Dear Sir, A 61-year-old woman reported to the dermatology outpatient clinic with several raised lesions accompanied by pruritus in the vulvar region for the past 2 years. Upon cutaneous examination, several skin-colored to hyperpigmented papules measuring between 0.2 mm × 0.5 mm were observed on the vulva. Few of them were shiny and darker in appearance. Similar lesions were present over the lower orbital area [Figure 1a-c]. Angiokeratoma, milia, syringoma, and steatocystoma multiplex were retained as differential diagnoses. Hepatitis B, hepatitis C, herpes simplex virus-I and II, and human immunodeficiency virus tests were all negative, as were all standard tests. Speculum examination was not performed. Vulva biopsy sent for histopathological (HP) examination. HP report consisted of both epidermal inclusion cyst (EIC) and syringoma, which showed well-circumscribed cyst having squamous epithelial lining and keratin flakes with areas of round to comma-shaped ductules made up of basaloid cells [Figure 2a and b]. The patient refused radiofrequency cauterization of the lesions. Topical tretinoin was recommended, but the patient was lost to follow-up.Figure 1: (a and b) Multiple skin coloured papules size ranging from 0.2 mm to 0.5 mm over lower eyelid and few at forehead (black arrow) (c) Multiple tiny skin coloured to hyperpigmented papules size 0.1 mm–0.2 mm over inner side of labia majora and lower side of vulva (black arrow)Figure 2: (a) Microsection from vulval lesions shows stratified squamous keratinized epithelium and underlying superficial dermis shows proliferation of round to comma shaped ductules (black arrow) and pilosebaceous unit and increased fibrosis (H and E, ×10) (b) Microsection shows well circumscribed cyst having squamous epithelial lining and keratin flakes (black star) along with areas showing round to comma shaped ductules (black arrow) made up of basaloid cells (H and E, ×4)Syringomas are eccrine or apocrine tumors that are small, skin-colored papules that range in size from 2 to 4 mm. Although they can appear anywhere on the body, the area around the eyes is where they are most commonly found.[1] As in our case, vulvar syringomas can coexist with facial syringomas or develop as the part of an eruptive pattern. Usually occurring in childhood or early adulthood, eruptive syringomas can be associated with trauma, hyperthyroidism, diabetes mellitus, Down syndrome, and antiepileptic medications.[2] EICs are yellow-white papulonodules that are usually small, round that range in size from a few millimeters to several centimeters in the vulva. It can affect the face, genitalia, limbs, and trunk. In addition, these cysts may form inside the vagina, primarily over the clitoris. The majority of lesions are solitary, according to the literature. Trauma to the genital area, such as female genital mutilation, could be the cause.[3] An epidermal cyst is the sebaceous gland itself, while an inclusion cyst comprises epithelial tissue. When the oil glands are blocked, vulvar sebaceous cysts develop. When it becomes infected, incision, drainage, and excision are necessary.[4] However, a rare combination of syringomas and EICs in vulva draw our attention to report this case. Both are benign lesions that are primarily asymptomatic and occur at various places on the body.[5] In addition, they have unique HP features that can be used to diagnose them. The eccrine duct’s involvement has been proposed in the formation of both lesions, although their unknown causes. In order to establish the nature of their connection, additional research involving a substantial number of studies is required. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) pose a significant challenge to sexual and reproductive health and well-being across the world. There are reports of increasing trends of STI in India and across the world. The technical guidelines are revised by the National AIDS and STD Control Program (NACP) in India to ensure the implementation of evidence-based approaches for prevention and management of STI and RTI in the country. These guidelines prioritize timely and effective care, recognizing the differential availability of resources for management of these infections across the possible geographies in the country. The recommendations outline clear, step-by-step protocols for healthcare providers, covering clinical and behavioral assessments, laboratory testing, and updated syndromic case management algorithms. It also provides guidance on managing complex or treatment-resistant infections, ensuring that patients receive appropriate and effective care. This paper presents the summary of updated recommendations in the National Technical Guidelines on STIs and RTIs (2024) released by NACP, Ministry of Health and Family Welfare, Government of India.

Abstract Multiple sexually transmitted infections (STIs) can occur in a single patient, more so in immunocompromised and rarely in immunocompetent patients. We report a case of concurrent syphilitic gumma, condyloma accuminatum, and herpes genitalis in an immunocompetent patient, which resolved with specific treatment. STIs are linked to human behavior. Identification of these risk groups and providing treatment and counseling becomes important in control of STIs.

Abstract The “Grooves Sign” was initially described in relation to lymphogranuloma venereum, where the enlargement of both inguinal and femoral lymph nodes creates a groove between them, caused by the attachment of the inguinal ligament at the center. Subsequently, the term “Pseudo Grooves Sign” was coined in relation to donovanosis, wherein subcutaneous swelling on both sides of Poupart’s ligament results in a groove. In this report, we describe the presence of the “Pseudo Grooves Sign” in a case of cutaneous tuberculosis, emphasizing the significance of considering all other potential diagnoses when dealing with such scenarios.

Abstract Papulonecrotic tuberculid (PNT) is a rare hypersensitivity reaction to Mycobacterium tuberculosis , typically seen in immunocompetent individuals but occasionally reported in human immunodeficiency virus (HIV)-positive patients. We describe the case of a 30-year-old HIV-positive male with high-risk sexual behavior presenting with crusted papulopustular lesions and severe headache. Cerebrospinal fluid and venereal disease research laboratory (VDRL) were positive for VDRL and treponema pallidum hemagglutination confirming neurosyphilis, while skin biopsy revealed PNT. This case underscores the diagnostic challenge of differentiating co-infections and id reactions in HIV. The patient improved significantly with anti-tubercular therapy and benzylpenicillin.

A 32-year-old unmarried male presented with a painless penile ulcer of 15-day duration. He admitted to having had unprotected anal sexual contact 3 months prior. Examination revealed papular to verrucous, moist ulcers over the prepuce with phimosis, arranged in a floret-like pattern with bilateral painless inguinal lymphadenopathy [Figure 1]. Serological tests confirmed diagnosis of syphilis (venereal disease research laboratory 1:64, treponema pallidum hemagglutination assay positive), along with co-infection with human immunodeficiency virus (HIV). He was then started on antiretroviral therapy and treated with a single dose of benzathine penicillin G. This case highlights an unusual presentation of multiple primary chancres in an HIV co-infected individual.Figure 1: Multiple ulcers over the prepuce arranged in a floret-like patternDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Abstract Introduction: Genital mucosal lesions encompass a diverse spectrum of infectious, inflammatory, and neoplastic conditions and go beyond sexually transmitted infections. Accurate clinical diagnosis can be challenging due to anatomical location, overlapping presentations, and secondary changes. Histopathological examination remains a crucial tool to establish the definitive diagnosis and guide management. Aim: To study the clinical patterns of genital mucosal lesions other than STIs and analyse the correlation between clinical diagnosis and histopathological findings. Settings and Design: Cross sectional study; Department of Dermatology in a tertiary care teaching hospital. Subjects and Methods: A prospective cross-sectional study was conducted from July 2022 to January 2024 at a tertiary care hospital. A total of 27 patients presenting with genital mucosal lesions were included. Detailed history, clinical examination, and biopsy of the lesions were performed. Clinical and histopathological diagnoses were compared to assess correlation. Results: Among the 27 patients, males were more frequently affected (63%) than females (37%), with the most common age group being 31–40 years (33.3%). The most frequently observed clinical diagnoses included genital lichen planus (LP) (25.9%), LSCA (14.8%), and squamous cell carcinoma (SCC) (14.8%). Clinicopathological concordance was observed in 66.7% of cases. The highest correlation was seen in inflammatory disorders such as LP and lichen sclerosus, while lower correlation was noted in premalignant and malignant lesions including SCC and erythroplasia of Queyrat. Conclusions: A moderate clinicopathological correlation was observed in genital mucosal lesions, particularly among inflammatory dermatoses. Biopsy remains essential in confirming diagnosis and identifying cases with atypical or misleading features.

Introduction:Vulval dermatoses may present with varied manifestations ranging from asymptomatic to chronic disabling conditions. Due to the warm, moist, and frictional environment of the vulva and its frequent exposure to irritating substances such as urine, feces, repeated use of napkins, and vaginal secretions, the classic appearance of common dermatoses is modified.Aim and Objective:To study the pattern of nonvenereal disease of female external genitalia.Materials and Methods:The study involved 50 female participants over a 1-year period, with informed consent obtained from all. A comprehensive history was recorded, including demographic details, skin-related complaints, itching, discoloration, thickening, thinning, darkening, erosion, ulceration, onset, duration, pregnancy, menstrual status, and associated conditions. Sexual exposure history was also noted. A thorough examination of the external genitalia was conducted, along with a full physical assessment for any other body lesions. Relevant investigations were performed to confirm the diagnosis.Results:The most common age group was 31–40 years. The most common presenting symptom was itching. The most common noninfectious nonvenereal dermatoses were lichen sclerosus (18%), vitiligo (18%), and lichen simplex chronicus (12%). Other dermatoses included lymphedema, invasive squamous cell carcinoma, psoriasis, lichen planus, lymphangioma circumscriptum, irritant contact dermatitis, melanocytic nevi, and drug reaction.Conclusion:Due to the challenging nature of self-examination of the vulva, individuals may delay in seeking medical attention for genital lesions. This hesitation can result in heightened anxiety and fear, significantly affecting the patient’s quality of life by contributing to increased morbidity and disruptions in sexual function.

Background:Nonvenereal genital dermatoses (NVGD) are dermatological conditions that can mimic sexually transmitted infections (STIs), leading to misdiagnosis and unnecessary anxiety.Objective:The objective is to determine the prevalence of NVGD.Materials and Methods:This was an observational, descriptive study conducted in the Department of Dermatology, Venereology, and Leprology, Dhanalakshmi Srinivasan Medical College and Hospital, Tamil Nadu.Results:During the 12-month study, 350 patients (2.4%) presented with genital complaints. Among them, 106 (30.3%) were diagnosed with STIs, while 244 (69.7%) had NVGD and were enrolled in the study. The overall prevalence of NVGD was found to be 69% among patients presented with genital complaints. The most affected age group was 31–40 years (32.0%). The mean age of patients was 39.1 years. Males (52.9%) were slightly more affected than females (47.1%). Most patients (56.6%) were from rural areas, and 60.3% were married. Infections and infestations were the most common NVGD category (34.8%), with scabies (13.1%) and tinea cruris (13.1%) being the predominant conditions. Eczematous disorders accounted for 20.1%, primarily lichen simplex chronicus (13.9%). Sclerosing disorders, mainly lichen sclerosus, were more frequent in females (15.7%) than males (6.2%). Other conditions included pigmentary disorders (8.6%), physiological conditions (8.6%), papulosquamous disorders (5.3%), lichenoid disorders (4.1%), and drug reactions (4.1%). Malignancies were rare (0.8%), with only two cases of squamous cell carcinoma. Vascular lesions (1.2%) and miscellaneous conditions (1.6%) were also observed.Conclusion:This study highlights the significant burden of NVGD, emphasizing the need for awareness, accurate diagnosis, and appropriate management to prevent misdiagnosis and psychological distress.

Background:Genital mycoplasmas are emerging sexually transmitted pathogens implicated in genitourinary infections, with their incidence increasing in recent years. They frequently cause asymptomatic, recurrent, and chronic infections, leading to pelvic inflammatory disease and infertility, thus posing a significant public health challenge.Aim:The study aimed to determine the prevalence of Ureaplasma urealyticum, Mycoplasma hominis, and Mycoplasma genitalium among patients presenting with genital tract infections in a tertiary care hospital in South India.Materials and Methods:This prospective observational study was conducted from June 2022 to June 2024 in the department of dermatovenereology and leprology. Sexually active males and females (≥18 years) with genital discharge, dysuria, and lower abdominal pain were enrolled in the study. Vaginal, endocervical, and urethral discharge samples were subjected to preliminary microscopic examination (10% potassium hydroxide, Gram stain, and wet mount) and polymerase chain reaction for U. urealyticum, M. hominis, and M. genitalium.Results:Among 79 patients (10 males and 69 females), the overall prevalence of genital mycoplasmas was 43% (34/79). U. urealyticum was detected in 40.5% (32/79), while M. hominis was found in 6.3% (5/79). Coinfection with U. urealyticum and M. hominis was noted in 3.8% (3/79). No cases of M. genitalium were detected. Among U. urealyticum cases, 28.1% had candidiasis, 9.3% had bacterial vaginosis, and 6.2% had gonorrhea coinfections. M. hominis was associated with gonorrhea in 20% of cases.Conclusion:In our study, genital mycoplasmas were detected in 43% of patients presenting with genital symptoms. This high prevalence highlights their clinical relevance and underscores the need for targeted PCR-based screening in sexually transmitted infection clinics, considering their frequent underdiagnosis.