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  In this article
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgement
    References

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ORIGINAL ARTICLE
Year : 2003  |  Volume : 69  |  Issue : 2  |  Page : 126-128

Study of genital lesions


Dept. of Dermatology & Microbiology, Bowring and LC Hospitals, Bangalore - 560 001, Karnataka

Correspondence Address:
130, 2nd Main Road, Sheshadripuram, Bangalore - 560 020

   Abstract 

A total of one hundred patients (75 males and 25 females) age ranged from 17-65 years with genital lesions attending the STD clinic of Bowring and LC Hospitals Bangalore constituted the study group. Based on clinical features, the study groups were classified as syphilis (39), chancroid (30), herpes genitolis (13), condylomato lato (9), LGV (7t condylomata acuminata (5), genital scabies (3), granuloma inguinole (2) and genital candidiasis (1). In 68% microbiological findings confirmed the clinical diagnosis. Of the 100 cases 13% and 2% were positive for HIV antibodies and HbsAg respectively.

How to cite this article:
Anand Kumar B H, Vijaya D, Ravi R, Reddy R R. Study of genital lesions. Indian J Dermatol Venereol Leprol 2003;69:126-8


How to cite this URL:
Anand Kumar B H, Vijaya D, Ravi R, Reddy R R. Study of genital lesions. Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2019 Jun 24];69:126-8. Available from: http://www.ijdvl.com/text.asp?2003/69/2/126/5894



   Introduction Top

Sexually transmitted diseases (STD) are global health problem of great magnitude.[1] Different pathogens can cause the same syndrome, while there is often co-infection by more than one organism. It is usually impossible to make a reliable etiological diagnosis on clinical grounds only, but laboratory support to confirm a clinical diagnosis is not available in developing countries like India.[2] The present study was undertaken to find out the correlation of clinical diagnosis with microbiological findings.

   Materials and Methods Top

A total of 100 patients with genital lesions attending the STD clinic of Bowring and L.C. Hospital constituted the study group. The study period was from January 1998 to December 1998. Age and sex distribution of the study group are shown in [Table - 1]. Urethritis cases are not included in this study. Exudate/aspirated material/ scraping collected from the lesion were immediately processed in the microbiology department. Laboratory tests like Grams stain, Giemsa stain, wet mount and routine culture were performed for all the samples. Dark field microscopy (DGM) was performed for the demonstration of Treponema pallidum. Serur samples of all the patients were screened for VDRL HbsAg and HIV antibodies by ELISA. Criteria for diagnosing various genital lesions in the laboratori are, Sypilis-DGM examination for Tpallidur and VDRL test (reactive in 8 dil or >). Chancroid­ Grams.Giemsa+stain and culture for Haemophilm ducreyi. Herpes genitalis-Giemsa stain fa multinucleated giant cell. Granuloma inguinale­Grams, Giemsa stain for Calymmatobacteriur granulomatis. Genital scabies-wet mount for mite Genital candidiasis- KOH, Grams stain sac culture for candida species.
LGV-Giemsa stain for inclusion bodies ELISA-19G antibodies for C. trachomatis Condylomata acuminata-only on clinical grounds

   Results Top

Age, sex distribution and percentages clinical groups are shown in [Table - 1]. [Table - 2] shows the microbiological findings in various clinics group.
Out of 100 cases sole infection we demonstrated in 68%. Clinically diagnosed on case of syphilis and two case of LGV shown H.ducreyi. 13%, 2% of serum samples were positive for HIV and HBV infection respectively.

   Discussion Top

In our study STDs were more common in males (75%) than in females (25%). 59% of the study group belonged to the age of 21 -30 years, sexually active age as reported by D'Souza and Gharami.[3],[4] Presence of genital ulcerative diseases like syphilis, chancroid, herpes genitalis increase susceptibility to HIV infection. Raw surface area and active lymphocytes at the base of ulcers are easy targets for HIV In the present study syphilis (39%) is the commonest cause of genital lesion in both the sexes as reported by Dutta (41.4%) and is more compared to reports by Gharami (30.6%). D'Souza (2%), and Kumar et al (14.84%).[6] Next commonest disease was chancroid (30%) in both sexes, and is less compared to D'Souzo (55%), Kar (37.7%) and high compared to Jayasingh (15.4%).[7] This could be explained as the pattern of STDs differs from country to country and from region to region, especially in large countries such as India.
Herpes genitalis found in 13% is in correlation with Vijayalakshmi (12.4%) and more than the study of Kar (3.8) and less compared to Gharami (28.8%). 7(53.8%) cases were diagnosed by Giemsa stain which is higher than the study of Kumar et al (21.2%). 2% of granuloma inguinale of the present study is in correlation with Jayasingh (3%), Datta (1.4%) and less compared to Vijayalakzhmi (4.47%) as the climatic conditions influence the prevalence of granuloma inguinale.[8] Both the cases were positive for Calymmatobacterium granulomatis by Grams and Giemsa stain. LGV was 7% in our study which is low compared to the study of Jayasingh (11.7%) and Kar (11.6%).
Condylomata acuminata (5%) were more in females (3%) than in males (2%). Condylomata acuminata (5) cases were diagnosed purely on clinical grounds. Herpes genitalis (13), condylomata acuminata (5) genital scabies (2) and genital candidiasis (1) found in the present study (21 %) are in correlation with report by Jayasingh (25.4%).
Of the 100 cases 13% were positive for HIV antibodies. It is more compared to Kar's report (12) but less compared to Mehendale study (21.2%).[9] The strong association between genital lesions and HIV infection in this population highlights the urgency of preventing genital ulcers.[10] Syphilis cases showed higher rate of HIV positivity (15.38%) than others. It indicates that the disease increases the risk of acquiring HIV. Eight cases revealed reactive serology for syphilis. They have associated chancroid (16.66%), codylomataacuminata (20%), genital scabies (33.33%) and genital candidiasis (100%).
Two percent of HBV infection found in association with chancroid and condylomata acuminate cases is in comparison with the study of Kaur (3%).[11]
To conclude, syphilis continues to be the commonest STD in our place as in most of the developing countries. Owing to atypical presentation and mixed infections clinical diagnosis has to be corroborated by appropriate laboratory tests. As laboratory facilities are not available in most of the centers, syndromic approach and syndrome based treatment are practicable in developing countries to prevent the spread of sexually transmitted diseases.

   Acknowledgement Top

The authors are grateful to chairperson, KSCST, IISC Bangalore, for the financial support. Authors are thankful to Dr. L. Chandramma superintendent and the staff of Microbiology department of Bowring and L.C. Hospital, Bangalore for the encouragement and co­operation in this study. 

   References Top

1.Jeyasingh P Ramanaiah TBBSV, Fernandes SD. Pattern of sexually transmitted disease in Madurai India. (kinghorn) (8) Borlia MF Blumberg JW, Kraul CW, et al Penile lesions among US armed forces personnel in Japan. Arch Dermatol 1962; 86: 273-281.  Back to cited text no. 1    
2.Rajiv sule. Sexually transmitted disease-HIV/AIDS diagnosis and management. A physician Hand book. Vinay Kulkarni 1999; 1st Ed Pune: Prayas: 169-187.  Back to cited text no. 2    
3.D'Souza K, Deodhar LP Tendulkar UM. A microbiological study a penile ulcers with clinical correlation. Indian J Dermotol Venereal Leprc 1992;58:246-251.  Back to cited text no. 3    
4.Ramesh Chandra Vharami, Bhagat Ram Garg, et al. Profile c sexually transmitted diseases in HIV seropositive patients. Indian J Se Transm Dis 1999; 20: 2:12-17.  Back to cited text no. 4    
5.Datta AK. Genital ulcers in male. Indian J Dermatol Venereal Leprc 1978;44:204-204.  Back to cited text no. 5    
6.Kumar B, Sharma VK, Malhotra 5, et al. Pattern of sexually transmift disease in Chandigarh. Indian J Dermatol Venereal Leprol 1987; 53 286-291.  Back to cited text no. 6    
7.Kar PK. Sexual behaviour and HIV prevalence in patients wit sexually transmitted disease attending an STD clinic in North easier state of India. Indian J Dermatol Venereal Leprol 1999; 65: 4:182 185.  Back to cited text no. 7    
8.Vijayalakshmi K. Analytical study of 1054 genital lesions. Indian Dermatol Venereal Leprol 1972; 38:125-131.  Back to cited text no. 8    
9.Mahendale SM, et al. Evidence of high prevalence of HIV amon individuals attending STD clinics in Pune. Indian J Med Res 1996; 104 327-335.  Back to cited text no. 9    
10.Mertz KJ, Weiss JB, Webb RM, et al. An investigation of genitc ulcers in Jacksin, Mississippi, with use of a multiplex polymerise choi reaction assay:high prevalence of chancroid and Hums immunodeficiency virus infection. J Infectious Diseases 1998; 178:1 1060-1066.  Back to cited text no. 10    
11.Harjeet Kaur, Ruby Marcholla. Seroepidemiology of HIV, HBV, HC and treponemal infections. J Commum Dis 1997; 30: 20-31.  Back to cited text no. 11    

 

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