Mucocutaneous disorders in Hiv positive patients.

Twenty eight HIV positive patients were included in this study. They were evaluated for their mucocutaneous disorders, sexually transmitted diseases and other systemic disorders between 1994-95 in the department of Dermatology and STD Dr R M L Hospital of New Delhi. The heterosexual contact with commercial sex workers (CSWs) was the most common route of HIV transmission. Chancroid, syphilis and genital warts were common STDs found in HIV positive patients. Oral thrush (67.9%) was the commonest mucocutaneous disorder found in these patients followed by herpes zoster (25%) and seborrhoeic dermatitis (21.4%). There was no unusual clinical presentation seen in mucocutaneous disorders and STDs.

Usefulness of immunoperoxidase test for serodiagnosis of genital chlamydial infections.

An immunoperoxidase test detecting Chlamydia trachomatis specific serum IgG and IgA antibodies, was carried out to determine its efficacy in establishing chlamydial etiology in 104 clinically diagnosed patients attending a major STD Clinic in Delhi. The patients consisted of 58 with nonspecific urethritis/cervicitis (NSU/NSC), 11 with pelvic inflammatory disease (PID), 23 with primary infertility in either male or female and 12 with lymphogranuloma venereum (LGV). IgG antibodies were tested at a dilution of 1:64 and 1:128 and IgA antibodies at 1:16. Although 27.7 per cent (5 of 18) of the controls had IgG antibodies (> or = 1:128), none had IgA, showing the IgA marker as 100 per cent specific. In 80.8 per cent of all the patients, active infection was detected, 81.0 per cent in NSU/NSC, 81.8 per cent in PID, 76.9 per cent in female infertility, 80 per cent in male infertility and 83.3 per cent in LGV patients. The immunoperoxidase test was found to be an extremely simple and rapid test especially suited for laboratories where facilities are limited.

HIV serosurveillance among prostitutes and patients from a sexually transmitted diseases clinic in Delhi, India.

Screening of 701 prostitutes in Delhi for HIV antibodies by a competitive ELISA test and supplementary Western blot test showed that only one of them was infected. Of the 4,572 samples from the patients attending a sexually transmitted disease clinic in Delhi, none showed evidence of HIV infection. In contrast to this low frequency of HIV infection in Delhi, a much higher frequency has been reported to the Indian Council of Medical Research from major metropolitan centers on the coast of India, namely, Bombay and Madras and their surrounding areas. It is possible that the infection is making inroads from these coastal areas to the interior of the country.

Utility of semithin sections in the diagnosis of donovanosis.

The relative merits of tissue smears, paraffin sections and semithin plastic embedded sections in the diagnosis of donovanosis were assessed. In three cases reported negative or doubtful for the organisms by the former two methods, semithin plastic sections provided definite diagnosis. The latter method revealed in addition the organisms in epidermis and perivascular locations. From amongst the three stains: toluidine blue, Leishman's and thionine azure II basic fuchsin, the last mentioned was found to be the method of choice for demonstrating the organisms differently from the host cells.

An ultrastructural study of donovanosis.

In an ultrastructural study undertaken on donovanosis, the inflammatory response was studied along with the fine structure of causative organisms, Calymmatobacterium granulomatis. Macrophages were seen to be activated and showed presence of numerous filopodia and increase in the number of lysosomes and rough endoplasmic reticulum. Many cells showed vacuoles of varying size in the cytoplasm some of which contained the organisms. Other cells seen included plasma cells, polymorphonuclear cells and sparse lymphocytes. In one case few multinucleated giant cells and dendritic cells with long cytoplasmic processes making cell-cell contact with other inflammatory cells were seen. Such cells have not been described in donovanosis so far. The organisms showed surface structures like pili and vesicles, the role of which is yet to be clearly understood.

National STDs control programme.

PIP: In 1947 the Bhore Committee recommended that sexually transmitted diseases should be dealt with by special organizations within the provinces, but the institutions were not adequate, and there was no coordinated plan. Before the 1st 5-year plan, there were 50 state-administered sexually transmitted disease clinics in India. During the 1st 5-year plan, facilities were upgraded, the central government took over certain aspects of the program, and the World Health Organization Venereal Disease team submitted a report on control of venereal diseases in India. By the end of the 5th 5-year plan, the government had set up another 187 clinics. Until the 6th 5-year plan, the central government supplied material, equipment, and drugs to the clinics, but the operating costs were borne by the states. During the 6th 5-year plan, the central government took over all aspects of the program. It is estimated that 20 million Indians suffer from venereal disease. With World Health Organization assistance, group educational activities in sexually transmitted diseases are being organized in different parts of the country, so that all personnel will be better equipped to treat patients. Group educational activities for treatment of yaws are also being organized for paramedical personnel who will have to deal with yaws in tribal areas. The UN Childrens Fund is also providing funds for communication and social mobilization against venereal diseases.^ieng

AIDS screening in North India: clinical spectrum of HIV infection.

PIP: 8 subjects with human immunodeficiency virus (HIV) infection were encountered between June-December 1986 and were diagnosed as having AIDS (3), PGL (1), MLA (1), and asymptomatic HIV carrier state (3). The clinical presentation, immunologic features, and course of those with AIDS or PGL, were similar to those reported from American, European, and tropical African countries, with low T-helper cells, reversed CD4/CD8 ratio, and the presence of antibody to HIV. Asymptomatic carriers also had reversed CD4/CD8 ratio. 6 of these individuals were foreign visitors, 5 from tropical African countries and 1 from the US, while 2 were Indians who had frequent sexual exposure abroad in countries where AIDS is quite prevalent (1 homosexual in West Germany and other possibly had sexual exposure in Uganda). None of the 2046 Indian nationals in the high risk group screened until January 1987 without history of sexual, blood, or blood product exposure abroad were found to seropositive at this center in North India. These findings suggest that HIV infection is not endemic in North India. However, there is a risk of spread of this infection in North India through sexual or blood contact with foreign visitors.^ieng

A Study of Behavioural Aspects of Sexually Transmitted Diseases.

Some of the behaaoural aspects of 227 randomly selected male,patients attending the STD ClWc of Safung Hospitak New were The majority were below thirty years of age and poorly educated. Two thirds -of the patients were teetotalers .37.4% study group were pronuscuous and 353% of the group were repwcrs' A high of pre-marital sex was noted. 352% of the stated their spouse to be the cause of the StD. 11.9% of the study group admittc to homosexuality. Professional women (prostitutes and call girls) were the source of the majority of infections-. There was a statistically significant relationship between consumption of alcohol and promiscuity. Now of the major STDS. was significantly Mort frequently acquired from any particular source. NSU however was more frequent amongthchom . Such studies should be conducted from time to time to understand and evaluate the trend of permissiveness in the society.

A Clinicopathological Study of Donovanosis.

A cfinicopathological study of 50 cases of genital ulcers has been undertaken with a view to. identify cases of donovanosis. The diagnosis of donovanosis was established either by tissue smear examination or through histopathological study.26 cases were found to be of donovanosis and biopsy examination was found to be more reliable than smear examination . The pitfalls in the diagnosis of donovanosis in partially treated cases and the epidemiological aspects are being highlighted.

A Clinico-epidemilogical Study of Gental Warts.

The epidemiological and clinical, characteristics of 109 patients (94 then and 15 women) with gental warts were studied at the STD Training and Denimonstration Centre, Safdarjang Hospital, New Delhi. Genital warts is a disease of young adults and correlates with sexual maturity. The majority of patients were poor socio-economically, non-promiscuous and not addicted to alcohool. Most of the with the disease, were single and the women . married, reflecting the differing sources of acquisition of the disease. Homosexuality played a significant role in the acquisition of perianal warts in males. The mean incubation period. Warts were more numerous in women.. Long foreskins, by presenting a more moist environment probably preispose to the acquisition and propagation of warts. Personal hygiene soon after coitus did not seem significant, in the prevention of warts Cutaneous warts were associated in 8% of the cases. Concomitant sexually transmitted infections were present in 38.5% of the patients. Genital warts showed a preferential distribution at sites frequently subjected to the trauma of coitus.

A Profile Gonococcal Uretheritis in Male.

A study of 125 uncomplicated urethritis in males were selected at and analysed from different angles in view the changing facets of gonococcal infection and its impact at the present time.

Default Among Patients with Gonorrhoea-the Role of Health Education.

Factors relating to default among 100 health educated and 63 uneducated patients with gonorrhoea were studied. Default was not significantly associated with age, marital status or level of education. Repeaters were not particularly more prone to default than non-repeaters. Health education did not significantly influence default. Default was significantly low (p.001) among a small group of patients with concomitant diseases detected at the initial or follow - up visits. A high incidence of trichomoniasis (14.5%) in the present study detected in the follow-up period emphasizes the need for thorough clinical and laboratory examination at each follow up visit.