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      Trends in genital ulcer disease: An observational study at a tertiary care teaching hospital

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          Abstract

          Introduction:

          Genital ulcer disease (GUD) often creates diagnostic difficulty in developing countries like India, with limited resources available in the health-care system. The changing etiology in GUDs over the years makes it imperative that a correct diagnosis is made to establish appropriate treatment and formulate awareness programs.

          Aims:

          This study was done to determine the recent trends in the demographic parameters, clinical presentations, etiology of GUDs, and their association with human immunodeficiency virus (HIV).

          Materials and Methods:

          An observational cross-sectional study was conducted from October 2021 to August 2022 at the Dermatology Outpatient Department in our hospital. All the patients who presented with GUDs were included after written informed consent. The diagnosis of GUD was confirmed by thorough clinical examination and appropriate laboratory test. Data were entered and analyzed using IBM SPSS software.

          Results:

          Out of 135 cases of GUDs, the majority were males (79%). The most common age group was 21–30 years, with a mean age of 35.23 ± 14.98 years. Most of the patients were heterosexual (90%). Multiple sexual partners were found in 40% of cases. Herpes genitalis was the most common GUD (59%), followed by syphilis (15%). HIV infection was found in 6.6% of cases.

          Conclusion:

          This study represents the increasing burden of viral GUDs compared to the last three decades. The ulcerative sexually transmitted infection facilitates the transmission of HIV. In this HIV era, there is a need for increased efforts toward acknowledgment, safe sexual practices, periodic screening, and sexual health awareness programs in the high-risk population.

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          Most cited references20

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          A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?

          Many studies have explored the role of "classic" sexually transmitted diseases (STDs) in determining the pattern of HIV epidemics. However, the many different STDs may contribute in different ways, at different magnitudes. To review available studies on the bidirectional interactions of HIV and STDs to explore the extent of current knowledge on the different influences of the varied STDs in heterosexual HIV epidemics. Longitudinal studies on susceptibility and controlled studies on infectiousness and duration of disease identified on electronic databases through reference lists and citation indices up to the end of 1999 were systematically reviewed, including meta-analyses assessing the influence of STDs on susceptibility to HIV. Studies have a clear publication bias with a significant result that hinders robust interpretation. However, genital ulcerative disease appears to have a greater impact than nonulcerative disease, and men are more affected than women by the effects of STDs on susceptibility to HIV. There is evidence that STDs increase the infectiousness of HIV from men to women, whereas the evidence is more equivocal for the infectiousness of women. Few studies identify the impact of different STDs, and there is a marked lack of studies investigating the impact of HIV infection on the transmission of other STDs. A large body of work has measured the association between STDs and HIV. However, publication bias and gaps in the focus of studies mean that a detailed, quantitative understanding of the interaction requires much more attention.
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            Genital herpes and human immunodeficiency virus: double trouble.

            The synergistic relationship between herpes simplex virus type 2 (HSV-2) and transmission of human immunodeficiency virus (HIV) can be substantial in developing countries that have high prevalences of both viral infections. Genital herpes, most frequently caused by HSV-2, has become the leading cause of genital ulcer disease worldwide. This review of recent research on genital herpes and enhanced susceptibility to, and transmission of, HIV is part of the "Advances in HIV/AIDS research series" which endeavours to form a bridge between the research into HIV and acquired immunodeficiency syndrome (AIDS) and the practice of HIV/AIDS prevention, care and support in developing countries. Research findings have shown that being seropositive for HSV-2 can increase the risk of HIV acquisition among high-risk HIV-negative people exposed to HIV and, likewise, the infectiousness of individuals co-infected with HIV-1 and HSV-2 can increase during periods of HSV-2 reactivation. These observations have led to the initiation of several intervention trials and could ultimately lead to the setting of new priorities in public health and clinical practice. WHO has recently issued new guidelines for the syndromic management of genital ulcer disease that include antiviral treatment for lesions consistent with genital herpes. The United States Centers for Disease Control and Prevention issued updated Sexually Transmitted Diseases Treatment Guidelines in 2002 that recommended the use of type-specific serological tests for diagnosing HSV-2. Recently launched proof-of-concept, HSV-2 intervention trials in several countries will help to determine the proportion of new HIV infections that could be prevented by suppression of HSV-2, and the findings from these studies will inform those involved in setting prevention and treatment priorities and strategies in developing countries.
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              A retrospective study of the pattern of sexually transmitted diseases during a ten-year period.

              Proper knowledge of the patterns of sexually transmitted diseases (STDs) in different geographical regions is necessary for evolving proper strategies for control of these diseases. To study the pattern of STDs and to analyze the changes during a ten-year period from 1990 among patients attending Medical College Hospital, Kottayam. Case records of 686 patients with STDs who attended the outpatient wing of the Department of Dermatology and Venereology were studied. There were 504 males and 182 females in the total of 686 patients. Marital contact alone was reported by 123 (67.6%) female patients. Genital ulcer diseases (GUDs) accounted for the maximum number of STDs, with 504 cases (73.5%), followed by condyloma acuminatum (17.5%) and gonorrhea (10.1%). Forty-three patients had multiple infections. The total number of patients during the first year of study was 129, while it was 41 during the last year. Bacterial STDs showed a striking reduction in numbers. The decline was less marked in the case of viral STDs. The majority of patients had genital ulcer diseases. Spouses were the most common source of infection for female patients. There was a marked decline in the number of patients with various STDs during the ten-year period. The decline was more evident in the bacterial STDs resulting in an apparent increase of the viral STDs towards the end of the period of study.
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                Author and article information

                Journal
                Indian J Sex Transm Dis AIDS
                Indian J Sex Transm Dis AIDS
                IJSTD
                Indian Journal of Sexually Transmitted Diseases and AIDS
                Wolters Kluwer - Medknow (India )
                2589-0557
                2589-0565
                Jul-Dec 2023
                06 December 2023
                : 44
                : 2
                : 121-127
                Affiliations
                [1]Department of Dermatology, Venerology and Leprosy, C.U. Shah Medical College, Surendranagar, Gujarat, India
                Author notes
                Address for correspondence: Dr. Vaishali S. Makwana, Department of Dermatology, Venerology and Leprosy, C.U. Shah Medical College, Surendranagar, Gujarat, India. E-mail: 123vaishali123@ 123456gmail.com
                Article
                IJSTD-44-121
                10.4103/ijstd.ijstd_125_22
                10785111
                38223157
                d2580937-1337-4cb9-bd78-647f8157d14a
                Copyright: © 2023 Indian Journal of Sexually Transmitted Diseases and AIDS

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 27 December 2022
                : 15 February 2023
                : 14 April 2023
                Categories
                Original Article

                genital ulcer disease,herpes genitalis,heterosexual,human immunodeficiency virus,syphilis

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