transmission of human immunodeficiency virus.

Objectives

(1) To estimate the number/proportion of cases of STI/RTI being treated by health-care providers. (2) To document investigations being prescribed for diagnosis. (3) To document treatment protocols being used by health-care providers for STI/RTI management.

Methodology

This was cross-sectional study conducted in Vadodara city. A total of 118 health-care providers were interviewed by using pre-tested semi-structured questionnaire regarding the current status of STIs/RTIs, proportion of STIs/RTIs patients, investigation and managements.

Results

Proportion of STI/RTI patients out of all outpatient department patients ranges from 1.03% for general practitioners (GPs), 2.86% for skin and venereal disease (VD), and 15% for obstetricians and gynecologists consultants. Use of investigation for the diagnosis of STI/RTI is minimal among obstetricians and gynecologists specialists (29.41%) and GPs (54.55%). Use of guidelines for the management of STI/RTI is not equal across consultants. Guidelines were followed by 67.50% of skin and VD consultants, 32.35% of obstetricians and gynecologists consultants, and 18.18% of GPs.

Conclusion

There is considerable variation in treatment-seeking and the use of standardized treatment protocols for the management of STI/RTI by the government as well as private providers.

Prevalence and Burden Related to Genital Warts in India

The prevalence of genital warts (GW) and self-reported human papillomavirus (HPV) as well as disease-related psychosocial impact among male and female patients aged 18-60 years in India were assessed. GW prevalence was estimated using a 2-week daily log of patients examined from June 7-September 22, 2011 by 200 participating physicians in 6 regions of India. Psychosocial impact was estimated using one-time, self-administered surveys, including HPV Impact Profile (HIP), Cuestionario Específico para Condiloma Acuminado ([Spanish] CECA; "Specific questionnaire for Condylomata Acuminata") and EuroQol-5 Dimension survey. T-tests or Mann-Whitney U-tests were used for continuous comparisons and Chi-square or Fisher exact tests were applied for categorical comparisons. Overall GW prevalence in India was estimated at 1.07% (95% confidence interval = 0.97-1.17) and was higher among men than women. Regional prevalence ranged from high in Delhi (2.17%) to low in Bangalore (0.40%). Patients aged 25-29 years had the highest GW prevalence (1.42%). GW patients were most often newly diagnosed (74.07%). Among those with existing GW, 56.24% were recurrent, and 43.76% were resistant. According to total HIP scores, 55.4% of male GW patients and 20.0% of those without GW reported moderate psychological impact (p < 0.0001). HIP scores among women revealed that patients with abnormal Papanicolaou (Pap) test results (34.3%), precancerous lesions (46.2%), external GW (48.0%), and those without HPV-related disease (18.5%) reported moderate psychological impact (p = 0.0089) (Psychosocial impact results are reported in the Supplementary Data ). Estimated national GW prevalence, diagnosis, and treatment costs in India were higher for men than for women. GW in men and HPV infection in women had a negative psychosocial impact on well-being and health-related quality of life (HRQoL) scores, especially among women diagnosed with GW and precancerous lesions compared to those with other selected HPV-related diseases. Despite its limitations, this study provides an estimation of GW data in India not previously available.

Treatment of molluscum contagiosum in adult, pediatric, and immunodeficient populations

BACKGROUND

Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide.

OBJECTIVE

The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered.

METHODS

A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult.

RESULTS

The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations.

CONCLUSION

Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.

Treatment outcomes and loss to follow-up rate of male patients with gonococcal and nongonococcal urethritis who attended the sexually transmitted disease clinic: An 8-year retrospective study

BACKGROUND

Poor follow-up compliance of patients with infectious urethritis is a recognized and serious public health problem in Thailand.

AIM

The aim of this study was to determine treatment outcomes and loss to follow-up rate of male patients with gonococcal urethritis (GU) and non-GU (NGU) at a sexually transmitted disease (STD) clinic at Thailand's tertiary hospital.

METHODS

This retrospective chart review of male patients who sought treatment at STDs Clinic, Siriraj Hospital, and who were diagnosed with GU and/or NGU was conducted during January 2007 to December 2014 study period.

RESULTS

Two hundred and twenty-seven male urethritis patients were included in this study with a mean age was 29.5 years. GU and NGU were found in 120 (52.9%) and 107 (47.1%) of patients, respectively. Overall prevalence of GU and NGU during the 8-year study period at STD Clinic, Siriraj Hospital, was 8.6% and 7.8%, respectively. Ninety-six patients (42.3%) were lost to follow-up. Recurrent urethritis was found in 23.8% of patients, and HIV infection was identified in 11.6%. Mean age of patients lost to follow-up was 29 years. Compared with patients who attended every scheduled follow-up visit, men who have sex with men had a significantly lower rate of loss to follow-up (P = 0.012).

CONCLUSION

Almost half of patients with GU or NGU were lost to follow-up, and one-quarter had recurrent urethritis. Fast and easy access to services that provide accurate diagnostic testing and effective treatment should be a public health priority to prevent complications and reduce rates of disease transmission.

Clinico-Epidemiological Profile of Viral Sexually Transmitted Infections in Seropositive Patients Attending a Tertiary Care Hospital in North India

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.

A retrospective study of the pattern of sexually transmitted infections from a tertiary care hospital of Rajasthan

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.

A study of 113 cases of genital ulcerative disease and urethral discharge syndrome with validation of syndromic management of sexually transmitted diseases

AIMS

To validate syndromic management of cases having genital ulcerative disease (GUD) and urethral discharge syndrome (UDS).

MATERIALS AND METHODS

A study of 113 cases of GUD and UDS was carried out in the Department of Skin and VD from March 2011 to August 2012. All cases having history and clinical evidence suggestive of GUD and UDS were included in the study.

RESULTS

According to syndromic diagnosis, GUD herpetic syndrome was the most common 71 (62.27%), followed by GUD non-herpetic syndrome 25 (21.89%) and UDS 17 (14.91%). Out of 71 cases clinically diagnosed as GUD herpetic, 16 (22.53%) were validated by immunoglobulin M (IgM) anti herpes simplex virus-2 (HSV) serology, 14 (19.71%) by Tzanck smear and 3 (4.22%) by both. 24 (33.80%) were Reactive plasma Reagin (RPR)(<1:8) reactive and trepenomma palidum haem-agglutination positive. Out of total 25 clinically diagnosed GUD non herpetic cases, 22 (88%) were validated by laboratory tests Out of 17 cases of UDS, 15 (88%) were validated by smear.

CONCLUSION

Sensitivity and specificity of clinically diagnosed syndrome is not so high particularly for GUD herpetic syndrome Continuous monitoring of diagnostic component of syndromic approach is key to success of STD control program.