With the widespread availability of antiretroviral therapy, there is a dramatic decline in HIV related morbidity and mortality in both developed and developing countries. Further, the current antiretroviral drug combinations are safer and the availability of newer monitoring assays and guidelines has vastly improved the patient management. The clinician needs to evaluate several key issues prior to institution of antiretroviral regimen including the correct stage of starting the treatment and the kind of regimen to initiate. In addition to various disease related factors, it is also critical to assess the patient's general condition including nutritional status, presence of co-morbidities and mental preparedness prior to starting the therapy. The patients need to develop an overall understanding of the treatment and its benefits and the importance of lifelong adherence to the drugs. The presence of special situations like pediatric age, older patients, pregnancy, lactation and presence of opportunistic infections also require modification of the therapy. This review briefly summarizes issues relevant to the clinician prior to the initiation of antiretroviral therapy.

In many parts of the world particularly sub-Saharan Africa, congenital syphilis is a significant public health problem. Though it is rare in most affluent countries there has been a slight resurgence recently in several European countries. The diagnosis of suspected cases and management of congenital syphilis may be confusing and the potential for severe disability is high when cases are missed. The cornerstone of congenital syphilis control is antenatal screening and treatment of mothers with penicillin and in affluent countries it should be strengthened among those at high risk. In developing countries antenatal care screening needs to be strengthened by implementing point-of-care decentralised screening and treatment, also alternative novel approaches to control congenital syphilis should be looked at and utilized. International health agencies and political parties should take steps urgently to support focused approaches to tackling the problem of continuing congenital syphilis.

Background: Cytomegalovirus (CMV) retinitis remains the most common ocular opportunistic infection in patients with acquired immunodeficiency syndrome even in the era of highly active antiretroviral therapy (HAART). Increased survival of patients on HAART has increased incidence of blindness, which will further increase in the future. The objective of this study was to determine the incidence of CMV retinitis and the effect of HAART on the natural history of CMV retinitis in patients referred from ART center. Materials and Methods: Patients with baseline/current CD4 counts <150 cells/µl were evaluated for CMV retinitis. Complete ophthalmological evaluation was carried out and records of CD4 counts, HAART regime, presence of any form of CMV retinitis and response to HAART were noted. Results: Out of 800 patients registered with CD4 <150 cells/µl in ART center, 100 patients reached us. Among these, CMV retinitis was observed in 15% patients, with median CD4 count at the time of examination being 56 cells/µl (range: 24-306 cells/µl). 66.67% patients were HAART non-responders and 63.6% eyes were economically blind. Conclusion: CMV retinitis occurs even in patients with higher CD4 counts. Timely diagnosis and intervention of this treatable condition can reduce the number of blinding years in these young patients who otherwise live longer as a result of HAART.

Background: Sexually transmitted diseases (STDs) in children can be acquired either by sexual, or non-sexual route. Sexually transmitted infection (STI) in children reflect the pattern of STI in adult population and the knowledge, attitude and practices of the society. They also serve as an indicator of STI control strategies. Aims: A retrospective study spanning over a period of 5 years from 2007 to 2011) was undertaken to make a detailed analysis of demographic, behavioral, epidemiological and clinical profile of STD among children (<19 years). Materials and Methods: The medical records of children attending the STI clinic of Smt. Sucheta Kriplani Hospital from year 2007 to 2011 were studied. Results of Gram's staining, KOH examination, Tzanck smear, culture and serological tests like Venereal Disease Research Laboratory for syphilis and ELISA for human immunodeficiency virus (HIV) wherever performed were recorded along with the final diagnosis. Results: The study showed a steady rise in the prevalence of STIs from 1% to 4.9% in the initial 4 years. STIs were more commonly observed in girls (M:F ratio - 1:1.13) and in adolescents >16 years of age. Homosexuality was present in 33.3% of males. History of sexual abuse was given by 4 children. 2 children were seropositive for HIV by ELISA technique. Viral STIs (Cyanea acuminata, molluscum contagiosum, herpes genitalis) were 1.5 times more common than bacterial infections. Conclusion: The societal sexual practices have undergone tremendous changes, which is reflected in a steady rise in STIs (predominantly viral), sexual abuse and homosexuality in children. There is an urgent need for strengthening of school health programs aiming at adolescent sexual health.

Background and Objectives: Sexually experienced, unmarried adolescent women, usually commence sex, with marriage in mind. Initially, they resist sex but are unsuccessful due to lack of resilience to end an oppressive relationship, or convince their partners to postpone sex or use protection. To retain partners, they accept unprotected sex and suffer its consequences such as unwanted pregnancies, sexually transmitted diseases, HIV/AIDS and cervical cancer. Considerable numbers of adolescents face this emotional stress and suffer the consequences, while some manage to endure and emerge from the ordeal. This study attempts to determine this resilience and extrapolate it to others who might not be so successful without an intervention. Methodology: The study compares sexual resilience in 100 unmarried adolescent abortion-seekers, in terms of time taken from meeting the partner, to sexual debut and correlates this with background factors such as age, education, family income, self-esteem, sexual knowledge, attitude toward pre-marital sex (PMS) and partner pressure. Results: Mean debut age was 17.32 years. Partners took more initiative to form emotional (64%) and physical relationship (78%). Adolescent girls' initiative reduced markedly from emotional (22%) to physical relation (5%). Correlation of sexual resilience with age, family income education and knowledge was not significant. It was significantly correlated with attitude toward PMS, self-esteem and partner pressure. Interpretation and Conclusion: It is desirable to improve self-esteem and attitude of young women to build negotiation skills in intimate relations. Counselors have to reorient the perspectives to improve attitude toward abstinence and increase self-esteem to resist pressure from partners.

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.

Though patients affected with both acquired immuno deficiency syndrome (AIDS) and leprosy commonly present with type 1 lepra reaction, there are few isolated reports of type 2 lepra reaction in retropositive patients affected with leprosy. We are presenting a case report of 35-year-old male affected with AIDS, tubercular lymphadenitis, and lepromatous leprosy with recurrent episodes of type 2 lepra reaction manifesting as erythema nodosum leprosum (ENL). Dipstick enzyme-linked immunosorbent assay (ELISA) for filarial antigen was also positive. The patient was treated with 100 mg thalidomide daily, 300 mg diethylcarbamazine, and modified multidrug therapy (MDT) for leprosy. He responded well and has not had any further reaction in the last 6 months.

Cutaneous metastasis from an internal organ malignancy is rare and as, the presenting sign of malignancy is an uncommon phenomenon. Their presence, signals a poor prognosis. We report a case of 50-year-old female who was referred to sexually transmitted diseases - out patient department, with complaints of multiple genital ulcers to rule out sexually transmitted infections. After thorough evaluation, she was found to be a case of carcinoma cervix with metastatic squamous cell carcinomatous deposits on external genitalia. This case was unique because of relatively asymptomatic nature of internal malignancy and atypical presentation of carcinoma cervix as cutaneous metastasis.

This 35-year-old man presented with history of hemoptysis and breathlessness on exertion of 3 months duration. Examination revealed feeble left radial, brachial and carotid pulses. Chest radiograph showed a superior mediastinal mass and contrast enhanced computed tomography chest showed a large aortic arch with mass and compression effects. Endosonographic examination was suggestive of aortic aneurysm. During further evaluation, serum Venereal Disease Research Laboratory test was found to be positive in titers of 1:32. Treponema pallidum hemagglutination test was performed and showed positive titers of 1:64. Neurosyphilis was ruled out by normal cerebrospinal fluid examination findings. Patient was treated with injectable benzathine penicillin and aortic aneurysm repair was planned. The authors present a rare case of tertiary syphilis complicated with aortic aneurysm in this era of early use of highly effective antibiotics.

A 30-year-old unmarried, heterosexual male presented with an 8-month history of tense blistering skin lesions over the hands. Physical examination revealed facial hypertrichosis and multiple erosions with crusts and scars over the dorsum of both hands. Woods lamp examination of the urine, histopathology and urinary porphyrin levels were suggestive of porphyria cutanea tarda (PCT). The patient responded well to hydroxychloroquine and antiretroviral drugs. This case report calls for a detailed evaluation and HIV testing in every patient with PCT.

Cutaneous Crohn's or anogenital granulomatosis is a rare disorder, which presents commonly as swelling and erosions on anogenital area and associated with features of intestinal Crohn's disease. We report a case of 23-year-old female who presented with vitiligo patches on back and legs for 1-year, painful edema and ulcers on anogenital area and oral cavity for 9 months and diarrhea with bleeding per annum for 1 month. Features on ultrasonography, multislice computed tomography scan, colonoscopy, and biopsy from nodule on anal wall were suggestive of granulomatous Crohn's disease. Thus, we present the case due to its rarity.

Granuloma inguinale (GI) is an acquired chronic, slowly progressive, mildly contagious disease of venereal origin, characterized by granulomatous ulceration of the genitalia and neighboring sites, with little or no tendency to spontaneous healing caused by Klebsiella (Calymmatobacterium) granulomatis. A 55-year-old male presented with fissured, foul smelling, fungating growth over prepuce with phimosis mimicking squamous cell carcinoma (SCC) without lymphadenopathy. It started with painless papulonodular showed pseudoepitheliomatous hyperplasia, infiltration in dermis, acanthosis and vacuolated macrophages suggestive of GI and not showing any histopathological features of SCC. Patient was successfully treated by giving cotrimoxazole twice a day for 21 days. Here, we presented a case of GI mimicking SCC of penis, which was diagnosed on basis of histopathology and treated with excision followed by medical therapy with cotrimoxazole.

Introduction: Genital ulcerative diseases are a major public health problem. The advert of human immunodeficiency virus (HIV)/AIDS over the past 25 years has deepened the scope of morbidity, mortality, and various forms of clinical presentations of sexually transmitted diseases (STDs). Materials and Methods: A total of 50 cases having Genital ulcerative diseases and STD reporting to STD clinic during the period of the year from November 2005 to December 2006 were included and detailed history and clinical examination were carried out and provisional diagnosis is made. Laboratory confirmation of clinically diagnosed cases was done using laboratory tests such as S. HIV, venereal disease research laboratory, Tzanck smear, gram stain, and Giemsa stain. Result: In the present study, the incidence of herpes progenitalis was (38%) followed by primary syphilis (32%), chancroid (26%), lymphogranuloma venereum (02%), and genital scabies (02%). HIV sero-positivity was detected in 12% (n = 6) cases. Conclusion: HIV was found to be more common among genital ulcer disease patients, especially syphilis and genital herpes.