Study of genital lesions

Introduction

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

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 inguinale-Grams, 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

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

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

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 co-operation in this study.