Background and Objectives: Syphilis is a classical sexually transmitted disease (STD), caused by Treponema pallidum subsp. pallidum. In this retrospective study, we analyzed trends of syphilis prevalence in patient groups attending our tertiary care center. Materials and Methods: The data was obtained by reviewing laboratory records of the STD laboratory from January 1, 2006 to December 31, 2011. Cases positive by both Venereal Disease Research Laboratory (VDRL) and Treponema pallidum particle agglutination (TPPA) tests were analyzed for seroprevalence of syphilis in different groups, and to analyze the rising or falling trends, if any. Results: A total of 28,920 serum samples were received in the 6-year study period for VDRL testing, of which 972 (3.4%) were found to be reactive. Of these, 1722 sera were also submitted for TPPA testing, 374 (21.7%) of which were positive. A total of 375 samples were submitted for both tests, indicating biological false positivity of 0.27%. A rising trend, though not statistically significant, was observed in pregnant women, drug users and patients from wards/out-patient departments, while a statistically significant rise in prevalence of syphilis was found in HIV-positive individuals. A falling trend (not statistically significant) was observed in STD clinic attendees. Conclusion: An increasing trend of syphilis was observed during the study period when all groups were analyzed together, especially in HIV-seropositive individuals, which calls for continued and sustained efforts for case detection, treatment, and preventive measures to contain the disease.

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Though many methods of prevention of STI/HIV are available, condoms remain of utmost importance. They have gone a long way from the oiled silk paper used by the Chinese and the hard sheaths made of tortoise- shell used by the Japanese to the latex condoms of today. The breakthrough came when the rubber vulcanization process was invented by Charles Goodyear and eventually the first rubber condom was made. The condom offers maximum protection( more than 90%) against HIV, Hepatitis B virus and N.Gonorrhoea. They also offer protection in scenarios when alternate sexual practices are adapted. The female condom in the only female driven contraceptive method available today. Graphene and Nano lubricated condoms are new in the market and others in futuristic approach may include wearable technology/Technology driven condom and invisible Condoms.Both Correct and Consistent use of condoms needs to be promoted for HIV/STI prevention.

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Plasma cell vulvitis is a very rare inflammatory disorder of vulva, characterized by a bright-red mucosal lesion of significant chronicity, which may be symptomatic. Very few case studies of this condition are reported in literature. We describe one such classical patient, who presented with slight dyspareunia. The diagnosis was confirmed on histopathological examination. It is important for clinicians to accurately diagnose this alarming condition in time.

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Background: Syphilis, the "great imitator," presents with a wide range of mucocutaneous and systemic manifestations, which can mimic many more diseases. Though there has been a rising prevalence of viral sexually transmitted infections (STIs), syphilis is not an uncommon diagnosis. Aims: To study the recent trend of acquired syphilis in the patients attending STI clinic. Materials and Methods: Retrospective analysis of all the syphilis patients registered with STI clinic of our institute from January 2013 to December 2014 was done. Thorough sociodemographic, clinical, and investigational data were assessed and compared with the annual incidence of last 4 years. Results: Of the total 1010 STI patients who attended the STI clinic, 110 cases were diagnosed as syphilis. There were 78 (70.9%) males and 32 (29.1%) females. Twenty-five (22.7%) patients were men who have sex with men (MSM). Primary syphilis was diagnosed in 28 (25.5%), secondary in 47 (42.7%), and latent in 35 (31.8%) cases. Lymphadenopathy was present in 55 (50%) patients with syphilis. Mixed infection was diagnosed in 29 (26.4%) patients of whom genital herpes was the most common. Twenty-seven (24.5%) patients were human immunodeficiency virus (HIV) reactive. Conclusion: Incidence of syphilis has shown a rising trend over past few years. The major risk factors considered are the HIV infection and homosexual behavior.

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Objectives: Data regarding the association of Mycoplasma genitalium with infertility is scarce. This study was planned to look for the presence and association of M. genitalium in women with infertility. Materials and Methods: A prospective observational study was conducted on 100 cases of infertile women. The control group included 100 healthy fertile women. Samples of first void urine (FVU), endocervical swabs (ECS), and endometrial biopsies were subjected to polymerase chain reaction targeting MgPa gene to look for the presence of M. genitalium DNA. All endometrial biopsy samples were subjected to histopathological examination. A detailed clinical history of patients was taken, and all relevant investigations were recorded. Results: M. genitalium was found in 16% of women with infertility from either of the samples that is, FVU and/or ECS and/or endometrium biopsy, and none from controls. ECS and biopsy could detect the highest number of cases (27%). Asymptomatic cases predominated in the study and M. genitalium positivity (73.3%) was seen more in primary infertility. Tubal occlusion and disordered proliferative endometrium were demonstrated in 33% and 26.66% of M. genitalium positive cases respectively. Conclusions: The study shows an association of M. genitalium infection and infertility and suggests routine screening of this pathogen in patients with infertility.

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Oral sex is commonly practiced by sexually active couples of various age groups, including male-female and same-gender adolescents. The various type of oral sex practices are fellatio, cunnilingus, and analingus. Oral sex can transmit oral, respiratory, and genital infections from one site in body to the other. Oral health has a direct correlation on the transmission of infection; a cut in the mouth, bleeding gums, lip sores or broken skin increases chances of life-threatening infections. Although oral sex is considered a low risk activity, it is important to use protection such as physical barriers, health and medical issues, ethical issues, and oral hygiene and dental issues. The ulcerations or unhealthy periodontium in mouth accelerates the phenomenon of transmission of infections into the circulation. Thus, consequences of unhealthy or painful oral cavity are significant and oral health should be given paramount importance for the practice of oral sex.

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Introduction: Prevalence and pattern of acquired syphilis are changing in India in recent years because of good laboratory diagnosis and treatment, but it still remains a major public health problem with significant regional variations. Aim: To study the changing trend of acquired syphilis in a Tertiary Care Center of North India. Subjects >and Methods: Retrospective analysis of all the cases of sexually transmitted infections (STIs) registered in the Skin and VD Department of PGIMS, Rohtak from January 2008 to December 2012 was done. Complete epidemiological, clinical, and investigational data were recorded and analyzed for changing trends in prevalence, pattern and clinical presentations of syphilis. Observation: Total of 1462 cases attended the STI clinic from January 2008 to December 2012. A total of 124 patients were venereal diseases research laboratory reactive, of which 33 (2.25%) were false positive cases, and Treponema pallidum hemagglutination was reactive in 91 cases (6.22%). Totally, 91 (6.22%) cases were diagnosed as syphilis. Of 91 cases, 78 (85.71%) were males and 13 (14.29%) were females. Primary syphilis was diagnosed in 21 (13.08%), secondary in 38 (41.76%), and latent in 32 (35.16%) patients. 4 (10.53%) of the secondary syphilis were having asymptomatic rash, 14 (36.84%) had condyloma lata and 17 (44.74%) had genital ulcer with cutaneous rash. Mixed infection was detected in 7 patients. 8 (8.79%) were human immunodeficiency virus positive. Conclusion: Although our study indicates a decreasing trend in the prevalence of syphilis in last 5 years, there is a rise in latent syphilis as compared to primary syphilis demanding steps to increase awareness among general population.

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Introduction: Vulvar lichen sclerosus (VLS) often remains undetected for years due to lack of awareness, as well as private nature of the disease. Advanced disease severely affects the quality of life and is associated with increased risk of vulvar squamous cell carcinoma (SCC). The aim of this study was to assess the usefulness of a physician-administered clinical scoring system for the clinical diagnosis and evaluation of VLS. To the best of our knowledge, this is the first study using the clinical score developed by Günthert et al. on the VLS patients. Materials and Methods: The study conducted was an observational cross-sectional study of 36 cases attending Dermatology OPD of Government Medical College with clinically proven and previously untreated VLS enrolled over a 1 year period. Cases were retrospectively subjected to evaluation by physician-administered clinical score based on 6 clinical features, viz. erosions, agglutination, hyperkeratosis, stenosis, fissures, and atrophy. Results: The average age of 36 clinically diagnosed VLS cases was 56.4 years. Most common clinical features were hyperkeratosis and atrophy found in 86.11% cases followed by erosions (75%) with one-third cases having grade 2 (severe) changes. One case had well-differentiated SCC clitoris at presentation. The mean physician-administered clinical score was 5.583, and 80.56% cases had clinical score ≥4 validating the clinical diagnosis. Discussion: Early diagnosis and prompt treatment is the key to prevent sequelae and complications of VLS. The physician-administered clinical score can be a useful tool to diagnose and later evaluate the response of treatment and prognosis of VLS cases.

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Psoriasis is an autoimmune chronic inflammatory skin disease known to be triggered by streptococcal and HIV infections. However, human papilloma virus infection (HPV) as a triggering factor for the development of psoriasis has not been reported yet. We, hereby report a case of plaque type with inverse psoriasis which probably could have been triggered by genital warts (HPV infection) and discuss the possible pathomechanisms for their coexistence and its management.

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Background: Human Immunodeficiency Virus (HIV) infection produces a wide range of infectious and noninfectious dermatoses which correlate with the degree of immunodeficiency. Since the introduction of highly active antiretroviral therapy (HAART), there has been a dramatic decrease in the incidence of HIV-associated dermatoses. However, HAART itself causes various cutaneous adverse drug reactions. Aims: To assess the various mucocutaneous manifestations in HIV-infected individuals and its association with CD4 count and to assess the effect of HAART on mucocutaneous manifestations. Materials and Methods: Of the 170 patients recruited, 110 patients were previously diagnosed with HIV and were on follow-up. The rest 60 patients were newly diagnosed cases at recruitment, and these patients were followed up every month for mucocutaneous manifestations for a period of 6 months. Results: Of the 170 patients screened, 69.41% patients had at least one mucocutaneous lesion at presentation. Fungal, viral, and bacterial infections were observed present in 17.6%, 10.6%, and 9.4% patients, respectively. There was a significant difference in the occurrence of candidal infections in the HAART versus non-HAART group (P = 0.0002). Candidiasis (P ≤ 0.0001) and human papillomavirus infection (P = 0.0475) occurred more commonly with CD4 count <200 cells/mm ³ . Among the noninfectious dermatoses, inflammatory dermatoses (17.6%) were more commonly observed at recruitment followed by adverse cutaneous drug reactions (16.5%) and neoplasms (5.3%). Conclusion: HAART has significantly altered the patterns of mucocutaneous manifestations. The prevalence of both infectious and inflammatory dermatoses has come down. However, there is an increase in the incidence of adverse cutaneous drug reactions.

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Eponym has originated from the Greek word "eponymos" meaning "giving name". It is a tribute to the pioneers in the field who have significantly contributed towards present understanding of the subject. Syphilis has amazed and plagued mankind since eternity. This disease is a great masquerade and can humble best of physicians with its varied presentations. Keen and immaculate observations of these workers have eased our understanding of many signs and phenomenon associated with this disease. This has led to evolution of number of eponyms, perhaps no other disease has as many eponyms associated with it, as does syphilis. Eponyms such as Kassowitz's law, Clutton's joints, Higoumenaki sign, Argyll-Robertson pupil etc. help in providing easy milieu for remembering. Besides paying tributes to stalwarts in the field, who dedicated their lives for this cause, they also facilitated our current understanding of the great masquerade.

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We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection.

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Long-term non-progressor HIV infection (LTNP-HIV) is seen in <1 percent of HIV-afflicted population. There are definite criteria for the diagnosis of LTNP-HIV. Malignancies either solid tumors or haematological cancers have not been reported in such population. We report here a rare case of follicular thyroid carcinoma in LTNP-HIV infection. She never had any opportunistic infections. She did not receive anti-retroviral therapy in the entire course of illness and continued to have good quality of life. Treatment of follicular thyroid cancer was similar to other patients without HIV infection. This could be the first case study from India.

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Enteric protozoan infections are a well-documented cause of diarrhea in immunocompromised patients. Special stains on stool specimens are routinely performed in such patients to diagnose these protozoa namely cryptosporidium, microsporidium, and isospora. Duodenal and jejunal biopsies can also be performed to obtain a tissue diagnosis. We report a case of microsporidium enteritis diagnosed on histopathological examination of small bowel resection specimen in a case of perforation peritonitis. The patient was a known HIV-positive on antiretroviral treatment for 2 years and on antitubercular treatment for 3 months. This case report highlights the importance of carefully screening the resection specimens for protozoal infections in immunocompromised individuals. The association of perforation peritonitis and microsporidium is rare. Hence, the possibility that untreated microsporidium infection can lead to perforation cannot be ruled out.

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Cancer is a significant cause of morbidity and mortality in human immunodeficiency virus-infected subjects. Verrucous carcinoma is a peculiarly slow evolving, but relentlessly expanding variant of epidermoid carcinoma that is extremely reluctant to metastasize. A 60-year-old unmarried male patient presented with urethral discharge of 3 weeks duration. Dorsal slit of the prepuce revealed an ulceroproliferative growth measuring 3 cm Χ 3 cm arising from prepuce and involving glans. Biopsy from the growth in the prepuce showed histopathological features of verrucous carcinoma. Partial amputation of the penis was done. Human papillomavirus DNA by polymerase chain reaction was negative. The patient was started on antiretroviral therapy.

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Vulvar squamous cell carcinomas (SCC) are rare malignancy of unknown etiology. Only 10% of these tumors occur under the age of 40 years. We are describing one such rare case where a 29-year-old female patient had presented with nonhealing ulcer over vulva since 4 months. Histopathology revealed invasive SCC of the vulva. The occurrence of invasive vulvar SCC in a younger patient is rare. In this patient, it is most likely precipitated by immunodeficiency caused by Human Immunodeficiency Virus.

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Background: Sexually transmitted infections (STIs) increase the risk of transmission of Human Immunodeficiency Virus (HIV) infection causing immense need to understand the patterns of STIs prevailing in the regions of a country for proper planning and implementation of STI control strategies. Due to the lack of adequate laboratory infrastructure in the country, information regarding the profile of STIs relies essentially on syndromic diagnosis. Aims and Objectives: To study the pattern of common STIs and the prevalence of HIV infection in patients attending the STI clinic of a tertiary care hospital in northern part of India using a syndromic approach. Materials and Methods: A retrospective analysis of data collected from the clinical records of 2700 patients over a period of 21 months (July 2012 to March 2014) was carried out at the Skin and VD Department of SMS Hospital, Jaipur. Detailed history, demographical data, and clinical features were recorded from all the patients. All patients were tested for HIV by ELISA and rapid plasma reagin. STIs were categorized in different syndromes as depicted by National AIDS Control Organization in the syndromic management of STIs. The data collected was analyzed statistically. The proportions were calculated for various syndromes and disease prevalence. Results: The overall most common STI was balanoposthitis, followed by genital herpes, vaginal/cervical discharge, molluscum contagiosum, genital warts, nonherpetic genital ulcer disease, lower abdominal pain, and urethral discharge in decreasing order. Among the study population, 2.55% were found to be HIV-positive. Conclusion: Viral STIs such as molluscum contagiosum, herpes genitalis, and condylomata acuminata are on the rise among STI/RTI clinic attendees.

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Background and Objectives: Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. Materials and Methods: Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL), Treponema pallidum hemagglutination assay (TPHA) and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. Results: The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. Conclusions: Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.

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Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India.

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Introduction: Male homosexual behavior carries a high risk of transmitting sexually transmitted infections (STIs). Ignorance regarding the associated high risk, indulgence inspite of no natural homosexual orientation and not using protective barrier methods can affect the sexual health of adolescents and adults. Aim: (1) To assess the proportion of men who have sex with men (MSM) having a natural homosexual orientation compared to those who had acquired the homosexual behavior initially under various circumstances (such as due to certain misconceptions, fear of having heterosexual contact, peer pressure, and influence of alcohol). (2) To assess the level of awareness regarding increased risk of transmission of STIs associated with homosexual behavior and regarding protective barrier methods. Materials and Methods: After obtaining consent from the subjects, questionnaire - based interview used for obtaining data for this observational (cross-sectional) study. Results: (1) Of the 50 subjects, only about 25% had interest in homosexual behavior prior to initial episode. (2) About 50% subjects indulged in homosexual behavior due to lack/fear of having heterosexual contact. (3) About 60% subjects believed that homosexual behavior carried relatively lower risk of acquiring STIs and 68% subjects have had unprotected contact. (4) About 70% subjects had only acquired this behavior and nearly 60% subjects were interested in heterosexual marriage and not interested in further homosexual behavior. Conclusion: (1) Homosexuality is a natural orientation in some and an acquired behavior in the rest. (2) If homosexual behavior is acquired, due to misconceptions, then imparting sex education and awareness regarding involved risks, and the importance of protective barrier methods will prevent ignorance driven behavior. For those with natural homosexual orientation, the importance of protective barrier methods in homosexual behavior needs emphasis.

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