Occurrence of genital ulcer due to herpes simplex virus type-1 (HSV-1) in attendees of a regional centre for sexually transmitted infections, central India: how disturbing is it?

Background: Genital herpes is caused predominantly by Herpes simplex virus type 2 (HSV-2) and less commonly by HSV-1. Genital HSV-1 infection results from oral sex, with fewer recurrences, mild symptoms, less asymptomatic shedding and poor genital transmission. The present study was undertaken to identify frequency of occurrence of HSV-1 and HSV-2 in genital herpes by microscopy, serology and Real Time Polymerase Chain Reaction (RT-PCR). Methods: Genital ulcer swabs and serum were collected at regional STI centre, Govt Medical College and Hospital, Nagpur.  A total of 53 patients of Genital Ulcer Disease from December 2020 -22 were examined for etiology by microscopy, serum IgM and IgG against HSV-1 and 2 by ELISA and HSV-1 and 2 DNA by RT- PCR. Results: Out of 53 genital swabs processed, 6 (11.3%) and 28 (52.8%) samples were positive for HSV-1 and 2 DNA respectively. Of the 6 HSV-1 DNA positive samples, seropositivity for HSV-1 IgM was in 2 (33.3%) samples and for HSV-1 IgG in 4 (66.7%) samples. Of the 28 HSV-2 DNA samples, HSV-2 IgM was positive in 4 (14.3%) samples and HSV-2 IgG was positive in 7 (25%) samples, multi nucleated giant cells were seen in 2 (7.14%) samples. The remaining 15 (53.6%) HSV-2 DNA positive samples were seronegative. Conclusions: HSV-1 was detected in 6 (11.3%) samples. Though these genital ulcers may be mild, it is important to counsel the patients for abstinence or safe sex practices to prevent their partners from acquiring painful non-genital ulcers due to HSV-1

Is there a need to review the syndromic case management of vaginal discharge due to candida in the Indian scenario?

Background: Vulvovaginal candidiasis (VVC) affects approximately 75% of women once in lifetime. National AIDS Control Organization has recommended Kit-2/Green (tablet secnidazole 2 gm OD stat and capsule fluconazole 150 mg OD stat) for syndromic case management (SCM) of patients with vaginal discharge since 2007. Patients are frequently revisiting the STI centre with recurrent VVC. The purpose of the study was to determine the effectiveness of fluconazole and other azoles in vulvovaginitis. Methods: Vaginal swabs from 188 patients attending regional STI centre, at Government Medical College, Nagpur between October 2020 to June 2022 were processed. A total of 128 conventionally confirmed isolates of Candida species were tested on RPMI 1640 medium for susceptibility to azoles by E test. An MIC of ≥8 μg/ml for fluconazole and ≥1 μg/ml for itraconazole, ketoconazole and voriconazole was interpreted as resistance as per CLSI M-60. Results: Candida species isolated were Candida albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. dubliniensis and C. krusei. Candida species resistant to fluconazole, itraconazole, ketoconazole and voriconazole were 22 (17.18%), 53 (41.40%), 19 (14.84%), and 3 (2.34%) respectively. C. glabrata was most resistant while C. parapsilosis was least resistant. Voriconazole was most effective. Conclusions: Extensive use of fluconazole in syndromic case management of vaginal discharge could be the probable reason for 17.18% resistance to fluconazole. Withdrawal of fluconazole and replacement with another antifungal azole in SCM of vaginal discharge may prevent recurrent VVC and perhaps lead to emergence of fluconazole sensitive candida

Recent trends in seroprevalence of syphilis in different patient groups attending a regional centre for sexually transmitted infections in central India

Background: Easy access to Suraksha clinics for sexually transmitted infections calls for a review of seroprevalence of syphilis. Methods: Serum samples from attendees of sexually transmitted infections (STI)/ reproductive tract infections (RTI) clinic/antenatal clinic, and samples of high-risk group (HRG: female sex workers and men having sex with men) brought by non-government organizations from 2017-22 were screened for syphilis by Venereal Disease Research Laboratory (VDRL) and Treponema pallidum hemagglutination (TPHA) tests. Samples positive by both tests were considered seropositive for syphilis. Statistical methods used for analysis were chi square test for linear trends and Kruskal Wallis test. Results: In STI clinic percentage positivity for syphilis has shown a statistically significant decline from 2017-22. In RTI clinic the decline was significant from 2017-19 but not significant in the years 2019-22. In antenatal clinic and in HRGs the change in seroprevalence was not significant from 2017-22 and 2017-20 respectively. However, the HRGs showed a significantly increasing trend in syphilis seropositivity from 2020-22. Conclusions: There is a significantly declining trend in the seroprevalence of syphilis in patients attending the STI/RTI clinic from 2017-22 and in HRGs from 2017-20. However, a significant increase in trend in HRG from 2020-22 may have been due to behavioural changes during the lockdown for covid 19 pandemic. A significant decline in syphilis in patients attending the STI and RTI clinic and in HRGs attending the regional centre indicates the effectiveness of consistent detection, treatment and counselling efforts of the national control program on STI in the region

Can a Rapid Test Justify as a Screening Test for Syphilis in Hard-To-Reach Population? Its Evaluation

<p>Introduction: Syphilis has re-emerged as a global public health threat with an estimated 6 million new cases every year. Asymptomatic nature of infection for a considerable time is a major reason for spread and challenge for prevention. Early diagnosis and treatment especially in hard-to-reach populations is essential for its control. Aim of this study was to evaluate the performance of rapid test for syphilis among the attendees in a sexually transmitted infection clinic. Material & Methods: The study was conducted from September 2022 to August 2023 at Government Medical  College and Hospital Nagpur. It was a prospective cross- sectional study wherein 118 patients of clinically  suspected syphilis attending the regional center for STI were tested by rapid test for qualitative detection of IgM, IgA, IgG antibodies to Treponema pallidum (Syphicheck: Oscar, Delhi India). Evaluation of the rapid test was done using Treponemal Pallidum Hemagglutination Assay (TPHA) as gold standard. Non treponemal test namely Venereal Disease Research Laboratory (VDRL) was also performed. Results: Out of 118 serum samples TPHA was positive in 52 samples, negative in 63 samples and indeterminate in 3 samples. The 3 indeterminate samples were excluded from evaluation of the other two tests. Out of 115 serum samples, in 52 samples a positive rapid test was in agreement with TPHA giving a sensitivity of 100%. In 3 samples rapid test was positive but TPHA was negative giving a specificity of 92.64%. The positive and negative predictive value of rapid test were 89.65% and 100% respectively. A reactive VDRL test correlated with TPHA in 46 samples giving a sensitivity of 88.46%. It was reactive in 11 samples which were negative by TPHA giving a specificity of 82.53%. All these 11 samples were positive in a low titre of ≤ 1:4. Conclusion: Sensitivity and specificity of rapid test was 100% and 92.64% whereas positive and negative predictive values were 89.65% and 100% respectively. The rapid test was easy to perform, required no technical expertise and is suitable for hard-to-reach population.</p><p>Keywords:- Syphilis, Treponema Pallidum, VDRL, TPHA.</p&gt

Integrating nano and microparticles

107-112A variety of nanomaterials have been developed in last few years with interesting physico-chemical properties. Most of the attempts so far have been to gain understanding of this new class of materials and look for potential applications. This has lead to the formulation of some scaling laws to explain, reasonably well, the properties of nanomaterials. It is realized, however, that the nanomaterials are often too difficult to handle due to their chemical, thermal etc instabilities as well as smallness. There is now a growing interest to integrate nanoparticles with microparticles to get advantages of both the nano and micro world of materials.The synthesis and characterization of ZnO, CdSe, TiO2 and SiO2 nano to micro particles and about core-shell particles have been studied