Sexually transmitted infections

Why are sexually-transmitted infections important??, Syndromic management of sexually-transmitted infections?, Syphilis?, Gonorrhoea?, Chlamydial infections?, Chancroid?, Granuloma inguinale donovanosis?, Trichomoniasis?, Bacterial vaginosis?, Genital herpes?, Candida vaginitis?, Human papillomavirus and genital warts?

Granuloma Inguinale

Granuloma ingunale (GI) or donovanosis is a genital ulcer disease caused by theCalymmatobacterium granulomatis. It is a Gram-negative, facultative, obligateintracellular and pleomorphic bacterium. This bacterium has phylogeneticallyclosed to and placed within the Klebsiella genus. Clinically, the disease is com-monly characterized as painless, slowly progressive ulcerative lesions on thegenitals or perineum without regional lymphadenopathy. The lesions are highlyvascular and bleed easily on contact Extragenital lesions may occur but are rareand more common in newborns from mothers with GI genital lesions. Thisdisease is often neglected, therefore it is often misdiagnosed and inaccuratetherapy. Treatment time is 3 weeks or until clinical cure has been achieved forall proposed regimens. It often occurs both in men and women of reproductiveage (20-40 years). This article consists of several theoretical references that havebeen viewed to have a better understanding of GI.

Granuloma Inguinale

Granuloma ingunale (GI) or donovanosis is a genital ulcer disease caused by theCalymmatobacterium granulomatis. It is a Gram-negative, facultative, obligateintracellular and pleomorphic bacterium. This bacterium has phylogeneticallyclosed to and placed within the Klebsiella genus. Clinically, the disease is com-monly characterized as painless, slowly progressive ulcerative lesions on thegenitals or perineum without regional lymphadenopathy. The lesions are highlyvascular and bleed easily on contact Extragenital lesions may occur but are rareand more common in newborns from mothers with GI genital lesions. Thisdisease is often neglected, therefore it is often misdiagnosed and inaccuratetherapy. Treatment time is 3 weeks or until clinical cure has been achieved forall proposed regimens. It often occurs both in men and women of reproductiveage (20-40 years). This article consists of several theoretical references that havebeen viewed to have a better understanding of GI.

Amoebiasis of the Penis: A Review and Update

Ulceration of the penis/foreskin which would tend to be painful, Swelling of the penis, Oedema of the penis, Discharge from ulcer or inflamed area of penis that could be purulent or may contain blood, Balanoposthitis, Exudation from a penile ulcer which could be mild, profuse, purulent or bloody, Sloughing off of part of the foreskin and other tissues with resulting hypospadias, indurated swelling of the penis which may initially involve one part of the penis but could quickly spread, A history of homosexual coital activity may be obtained, The spouse of a man who has Amoebiasis of the penis could also have Amoebiasis of vulva, cervix or endometrium, The prepuce may not be retractable, There may be ulceration or swelling of the glans penis that may be irregular. Clinical examination findings in cases of Amoebiasis of the penis could reveal some of the ensuing: The general and systematic examinations may be normal. Examination of the penis may show: Tight non-retractile foreskin, Ulceration of foreskin, Swelling of the foreskin, Swelling of the glans penis, Ulceration and swelling of glans penis., Swelling and inflammation of the shaft of the penis, Ulceration on the shaft of the penis, Development of an iatrogenic hypospadias which was not there before, The inguinal lymph nodes may not be palpable but sometimes they may be enlarged on one side or on both sides, The penile swelling may involve part of the penis but at times on rare occasions the entire penis may be swollen, the penile swelling could on rare occasions extend to the supra-pubic area, On rare occasions the swelling of the penis could extend to include the scrotum but this is extremely rare. Amoebiasis of the penis does mimic various common conditions that affect the penis including: squamous cell carcinoma of the penis, chancroid, primary syphilitic ulcer of the penis, granuloma inguinale, balanoposthitis, and many other lesions affecting the penis. A high-index of suspicion is required to diagnose Amoebiasis of the penis. Clinicians need to be aware that male homosexuals who practice penetrative penis-anal coital activity have a higher risk of developing amoebiasis of the penis especially in Amoebiasis endemic countries. If an individual is suspected to have balanoposthitis or non-specific infection of the penis and is treated with antibiotics but the lesion does not respond to treatment, amoebiasis of the penis should be suspected. Secretions and discharges from the penile ulcer as well as biopsies of the penile lesion should be submitted for pathology examination which would demonstrate trophozoites, entamoebae as well as inflammatory cells. Even if carcinoma of the penis is initially suspected biopsy of the penile lesion would show features of Amoebiasis in the absence of any features of malignancy but in the very rare situation of a combination of Amoebiasis of the penis and carcinoma of the penis microscopic pathology examination of a biopsy specimen of the penile lesion would show features of Amoebiasis and carcinoma of the penis. .Amoebiasis of the penis does quickly and effectively respond to anti-amoebic medicaments.

Sexually Transmitted Infections

Sexually transmitted infections (STI’s) are relatively common. Their presentations range from symptom-free to highly painful, debilitating and life-threatening. The approach to each type of infection varies, and depends on the ability to screen, the availability and effectiveness of treatment, and the likelihood of long-term sequelae. For many infections, prophylaxis is possible; other infections are more challenging to prevent. Unless sexual partners are also treated, re-infection is a concern, as is the further spread of disease to subsequent sexual contacts. Some infections, once effectively treated, lead to an asymptomatic carrier state that may or may not re-emerge as an active problem and/or cause sexual contacts to become ill. This review contains 10 tables, and 44 references. Key Words: sexually transmitted infections, chlamydia, gonorrhea, syphilis, HIV, herpes simplex, granuloma inguinale, lymphogranuloma venereum, chancroid, trichomoniasis

A rare case report of large bilateral vulval elephantiasis

Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae.

Intracellular klebsiella infections (donovanosis and rhinoscleroma)

Two rare intracellular species of Klebsiella, a Gram-negative bacillus, cause granulomatous disease in humans that is found in small endemic foci in warm climates, linked to poverty and poor hygiene. Donovanosis is caused by Klebsiella granulomatis (previously named Calymmatobacterium granulomatis) and is presumed to be sexually transmitted. Presenting with genital ulcers or growths, often accompanied by an inguinal ‘pseudobubo’ (granuloma inguinale), it is diagnosed by demonstrating Donovan bodies (vacuoles containing capsulated coccoid bacteria) lying within histiocytes in material taken from a typical lesion. Treatment is with azithromycin; surgery may be needed for complications. Rhinoscleroma, caused by Klebsiella rhinoscleromatis, is believed to transfer from person to person; following a period of rhinitis it most typically manifests with bulky growths in the upper respiratory tract. It is diagnosed by demonstrating intracellular organisms in typical lesions, combined with culture. Treatment is with ciprofloxacin; surgical debulking of lesions and/or reconstruction may be required.