Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 113  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
SHORT COMMUNICATION
Year : 2018  |  Volume : 63  |  Issue : 6  |  Page : 502-505
Disease pattern among sexually transmitted infection clinic attendees: A hospital-based study


Department of Pediatrics, Base Hospital, New Delhi, India

Date of Web Publication2-Nov-2018

Correspondence Address:
Dr. Debdeep Mitra
Department of Pediatrics, Base Hospital, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_640_16

Rights and Permissions

   Abstract 


Background: Sexually transmitted infections (STIs) have a definite role in the facilitation of HIV infection, which, in turn, also increases susceptibility to other STIs. Further, the social stigma and secrecy surrounding STIs create difficulty in estimating its true incidence and prevalence. Objective: The objective of this study was to know the pattern of diseases including different clinical presentations and final diagnosis among the STI clinic attendees. Materials and Methods: This study was a hospital-based study; a predesigned and pretested schedule was used to collect data from 140 patients after obtaining their consent. The study was carried out between January 1, 2016, and December 31, 2016. Statistical Analysis: Analysis was done using tabulation and proportion. Results and Observation: Genital ulcer (31.43%) was the most common clinical presentation among the attendees. Primary syphilis was the most common (17.14%) STI detected among the participants followed by herpes genitalis (16.43%). The most common mixed infection was primary syphilis with chancroid (36.36%) followed by herpes genitalis with primary syphilis (18.18%). Conclusion: Ulcerative STIs singly or in combination are more frequent than the non-ulcerative STIs. Further studies with large sample sizes are needed to obtain a more vivid picture.


Keywords: HIV, sexually transmitted infections


How to cite this article:
Talukdar K, Chopra A, Mitra D, Mitra B. Disease pattern among sexually transmitted infection clinic attendees: A hospital-based study. Indian J Dermatol 2018;63:502-5

How to cite this URL:
Talukdar K, Chopra A, Mitra D, Mitra B. Disease pattern among sexually transmitted infection clinic attendees: A hospital-based study. Indian J Dermatol [serial online] 2018 [cited 2018 Dec 11];63:502-5. Available from: http://www.e-ijd.org/text.asp?2018/63/6/502/244823





   Introduction Top


Sexually transmitted infections (STIs) constitute a major public health problem in India. The patterns of diseases are variable and depend on the socioeconomic, cultural, geographic, and environmental factors prevalent in different parts of the country.[1],[2],[3],[4] Moreover, the interest in STIs and their management have increased tremendously because of their proven role in the facilitation of HIV infection, which, in turn, also increases susceptibility to other STIs.[5] Social stigma associated with STIs has always been a reason for nondetection of cases, nondisclosure of source of contact, visits to quacks for treatment, and self-treatment. The secrecy surrounding STIs creates difficulty in estimating its true incidence and prevalence.[6] Knowledge about the pattern of sexually transmitted illness will provide a basis for their effective management and in the institution of preventive measures. In the current study, an effort was made to study the pattern of diseases among the attendees of STI clinic with isolated as well as mixed infections.


   Materials and Methods Top


This study was a hospital-based cross-sectional study. It was carried out between January 1, 2016, and December 31, 2016, in the STI clinic attached to a tertiary care hospital in northeast India.

Data were collected in a predesigned and pretested schedule. Patients were fully oriented about the nature and intention of the study, and a written consent was obtained from each study participant regarding the willingness to participate in the study.

A total of 10,811 patients attended the dermatology outpatient department during the study period. There were 155 STI patients among them, out of which 140 patients agreed to participate and gave consent for the study. The current study was done on those 140 patients.

Diagnoses of various sexually transmitted diseases (STDs) were based on the underlying criteria:

  1. Syphilis – identification of treponema pallidum by dark-field microscopy and/or venereal disease laboratory test – qualitative and quantitative
  2. Gonorrhea – identification of Neisseria gonorrhoeae in gram-stained urethral smear
  3. Chancroid – identification of Haemophilus ducreyi in gram-stained smear from an ulcer or unruptured inguinal bubo and on clinical grounds after ruling out other ulcerative STI
  4. Lymphogranuloma venereum – by histopathological examination and on clinical grounds after excluding other STI and non-STI conditions
  5. Donovanosis – identification of Calymmatobacterium granulomatis in tissue smear from the lesion
  6. Herpes genitalis – Tzanck test and on clinical grounds after exclusion of other ulcerative STI
  7. Nongonococcal urethritis – by excluding N. gonorrhoea from gram-stained urethral smear and by identifying five or more polymorphonuclear leukocytes per oil-immersion field
  8. Candidiasis – identification of candida species of fungi in wet potassium hydroxide preparation
  9. Trichomoniasis – identification of Trichomonas vaginalis in wet film
  10. Genital wart – clinically by the morphology of the lesion.



   Results and Observations Top


Of the 140 patients included in the study, there were 126 males and 14 females. On analysis of the collected data, it was observed that majority (31.43%) of the cases presented with genital ulcer, followed by urethral discharge (24.29%) and mixed presentation (20%). On further analysis, it was noted that majority (33.33%) of male participants presented with genital ulcer, while majority (35.70%) of female participants presented with warty lesion. A significant proportion of cases among both male (20.64%) and female (14.29%) came with mixed presentation, and most (71.43%) of them coming with genital ulcer + inguinal swelling [Table 1].
Table 1: Different syndromic presentations by the sexually transmitted diseases cases

Click here to view


Primary syphilis was the most common (17.14%) STD detected among the participants followed by herpes genitalis (16.43%), gonococcal urethritis (14.29%), and condyloma accuminata (11.43%), while granuloma inguinale (0.71%) and molluscum contagiosum (0.71%) were the least detected cases [Table 2].
Table 2: Distribution of patients according to STDs

Click here to view


On further analysis of the data, it was noted that the most common mixed infection was primary syphilis with chancroid (36.36%) followed by herpes genitalis with primary syphilis (18.18%), and in both the conditions, the participants clinically presented with genital ulcer and inguinal swelling [Table 3].
Table 3: Mixed infections among sexually transmitted disease cases and their clinical presentations

Click here to view



   Discussion Top


Mishra et al.[7] in their study of profile of patients attending STD clinic in a hospital in Gwalior found that discharge was present in all (100%) the female attendees and so was the most common presenting symptom among females followed by lower abdominal pain (61.3%), ulcers (16.6%), and nodules in genitals (11.4%). While among males, genital ulcer was the most common (80%) presenting symptom followed by discharge (14.7%), lower abdominal pain (14.7%), and nodules in genitalia (11.4%). Al-Mutairi et al.[8] found in their study that the most common presenting symptom was urethral discharge (54.1%) followed by genital ulcer (17.8%), papules/growth (16.4%), and urethral/pubic pain without associated discharge/ulcer (5.9%). In the present study, genital ulcer was the most common presenting symptom among the males (33.33%) followed by discharge (26.99%) which was more or less in conformity to the findings of Mishra et al., and among the females warty lesion was the most common (35.7%) followed by skin lesion (21.43%) which was contrary to the findings of the above-mentioned studies. The present study was done on 126 male and 14 female STD cases; this difference in the sample size could be a reason for the variations in the findings.

Thappa et al.[9] in their study of the prevalence of sexually transmitted infections in Cuttack, India noted that herpes genitalis (21.89%) and syphilis (16.27%) were the two most common sexually transmitted diseases while molluscum contagiosum (2.14%) was the least common STI. Findings of Thappa et al. were in conformity to the findings of the current study. Arora Chetna et al.[10] in their study found that among the males herpes genitalis (31.8%) followed by veneral warts (30.1%), gonorrhoea (10.7%) and syphilis (9.7%) were the four most common diseases. Among females pelvic inflammatory disease (PID) with or without secondary syphilis (32.2%), trichomoniasis (17%) and herpes genitalis (15.3%) were the commonest. As far as the males were concerned the findings of the current study were in conformity to the findings of Chetna Arora but regarding females the findings seemed to differ and the reason again could be projected to the small proportion of females within the sample in the current study.

Vibhu et al.[11] in their study found that among the mixed infections condyloma accuminata with syphilis was the most common (22.2%) followed by condyloma accuminata with herpes genitalis (11.1%), whereas Park et al.[12] in their study in Seoul, Korea, found that among the mixed infections syphilis and nongonococcal urethritis were the most common followed by syphilis with vaginitis. In the current study, the most common mixed infection was primary syphilis with chancroid (36.36%) followed by primary syphilis with herpes genitalis (18.18%). However, a firm conclusion regarding mixed infections could not be made from the current study; a future research with specific focus on this topic would be most appropriate.


   Conclusion Top


As per the current study, the majority of the patients presented with genital ulcer creating the profile of a patient who was at high risk of acquiring HIV infection in comparison to the nonulcerative STD cases. Thus, it was most essential to treat the STD cases on a priority basis with an intention to reduce the HIV prevalence. However, firm conclusion could be obtained only with a large sample size which, in turn, depended on the awareness and social stigma prevalent in the community, which had possibly affected the current study as was evident by the small sample size. To obtain a clear picture, further researches are needed keeping in mind the above fact.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Thappa DM, Singh S, Singh A. HIV infection and sexually transmitted diseases in a referral STD centre in South India. Sex Transm Infect 1999;75:191.  Back to cited text no. 1
    
2.
Khanna N, Pandhi RK, Lakhn Pal S. Changing trends in sexually transmitted diseases in Chandigarh. Indian J Sex Transm Dis 1996;17:79-81.  Back to cited text no. 2
    
3.
Bajaj JK, Kulkarni JD, Damle AS, Patwardhan NS, Karyakarte RP, Deshmukh AB. HIV seropositivity in STD patients. Indian J Med Microbiol 2000;18:44.  Back to cited text no. 3
    
4.
Khandpur S, Agarwal S, Kumar S, Sharma VK, Reddy BSN. Clinico-epidemiological profile & HIV seropositivity of STD patients. Indian J Sex Transm Dis 2001;22:62-5.  Back to cited text no. 4
    
5.
Wasserheit JN. Epidemiological synergy. Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;19:61-77.  Back to cited text no. 5
    
6.
Park K. Textbook of Preventive and Social Medicine. 20th ed. Banarsidas Bhanot Publishers. 2009 p. 289-95.  Back to cited text no. 6
    
7.
Mishra A, Verma P, Marathe N, Srivastava D. Study of the profile of patients with STDs attending an STD clinic in J.A.H. Gwalior. Indian J Community Med 2008;33:263-4.  Back to cited text no. 7
    
8.
Al-Mutairi N, Joshi A, Nour-Eldin O, Sharma AK, El-Adawy I, Rijhwani M, et al. Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait. Int J Dermatol 2007;46:594-9.  Back to cited text no. 8
    
9.
Thappa DM, Kaimal S. Sexually transmitted infections in India: Current status (except human immunodeficiency virus/acquired immunodeficiency syndrome). Indian J Dermatol 2007;52:78-82.  Back to cited text no. 9
  [Full text]  
10.
Arora C, Mishra B, Malik JS. Study of STD pattern and its associated risk factors – A hospital study. J Commun Dis 2006;38:70-3.  Back to cited text no. 10
    
11.
Vibhu M, Koranne Ravindra V, Bhawna H. Profile of sexually transmitted infections in HIV positive patients. Indian J Sex Transm Dis 2004;25:18-21.  Back to cited text no. 11
    
12.
Park J, Yoo S, Jung Y, Park E, Kwon S, Kim Y, et al. Trends of sexually transmitted diseases during recent three years: Among users of 11 public health centers in Seoul. J Korean Acad Fam Med 1998;19:150-66.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (249 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Materials and Me...
    Results and Obse...
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed137    
    Printed3    
    Emailed0    
    PDF Downloaded12    
    Comments [Add]    

Recommend this journal