Prostitution describes sexual intercourse in exchange for remuneration. The legal status of prostitution varies in different countries, from punishable by death to complete legality. The great degree of social stigma associated with prostitution, of both buyers and sellers, has lead to terminology such as 'commercial sex trade', 'commercial sex worker' (CSW), female sex worker (FSW) or sex trade worker. Organisers of prostitution are typically known as pimps (if male) and madams (if female). Brothels are establishments specifically dedicated to prostitution, often confined to special red-light districts in big cities. The devadasi (handmaiden of god) system of dedicating unmarried young girls to gods in Hindu temples, which often made them objects of sexual pleasure of temple priests and pilgrims, was an established custom in India by 300 AD. An estimated 85% of all prostitutes in Calcutta and Delhi enter the sex work at an early age. The causes of prostitution include ill treatment by parents, bad company, family prostitutes, social customs, inability to arrange marriage, lack of sex education, media, prior incest and rape, early marriage and desertion, lack of recreational facilities, ignorance, and acceptance of prostitution. Truck drivers engaging in unprotected sexual intercourse with multiple partners in rural India could be major vectors of HIV transmission. The commercial sex industry is a multibillion dollar Indian and global market which now includes strip clubs, massage brothels, phone sex, adult and child pornography, street brothel, and escort prostitution. So long as men want to buy sex, prostitution is assumed to be inevitable.

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Lipschütz first identified an acute disease with ulceration of the external genital organs of young women. The syndrome has been termed acute vulvar ulcer or ulcus vulvae acutum. The following typical case history of a 19-year-old girl is a good illustration of this interesting clinical entity.

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Post-exposure prophylaxis (PEP) is a medical response given to prevent the transmission of pathogens after potential exposure. The PEP for HIV refers to a set of comprehensive services to prevent HIV infection in exposed individuals where the exposure can be occupational or non-occupational (nPEP) and the provision of short-term (28 days) antiretroviral drugs depending on risk assessment with follow-up. High concentration of free infectious virus and virus-infected cells have been reported in blood, genital fluids and cerebrospinal fluid. The average risk of HIV infection after percutaneous exposure to HIV-infected blood is 0.3%. The nPEP can be offered for cases like unprotected sexual exposure, sexual assault survivors, injecting drug users (IDUs) sharing equipment, etc. While considering PEP, evaluation of exposure, exposure source and exposed person is to be done and 2 or 3 drug PEP (depending upon the type of exposure) can be started within 72 h and need to be continued for 28 days. Drugs preferred are zidovudine + lamivudine. If needed, a boosted protease inhibitor can be added.

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WHO estimates that 20% of persons living with HIV/AIDS are in their 20s and one out of twenty adolescents contract a sexually transmitted disease (STD) each year. A total of 303 adolescents and youths (10-24 years of age) attending an STD clinic were subjected to a questionnaire to assess sexual behavioural patterns that predisposed them to STD. Scope of the questions included age at initiation of sexual intercourse, partner at first exposure, number of sexual partners, use of condoms, exposure to commercial sex workers (CSWs), previous infection with STDs and role of alcohol. Their diagnosis was based on history, clinical findings and laboratory confirmation. Adolescents and youths accounted for 30% of the total number of patients attending the STD clinic during this period. The male to female ratio was 1:0.95. Ninety-six percent (290) were single while 4% (13) were married. Seventy-two percent (217) were students. Age at onset of sexual activity was 10-20 years in 80%, 85% practiced risky sexual behaviour, patronising casual partners was frequent especially after alcohol use, 10% had been exposed to CSWs, condom use was poor, number of sexual partners varied between 1 and 5 and previous infections were not professionally treated. Adolescents and young people are sexually active and practice risky sexual behavioural patterns. Adolescents and youths account for a high percentage of patients patronising the STD clinic. Sexual education and youth friendly reproductive health services are urgently needed to curb the spread of HIV/AIDS/STDs.

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A 30-year-old, previously healthy, nulliparous married woman presented with painful genital ulceration of 1 month duration. She was admitted with a diagnosis of chronic genital herpes with oral thrush and pulmonary tuberculosis. ELISA test for antibodies against HIV was positive for both the partners. She was treated in isolation ward with four-drug regimen of antituberculous therapy (ATT), oral cloxacillin oral fluconazole and acyclovir 400 mg three times daily. The genital lesions completely resolved after treatment with acyclovir.

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Lichen sclerosus (LS) is a chronic inflammatory dermatosis that causes substantial discomfort and morbidity, most commonly in adult women. The objective of our study is to study the pattern of vulval LS and to correlate LS with various clinical parameters. The study included 26 female patients with vulval LS presenting over a period of 22 months, starting from September 2005 to June 2007. Demographic characteristics and clinical findings were recorded. The mean age of LS patients was 44 years (range 3-65 years). Lichen sclerosus was most commonly observed in postmenopausal women (18, 69.2%), followed by women in reproductive age group (5, 19.23%), and prepubertal girls (3, 11.5%). All patients presented with ivory white atrophic plaque. Surface of the plaque showed telangiectasia in one patient; both erosions and fissuring in two patients, ­erosions in four patients, fissuring in two patients, and wrinkling in all patients. Introitus was stenosed in five (19.2%) patients, out of which three (11.5%) patients also had perianal involvement leading to "figure of 8" appearance. Three patients had atrophy of labia minora and clitoris to an extent that labia minora appeared merged with labia majora and clitoris was buried. This study highlights the importance of diagnosing LS as it is associated with considerable morbidity.

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The aim of our study was to examine the frequency and characteristics of recurrent lower urinary tract infections (LUTIs) due to sexual intercourse (sex-induced cystitis - SIC) in female population of three districts of the rural Thebes targeted to investigate the influence of age and culture on its epidemiology. We examined 432 women between 15 and 65 years of age in female populations of three district of the rural areas of Thebes between May 2006 and January 2007 with symptoms of recurrent LUTIs. Women who reported a sexual intercourse 24-72 h before the onset of symptoms were evaluated as possible cases of SIC. Urinalysis was done during therapy, 10 days after completion of treatment and within 24 weeks after the initial therapy. Women with a positive urine culture were evaluated by an ultrasound examination of their urinary tract and those having abnormality of urinary tract were excluded from the study, while the remaining completed a simple questionnaire querying on several risk factors that could be possibly associated with SIC. The SIC, accounted for almost 40% of the recurrent cases, was the most frequent in non-menopausal women of age between 23-27 years and 40-47 years and affected almost equally women of all three groups (local, immigrants and rom). There were no statistically significant differences between the cultural groups in the frequency rate of SIC; however, the immigrant women study group showed a slightly lower frequency of SIC when compared to the other groups. Frequency of SIC was slightly higher during summer in all populations studied. The SIC being a neglected and often misdiagnosed disorder, represents a challenging and significant healthcare issue affecting mainly young women of lower socioeconomic groups independent of the ethnicity, behavioural and ethical issues.

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Presence of genital ulcer disease facilitates human immunodeficiency virus (HIV) transmission and their ­diagnosis is essential for the proper management. Venereal Disease Research Laboratory (VDRL) test is used as a screening test for the diagnosis of syphilis. However, unusual VDRL test results have been reported in HIV-infected persons with syphilis. There are reports showing higher than expected VDRL titers as well as biological false positive in most of the studies. A negative Rapid Plasma Reagin (RPR) test or VDRL test result may not rule out syphilis in patients with HIV infection. For laboratory confirmation of syphilis, one specific Treponemal test, namely, Fluroscent Treponemal Antibody Absorption (FTA-ABS) test or Treponema Pallidum Haemagglutination Assay (TPHA) should be done along with VDRL. In the present study, 88 HIV-seropositive patients with history of high-risk behaviour were screened for syphilis by VDRL test. Out of these 88 cases, 42 (47.7%) patients were positive for TPHA and eight (9.1%) patients were reactive for VDRL in various titers. All the eight patients who were reactive for VDRL test were also positive for TPHA test. Persons with HIV infection acquired through sexual route should be screened for sexually transmitted infections (STIs), and all patients with STIs should be counselled for HIV testing. This will help in proper management of patients having STIs and HIV coinfection.

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Sexually transmitted diseases (STDs) are an important cause of morbidity in pediatric patients. The purpose for carrying out the present study is to study the clinico-epidemiological profile of pediatric patients attending the STD clinic of Civil Hospital Ahmedabad. Out of total 1870 patients with various STDs, 37 (1.98%) were children below 15 years of age. Males comprised of 29 (78.4%) cases. The majority of the patients 26 (70.3%) with STDs belonged to the age group of 11-15 years. Herpes progenitalis was the most common STD reported in 35.1% of cases, followed by syphilis (32.4%), and condyloma acuminata (10.8%). History of homosexual contact was reported in 43.2% of cases while child sex abuse (CSA) was reported in 27% of cases. Two cases were seropositive for HIV.

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As per literature, very few case reports of leprosy ( M. leprae infection) in association with HIV are available till date. The cause for this rare coexistence when compared to Mycobacterium tuberculosis may be due to the fact that (a) M. leprae infection occurs due to affection of specific cell mediated immunity, (b) missing of signs and/or symptoms of leprosy both by physicians and patients as they are masked by overwhelming opportunistic infections and (c) long-time taken by M. leprae to manifest the disease. A case of lepromatous leprosy in an HIV-infected person is herewith reported for its rarity, wherein leprosy was nearly missed. Hence it is suggested to look for any evidence of leprosy in all HIV-positive cases. Then only the real incidence of leprosy in HIV-positive patients will come in the light.

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Angiomyxoma is a rare tumor developing from myxoid cells. There are two types of angiomyxomas, superficial - which grows near the surface and aggressive - which involves the deeper structures. A 15-year-old unmarried girl presented with an asymptomatic mass on the genitalia of 3 years duration. Her general and systemic examination was within normal limits. Patient was referred to Urology Department where the mass was excised and was sent for histopathological examination, which clinched the diagnosis of superficial angiomyxoma. The patient is kept under follow-up. This case is a typical example which highlights the role of STD department in diagnosing, treating, and reassuring the patient with a nonvenereal disease, causing apprehension.

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The aim was to study the cutaneous adverse effects of nevirapine (NVP). One hundred ten patients on NVP based regimen were enrolled in the study and monitored for adverse reactions (ADR). A detailed history of every patient was taken including past history of antiretroviral treatment. All patients were clinically evaluated and treated for opportunistic infections. Three drug regimen (Zidovudine/ Stavudine + Lamivudine + NVP) was prescribed to all cases having CD4 count < 200 cells/mm ³ or clinically symptomatic cases. NVP was given in a lead in dose (200 mg once daily) for initial 15 days. If no hypersensitivity was seen then dose was increased to 200 mg twice daily. NVP induced rash was observed in 13 cases (11.8%). Rash was the commonest ADR of NVP and was graded according to standard guidelines. Stevens Johnson syndrome (grade IV rash) was observed in 3 cases. In 7 cases NVP was substituted by Efavirenz (EFV) while 2 cases continued with 2 drugs due to lack of resources. Two cases stopped treatment. Clinicians should always start the NVP in lead-in dose and closely monitor patients on NVP based regimen especially during the first two months of therapy.

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