Clinical Characteristics of Anogenital Warts Among Patients Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur Between 2015 and 2020

Background@#Anogenital human papillomavirus (HPV) is the most frequent reported sexually transmitted infection in the world. We aim to describe the local demographic data and the clinical characteristics of anogenital warts (AGWs).@*Methods@#This is a retrospective study on all patients with AGWs who attended the GUM clinic between 2015 and 2020. Data was obtained from case notes and further analysed.@*Results@#A total of 935 patients with AGWs attended the GUM clinic between 2015 and 2020. The mean age was 30.4 years (range 12-84). The male to female ratio was 2.35:1. Majority were Malaysian (97%). Majority of the Malaysian were Malays (61.5%) followed by Chinese (27.7%) and Indian (8.9%). About 5.6% had a history of substance abuse. While the majority (57.9%) were heterosexual, 34.8% were homosexual and 6.4% were bisexual. About 59.8% had more than one sexual partner. A quarter (25.6%) was infected with the human immunodeficiency virus. The most frequent site of AGWs in males was the perianal area (52.6%), followed by the penis (45.7%), and with a fifth of them having lesions at multiple sites. For female patients, the most frequent site of AGWs was the posterior fourchette (45.2%) followed by the labia minora (33%) with 46.6% had involvement at multiple sites. Approximately 17.6% had other concomitant sexually transmitted infections. Local treatment application used included cryotherapy (86.4%), podophyllin (35.3%), tri-chloroacetic acid (26.8%) and imiquimod (2.6%). About 41.5% required combination of these modalities. Nearly 6.2% experienced recurrence. About 2% required surgical intervention.@*Conclusions@#AGWs was more commonly observed in male. The most frequent site of involvement was perianal for male (52.6%) and posterior fourchette in female (45.2%).

Prevalence of Sexually Transmitted Infections (STIs) among Adolescents Attending Genitourinary Medicine Clinic Hospital Kuala Lumpur between 2014 and 2018

Background@#Adolescents, who aged between 10 and 19 years old, comprise about 20% of the world’s population. They are vulnerable to acquisition of sexually transmitted infections (STIs). Here, we aim to determine the demography and pattern of STIs among adolescents attending Genito-Urinary Medicine (GUM) Clinic, Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all adolescents attending GUM clinic between 2014 and 2018. Data was obtained from case notes and further analysed.@*Results@#A total of 111 adolescents attended GUM clinic between 2014 and 2018. The mean age was 18 years (range 12-19). The male to female ratio was 2.26:1. All patients were Malaysian. Only 2 were foreign nationals. The majority were Malays (85.3%) followed by Indians (11%) and Chinese (3.7%). About 46.8% were still schooling, 28.8% were employed and 23.4% were unemployed. About 8.3% had a history of substance abuse. The majority (67.6%) were heterosexual, about 17.1% were homosexual and 3.6% were bisexual. Nearly 95% engaged in unprotected sex. Majority (46%) had casual sex. The most frequent presenting symptoms for male and female adolescents were discharge (43.2%) followed by swelling/growth (23.4%). About 83% had confirmed STIs. The most common STIs among the male were gonorrhoea (44.1%), genital warts (23.4%) and non-gonococcal urethritis (14.7%). The most common STIs among the female were herpes genitalis (50%), genital warts (33.3%) and syphilis (8.3%). Six patients were infected with the human immunodeficiency virus (HIV).@*Conclusion@#The most common STI among adolescents between 2014 and 2018 was gonorrhoea for male and herpes genitalis for female.

Human Immunodeficiency Virus-infected men who have sex with men with syphilis: A 5-year multicentre study in Malaysia

@#Objectives: High rates of syphilis have been reported worldwide among men who have sex with men (MSM). This study aims to describe the clinical pattern and treatment response of syphilis among human immunodeficiency virus (HIV)-infected MSM in Malaysia. Methods: This is a retrospective study on all HIV-infected MSM with syphilis between 2011 and 2015. Data was collected from case notes in five centres namely Hospital Kuala Lumpur, Hospital Sultanah Bahiyah, Hospital Umum Sarawak, University of Malaya Medical Centre and Hospital Sungai Buloh. Results: A total of 294 HIV seropositive MSM with the median age of 29 years (range 16-66) were confirmed to have syphilis. Nearly half (47.6%) were in the age group of 20-29 years. About a quarter (24.1%) was previously infected with syphilis. Eighty-three patients (28.2%) had other concomitant sexually transmitted infection with genital warts being the most frequently reported (17%). The number of patients with early and late syphilis in our cohort were almost equal. The median pre-treatment non-treponemal antibody titre (VDRL or RPR) for early syphilis (1:64) was significantly higher than for late syphilis (1:8) (p<0.0001). The median CD4 count and the number of patients with CD4 <200/μl in early syphilis were comparable to late syphilis. Nearly four-fifth (78.9%) received benzathine-penicillin only, 5.8% doxycycline, 1.4% Cpenicillin, 1% procaine penicillin, and 12.4% a combination of the above medications. About 44% received treatment and were lost to follow-up. Among those who completed 1 -year follow-up after treatment, 72.3% responded to treatment (serological non-reactive – 18.2%, four-fold drop in titre – 10.9%; serofast – 43.6%), 8.5% failed treatment and 17% had re-infection. Excluding those who were re-infected, lost to follow-up and died, the rates of treatment failure were 12.1% and 8.8% for early and late syphilis respectively (p=0.582) Conclusion: The most common stage of syphilis among MSM with HIV was latent syphilis. Overall, about 8.5% failed treatment at 1-year follow-up.

Prevalence of Co-infection with Gonorrhoea and Non-Gonococcal Urethritis in Males with Urethral Discharge Genitourinary Clinic, Hospital Kuala Lumpur: A 5-year study between 2011 – 2015

Introduction:Dual infection with Neisseria gonorrhoeae and Chlamydia sp has been reported in several studies worldwidein men presenting with urethral discharge. The rate of co-infection has been reported to be between 1.5 to 51%.This study aims to determine the demographic characteristics and sexual behaviour of men diagnosed to haveurethritis.Methods:This is a retrospective study on all men who presented with urethral discharge and diagnosed to havegonococcal (GU) and non-gonococcal urethritis (NGU) for the year 2011 to 2015 in Genito-UrinaryMedicine Clinic (GUM), Hospital Kuala Lumpur. The case notes were retrieved and reviewed.Results:There were a total of 307 men who attended the GUM clinic with urethral discharge. The mean ageof patients was 26.4 years (range 16-57 years). Majority (64.5%) were in the age group between 20-29 years. Around 95% were Malaysians and of these about 80% were Malays. Thirty-seven patients(12%) completed their tertiary education. There were 24 patients (8%) documented to have substanceabuse. Majority (78%) were heterosexual. About 36% of patients had 2 or more partners (range 2-10)6 months before the symptoms developed. The most common cause of urethritis was gonococcalurethritis (66.4%), followed by NGU (24.4%). Among the NGU, nine were detected to have Chlamydiasp infection (12%). Co-infection with Neisseria gonorrhoea and Chlamydia sp were detected in 28men (9.1%). Seven (2.3%) were HIV seropositive.Conclusion:Majority of males diagnosed with gonorrhoea were heterosexuals acquired mainly via casual partners.About 10% had co-infection with Neisseria gonorrhoeae and Chlamydia sp.