Non-venereal genital dermatoses and their impact on quality of life-A cross-sectional study.

BACKGROUND: Lesions on the external genitalia could be venereal or non-venereal. Non-venereal genital dermatoses are common and may cause considerable anxiety to patients, particularly if noticed after sexual intercourse. However, this aspect has not been studied much till now. OBJECTIVES: Our study proposes to describe the profile of non-venereal genital dermatoses and determine their impact on quality of life both social and sexual, using the dermatology life quality index questionnaire. METHODS: We recruited patients aged 18 years and above, who were diagnosed to have non-venereal genital dermatoses during the study period. A detailed history was obtained and clinical examination done with relevant investigations when necessary. The dermatology life quality index was assessed and graded in all patients using Finlay dermatology life quality index questionnaire. RESULTS: A total of 293 patients with non-venereal genital dermatoses were seen and 25 different dermatoses were observed. Men 242(82.6%) outnumbered women. The commonest age group affected was 31-50 years 144(50%). Chronic inflammatory dermatoses 135(41.6%) constituted the majority of cases. Scrotal dermatitis 46(15.7%), lichen simplex chronicus 37(12.6%), vitiligo 31(10.6%) were seen most frequently. In the study group, 111(37.9%) patients had moderate and 133(45.4%) had large impact on the quality of life. Erectile dysfunction was seen in 48(19.8%) men and 9(3.7%) had premature ejaculation. A significant effect on dermatology life quality index was found with increasing age (P = 0.007), positive marital status (P = 0.006), history of unprotected sex (P < 0.001), history of recurrences (P = 0.002) and venereophobia. (P = 0.008). LIMITATIONS: The number of women in the study group was less compared to men and we could not ascertain the type of sexual dysfunction in them. CONCLUSION: Non-venereal genital dermatoses are common, more so among men. They have a significant impact on the quality of life of the individual. Recognizing and addressing this problem will help in managing these patients effectively.

Atividade sexual em pacientes pós-infarto agudo do miocárdio / Sexual activity in post-infarction patients acute myocardial

Objetivo: identificar as alterações de comportamento na atividade sexual de pacientes que tiveram infarto agudo do miocárdio. Método: estudo descritivo, de caráter transversal e abordagem quantitativa, realizado em um hospital público de grande porte e referência em cardiologia. A coleta de dados foi realizada por meio de entrevista direta, em local reservado, com aplicação de questionário estruturado pelos pesquisadores, tendo sido previamente executado um pré-teste para verificar sua adequabilidade. A análise estatística ocorreu através do software Assistat versão 7.7, sendo aprovado pelo CEP do HAM sob o n.º do CAAE: 65400117.3.0000.5197. Resultados: 50% dos pacientes referiram diminuição no interesse sexual e 60% presença de disfunção. Todos os pacientes apresentaram dúvidas sobre como retornar o desempenho de suas atividades sexuais, e contatou-se a completa ausência de orientações por parte dos profissionais de saúde. Conclusões: constata-se a necessidade de implementação de ações educativas pelos profissionais de saúde, principalmente pelo enfermeiro que reconhece seu papel nas ações educativas com os pacientes. Com isso, se faz necessário a abertura de espaços onde as necessidades de informação e o esclarecimento de dúvidas desses pacientes sejam sanados.(AU)

ABstRACt |Objective: to identify behavioral changes in the sexual activity of patients who had acute myocardial infarction. Method: descriptive, transversal study and quantitative approach, performed in a large public hospital and reference in cardiology. The data collection was done through a direct interview, in a reserved place, with application of a questionnaire structured by the researchers, having previously been performed a pre-test to verify its suitability. Statistical analysis was performed using the Assistat software version 7.7, and was approved by the CEP in HAM under the CAAE no.: 65400117.3.0000.5197. Results: 50% of patients reported decreased sexual interest and 60% had dysfunction. All patients had doubts about how to return the performance of their sexual activities, and contacted the complete absence of guidelines from health professionals. Conclusions: it is necessary to implement educational actions by health professionals, especially by nurses who recognize their role in educational actions with patients. With this, it is necessary to open spaces where the information needs and the clarification of doubts of these patients are remedied.

REsuMEN |Objetivo: identificar los cambios de comportamiento en la actividad sexual de pacientes que tuvieron infarto agudo de miocardio. Método: estudio descriptivo, de carácter transversal y abordaje cuantitativo, realizado en un hospital público de gran porte y referencia en cardiología. La recolección de datos fue realizada por medio de entrevista directa, en local reservado, con aplicación de cuestionario estructurado por los investigadores, habiendo sido previamente ejecutado un pre-test para verificar su adecuación. El análisis estadístico ocurrió a través del software Assistat versión 7.7, siendo aprobado por el CEP del HAM bajo el nº del CAAE: 65400117.3.0000.5197. Resultados: 50% de los pacientes refirieron disminución en el interés sexual y 60% presencia de disfunción. Todos los pacientes presentaron dudas sobre cómo retornar el desempeño de sus actividades sexuales, y se contactó con la completa ausencia de orientaciones por parte de los profesionales de salud. Conclusiones: se constata la necesidad de implementación de acciones educativas por los profesionales de salud, principalmente por el enfermero que reconoce su papel en las acciones educativas con los pacientes. Con ello, se hace necesario la apertura de espacios donde las necesidades de información y el aclaramiento de dudas de esos pacientes sean sanados.

Oral sex related knowledge and oral sex behavior among homosexual and heterosexual men in Belgrade: A cross-sectional study.

BACKGROUND: Although the risk of sexually transmitted infections is far greater during vaginal and anal sex than during oral sex, increasing practice of oral sex and low rates of barrier method use will probably increase the relative importance of oral sex as a route of transmission for genital pathogens. AIMS: The aim of this study was to evaluate knowledge and attitudes about oral sex and sexually transmitted infections, as well as oral sex practices, both among heterosexuals and homosexual men and to compare those two groups. MATERIALS AND METHODS: In this cross-sectional study, data were collected from consecutive sexually active male patients who ever had oral sex and who attended counselling for sexually transmitted infections at the City Institute for Skin and Venereal Diseases in Belgrade from March to June 2016. One dermatologist interviewed all participants. RESULTS: The study included 359 men who ever had oral sex, 95 (26.5%) homosexual and 264 (73.5%) heterosexual men. In comparison with heterosexual men, homosexual men had considerably more lifetime sexual partners and oral sex partners during the past 3 months, and significantly more frequently practiced oral-anal sex. Oral-sex related knowledge of all participants was unsatisfactory [correct answers were given by 95 (26.5%) to 277 (77.2%) participants], but it was significantly better in homosexual men than in heterosexual. Frequency of condom use and human immunodeficiency virus testing was also significantly higher in the case of homosexual than heterosexual men. LIMITATIONS: The study was not performed in representative sample of population. It was restricted to the patients. Consequently it is questionable whether the results obtained could be generalized. CONCLUSION: Oral sex related knowledge deficits and risky oral sex practice exist in both homosexual and heterosexual men. These findings indicate a need for effective public health campaign and patient education about the risks of unprotected oral sex.

Guidelines on the use of finasteride in androgenetic alopecia.

BACKGROUND: Finasteride is a widely used drug in dermatology for the treatment of androgenetic alopecia. There are many reports of associated sexual side effects. This article reviews the use of once-daily 1 mg finasteride in androgenetic alopecia and its associated sexual adverse effects. METHODS: A literature search was performed to collect data on the use of finasteride in male pattern baldness. Relevant literature published till March 2014 was obtained from MEDLINE, EMBASE, CINAHL, Cochrane registers and LILACS. The keywords "finasteride", "male pattern baldness" and "androgenetic alopecia" were used for literature search. Similarly, a search was done for finasteride in female pattern hair loss with keywords "female pattern baldness", "finasteride" and "female pattern alopecia". All systematic reviews, meta-analyses, national guidelines, randomized controlled trials, prospective open label studies and retrospective case series in the English literature were reviewed. RESULTS: Two hundred sixty two studies were evaluated, twelve of which fulfilled the inclusion criteria. CONCLUSIONS AND RECOMMENDATIONS: Current evidence on the safety of finasteride indicates that it is safe but there is growing concern about its sexual side effects. In view of this, proper information should be provided to patients prior to starting treatment (Level of recommendation 1+, Grade of recommendation B). The reported sexual side effects are few and reverse with stoppage of the drug (Grade of recommendation B) but further studies are required.

Combination prevention: new hope for stopping the epidemic.

HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, "treatment as prevention" for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.

Behavioral surveillance survey regarding human immunodeficiency virus/acquired immunodeficiency syndrome among high school and junior college students.

BACKGROUND AND AIMS: It is necessary to know the baseline knowledge, attitude, and practices about human immunodeficiency virus/acquired immunodeficiency syndrome among young people and the changes in these with intervention to guide prevention efforts. METHODS: A cross-sectional pre- and post-survey with health education as a method of intervention was carried out in four different randomly selected schools and junior colleges among the Class IX-XII students of both sex. Instrument developed by the World Health Organization (WHO)/UNAIDS in their best practice recommendations was used for data collection. RESULTS: Knowledge about all correct methods was present in 61.23% of the respondents. Knowledge of at least two methods of prevention was present in 70.31% of the respondents. Misconceptions about prevention were that good diet (33.42%), avoiding mosquito bite (49.71%) and avoiding public toilets (65.14%) could help in the prevention. With intervention, there was an improvement in the knowledge. However, the proportion of students with misconceptions did not come down. Correct knowledge about two methods of prevention also did not reach the WHO recommendation of 90%. CONCLUSION: It is very difficult to change the attitude and practices by a single health educational intervention and an ongoing behavior change communication is recommended.

Hanseníase: implicações na sexualidade do portador / Leprosy: effects on the bearer's sexuality

Os estudos relacionados à hanseníase pouco abordam a questão humana, os sentimentos ou as experiências vivenciadas nessa trajetória, portanto esse trabalho tem como objetivos descrever as implicações na sexualidade do portador de hanseníase e analisar os aspectos que envolvem a sexualidade do portador. Trata-se de um estudo descritivo com abordagem qualitativa desenvolvido no Centro Maria Imaculada, que presta assistência aos portadores de hanseníase na prevenção, diagnóstico, tratamento e reabilitação, em Teresina-PI. Para a produção dos dados utilizou-se como instrumento um roteiro de entrevista semi-estruturada, os dados foram analisados de acordo com a Análise de Conteúdo de Minayo. As análises dos relatos culminaram no surgimento de quatro categorias: mudanças na atividade sexual após o diagnóstico de hanseníase; medo da transmissão da doença pelo contato sexual; sentimento de inferioridade e mudanças no cotidiano familiar. Verificou-se a dimensão do sofrimento causado pela doença no grupo de pessoas entrevistadas e as mudanças acarretadas em sua vida sexual ocasionados pela doença, impedindo que seus portadores vivenciem uma vida sexual ativa, sejam por problemas de ordem orgânica e/ou psicológica.

Studies related to leprosy give little attention to human affairs, feelings or experiences along the way, therefore, this paper aims to describe the effects leprosy has on the sexuality of leprosy patients and analyze the aspects which involve the sexuality of the bearer. This is a descriptive study with qualitative approach, developed at the "Centro Maria Imaculada", which provides assistance to leprosy patients in the prevention, diagnosis, treatment and rehabilitation, in Teresina-PI. A series of semi-structured interviews was used as an instrument so as to produce data; they were analyzed according to Minayo's Content Analysis. Analysis of the reports resulted in the emergence of four categories: changes in sexual activity after leprosy diagnosis, fear of disease transmission through sexual contact, feelings of inferiority, and changes in family's daily life. The extent of suffering caused by the disease in the group of interviewed people was noticed, and so were the changes brought about in their sexual life caused by the disease, preventing bearers from experiencing an active sexual life, be it due to organic and/or psychological matters.

Sexually transmitted diseases in Assam: an experience in a tertiary care referral hospital.

BACKGROUND: Sexually transmitted diseases (STDs) including AIDS are becoming a major public health problem in developing countries worldwide. AIMS: All the adult patients attending VCTC and STD clinics of Assam Medical College between May 2002 and December 2005 were enrolled in the study. METHODS: Records of patients with high-risk sexual behavior and presence of STD on clinical examination were recorded in a predesigned proforma. RESULTS: Of 479 individuals, 186 (38.8%) had evidence of STD and 70 were positive for HIV. Most (64%) were in the age group of 15 to 30 years. Candidiasis (vulvovaginal candidiasis in women and candidal balanitis/balanoposthitis in men) was the most common finding on clinical examination (21.5%) followed by syphilis (17.2%), genital warts (15%), herpes genitalis (11.3%), non-gonococcal urethritis (10.8%), and gonococcal urethritis (7%). CONCLUSION: High percentage of unmarried people (>45%) reporting with STD, which points to potential danger of HIV transmission in the region.

Men who have sex with men and transgenders in Mumbai, India: an emerging risk group for STIs and HIV.

BACKGROUND: Men who have sex with men and transgenders are an important risk group for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). They have risky sexual behaviors but low risk perception. OBJECTIVES: To assess the sexual behavior, STIs, HIV and identify factors associated with HIV in men who have sex with men (MSM) and transgenders (TGs) in Mumbai. METHODS: Participants were enrolled from two clinics in Mumbai. They completed an interviewer-administered questionnaire and were evaluated for STIs and HIV infection. RESULTS: A total of 150 participants, 122 MSM and 28 TGs were evaluated; 17% of MSM and 68% of the TGs were HIV infected. HIV infection in MSM was associated with serological positivity for HSV2 IgG [adjusted odds ratio (aOR), 95% confidence interval (CI): 9.0 (2.2-36.9)], a positive Treponema pallidum hemagglutination assay (TPHA) [aOR (95% CI): 6.0 (1.5-24.0)], greater than five acts of receptive anal sex in the past six months [aOR (95% CI): 4.3 (1.2-15.0)] and per category increase in age (18-24 yrs, 25-29 yrs, > 30 yrs) [aOR (95% CI): 3.1 (1.3-7.1)] in multivariate analysis. Consistent condom use during receptive anal sex in the past six months was low (27%). Many MSM were married (22%) or had sex with females and may act as a 'bridge population'. HIV infection in TGs was associated with a positive TPHA [OR (95% CI): 9.8 (1.5-63.9)] and HSV 2 IgG [OR (95% CI): 6.7 (1.1-40.4)] in univariate analysis. CONCLUSION: Prior STIs were strongly associated with HIV infection in MSM and TGs. These groups should be the focus of intensive intervention programs aimed at STI screening and treatment, reduction of risky sexual behavior and promotion of HIV counseling and testing.

Short-term follow up of patients with multibacillary leprosy and HIV infection.

During a period of 9 years, four male patients with HIV and Hansen's disease were detected in Tamil Nadu, South India. The sequence as to which infection came first is not known. All had high-risk sexual behavior with commercial sex workers and a past history of genital ulcer disease. Their spectrum of leprosy was multibacillary. Patient no. 1 had pure neural leprosy of the lepromatous type, which is rare. He also had a single episode of type 1 reaction which did not require steroid therapy. Despite having taken inadequate treatment, patient no. 2 remained clinically and bacteriologically quiescent after 4 years of follow up. He had a low CD4 count of 330 cells/mm3. The third patient completed a full course of multibacillary multidrug therapy, and a year later is clinically and bacteriologically inactive. The fourth patient died of AIDS within 2 months of the dual diagnosis.

PIP: Since the detection of HIV infection in the Christian Medical College and Hospital, Tamil Nadu, in 1986, patients attending the sexually transmitted disease (STD) clinic are counselled and screened for HIV antibodies using ELISA. Over the course of 9 years, 4 males, all from Tamil Nadu, were identified at the clinic with concurrent HIV infection and leprosy. The men were aged 20-27 years and had had multiple heterosexual contacts with prostitutes and a past history of genital ulcer disease. They were in the multibacillary (MB) spectrum of the disease as evidenced by the presence of numerous acid-fast bacilli in the nerve biopsy in 1 case and positive skin smears in the other 3 cases. Mitsuda tests conducted in 3 patients were negative, consistent with the MB spectrum of Hansen's disease (HD). The patients had concurrent infections, but it is unclear which infection occurred first. One patient developed a type 1 reaction which rapidly recovered with nonsteroidal antiinflammatory drugs. Observation of the patient over 3 years revealed no further episodes of reaction. No patient developed an erythema nodosum leprosum (ENL) reaction. One patient died 2 months after being diagnosed with HIV and HD. The other patients were followed for 3-5 years after the diagnosis of dual infection. Over that period, neither their leprosy worsened nor did their HIV infection progress to clinical AIDS. HIV infection therefore does not appear to influence an infection with Mycobacterium leprae.

Prevalence of HIV infection and high-risk characteristics among leprosy patients of south India; a case-control study.

With the observation of the occurrence of the human immunodeficiency virus (HIV) infection among leprosy patients in our pilot study carried out in Tamil Nadu, South India, a case-control study was planned to explore whether HIV infection is a risk factor for leprosy and to understand the characteristics of HIV infection and high-risk behaviors among leprosy patients. We screened 556 patients and 1004 nonleprosy controls (matching 502 cases for age, sex and area of residence) for HIV-1 and HIV-2 antibodies. They also were interviewed for personal information on history of blood transfusion, intravenous drug abuse, high-risk sexual behavior, and sexually transmitted diseases. Of the 1019 total cases screened (of both pilot and extended studies), 5 were found to be position for HIV antibodies (HIV-1 = 4, HIV-2 = 1); of the 1019 nonleprosy controls, 6 were positive for HIV-1 antibodies. An analysis by odds ratio revealed no association between leprosy and HIV infection (OR = 0.824, 95% CI = 0.201-3.593). A strong association was found only between high-risk behavior and HIV infection (OR = 5.186, 95% CI = 1.717-15.667). However, unmarried, unmarried after 30 years of age, exposure to spouses of the leprosy patients, and a history of surgery were all observed to be significantly more common among leprosy patients than the controls.

Human immunodeficiency virus and Treponema pallidum infections in Nigerian patients with leprosy.

Fifty-one patients were selected from 4 leprosaria in eastern Nigeria and were examined for evidence of syphilis. They were screened serologically for treponemal and human immunodeficiency virus (HIV) infections. Information about their sexual behaviour and demographic data were obtained to determine the factors associated with increased risk of contracting sexually transmitted diseases (STD). They were compared with 115 controls. The results showed that positive treponemal tests were more common in those patients living outside the leprosaria (P < 0.05). Age and sex of the patients living inside the leprosaria were not factors associated with treponemal infections. Leprosy appeared to be a factor for T. pallidum infection when compared with the control group (P < 0.05; OR 476; CI 1.16, 19.5). One leprosy patient and one control subject had positive HIV tests and there was no significant association between leprosy and HIV infection. These findings suggest the possibility of the spread of sexually transmitted diseases amongst the leprosy patient population. The importance with respect to control measures is that leprosy patients living outside leprosaria may constitute a potential reservoir for introducing sexually transmitted diseases into the leprosaria.

Impact of leprosy on family and intimate relationships.

Ninety-eight families with leprotic members were examined. Of these, only two families were identified where both couples were leprotic. The father was the known leprotic member in 46 cases and the mother in 12 families. There were seven cases where the father and one son were leprotic, while in one case it was the mother and son; 25 families presented a leprotic son or daughter, while their parents were apparently free. Leprotic siblings or cousins of nonleprotic parents were seen in five families. The duration of marriage and details of history were taken in each case. The relation between close contact and the development of leprosy will be discussed.