HSV PROFILE - 2500

HSV-I (Herpes Simplex Virus) IgG & IgM – NEW INFECTION – BOTH 1G G AND IGM
POSITIVE OR ONLY IGM POSITIVE
CHRONIC – MORE THAN 2 MONTHS IGG POSITIVE

causes sores around the mouth and lips (sometimes called fever blisters or cold sores).

HSV-II (Herpes Simplex Virus) IgG & IgM

M AINLY GENIT AL/ RECTAL SORES – M AINLY BELOW THE BELT

PCR assays for HSV DNA

Type-specific HSV serologic assays might be useful in the following scenarios: 1) recurrent
genital symptoms or atypical symptoms with negative HSV PCR or culture; 2) clinical diagnosis
of genital herpes without laboratory confirmation; and 3) a patient whose partner has genital
herpes. HSV serologic testing should be considered for persons presenting for an STD
evaluation (especially for those persons with multiple sex partners), persons with HIV infection,
and MSM at increased risk for HIV acquisition. Screening for HSV-1 and HSV-2 in the general
population is not indicated.
CHLAMYDIAE PROFILE – 1350
Anti Chlam ydia Antibody IgM

Anti Chlam ydia Antibody IgG

STD PLUS PANEL -3900

Elisa for HIV 1 & 2 ( HIV/AIDS)

HBsAg ( Hepatitis B )
Anti-HCV ( Hepatitis C )
HSV Profile

 HSV I IgG ( Herpes simplex)

 HSV I IgM (Herpes simplex)
 HSV II IgG ( Herpes simplex)
 HSV II IgM (Herpes simplex)

AntiChlam ydia Antibody IgG (Chlam ydia )

AntiChlam ydia Antibody IgM (Chlam ydia )

Treponema Pallidum Antibody , TPAB

Treponema Pallidum haemagglutination, TPHA

Recommended Regimens* FOR FIRST EPISODE

 Acyclovir 400 mg orally three times a day for 7–10 days
OR

 Acyclovir 200 mg orally five times a day for 7–10 days

OR
 Valacyclovir 1 g orally twice a day for 7–10 days
OR
 Famciclovir 250 mg orally three times a day for 7–10 days
*Treatment can be extended if healing is incomplete after 10 days of therapy.

recurrences are less frequent after initial genital HSV-1 infection.

Suppressive therapy reduces the frequency of genital herpes recurrences by 70%–80% in

patients who have frequent recurrences

Recommended Regimens

 Acyclovir 400 mg orally twice a day

OR

 Valacyclovir 500 mg orally once a day*

OR
 Valacyclovir 1 g orally once a day
OR
 Famiciclovir 250 mg orally twice a day

*Valacyclovir 500 mg once a day might be less effective than other valacyclovir or acyclovir
dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).

Acyclovir, famciclovir, and valacyclovir appear equally effective for episodic treatment of genital
herpes (342-346), but famciclovir appears somewhat less effective for suppression of viral
shedding (353). Ease of administration and cost also are important considerations for prolonged
treatment.

Episodic Therapy for Recurrent Genital Herpes

 Effective episodic treatment of recurrent herpes requires initiation of therapy within 1 day of
lesion onset or during the prodrome that precedes some outbreaks. The patient should be
provided with a supply of drug or a prescription for the medication with instructions to initiate
treatment immediately when symptoms begin.

Recommended Regimens

 Acyclovir 400 mg orally three times a day for 5 days

OR

 Acyclovir 800 mg orally twice a day for 5 days

OR
 Acyclovir 800 mg orally three times a day for 2 days
OR
 Valacyclovir 500 mg orally twice a day for 3 days
OR
 Valacyclovir 1 g orally once a day for 5 days
OR
 Famciclovir 125 mg orally twice daily for 5 days
OR
 Famciclovir 1 gram orally twice daily for 1 day
OR
 Famciclovir 500 mg once, followed by 250 mg twice daily for 2 days

Severe Disease
Intravenous (IV) acyclovir therapy should be provided for patients who have severe HSV disease
or complications that necessitate hospitalization (e.g., disseminated infection, pneumonitis, or
hepatitis) or CNS complications (e.g., meningoencephalitis). The recommended regimen is
acyclovir 5–10 mg/kg IV every 8 hours for 2–7 days or until clinical improvement is observed,
followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis
requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in
acyclovir dosage.

CHANCROID – H DUCREYI
 The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests
the diagnosis of chancroid

the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the clinical
presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical
for chancroid; 3) the patient has no evidence of T. pallidum infection by darkfield examination of
ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers;
and 4) an HSV PCR test or HSV culture performed on the ulcer exudate is negative.

Treatment
Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and
prevents transmission to others. In advanced cases, scarring can result despite successful
therapy.

Recommended Regimens

 Azithromycin 1 g orally in a single dose

OR

 Ceftriaxone 250 mg IM in a single dose

OR
 Ciprofloxacin 500 mg orally twice a day for 3 days
OR
 Erythromycin base 500 mg orally three times a day for 7 days

he time required for complete healing depends on the size of the ulcer; large ulcers might require
>2 weeks. In addition, healing is slower for some uncircumcised men who have ulcers under the
foreskin. Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might
require needle aspiration or incision and drainage, despite otherwise successful therapy.
Although needle aspiration of buboes is a simpler procedure, incision and drainage might be
preferred because of reduced need for subsequent drainage procedures.
 Granuloma Inguinale (Donovanosis)
Granuloma inguinale is a genital ulcerative disease caused by the intracellular gram-negative
bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis)

characterized as painless, slowly progressive ulcerative lesions on the genitals or perineum

without regional lymphadenopathy; subcutaneous granulomas (pseudobuboes) also might occur.
The lesions are highly vascular (i.e., beefy red appearance) and bleed. Extragenital infection can
occur with extension of infection to the pelvis, or it can disseminate to intra-abdominal organs,
bones, or the mouth. The lesions also can develop secondary bacterial infection and can coexist
with other sexually transmitted pathogens.

Recommended Regimen

 Azithromycin 1 g orally once per week or 500 mg daily for at least 3 weeks and until all lesions
have completely healed
Alternative Regimens

 Doxycycline 100 mg orally twice a day for at least 3 weeks and until all lesions have completely
healed
OR

 Ciprofloxacin 750 mg orally twice a day for at least 3 weeks and until all lesions have completely
healed
OR
 Erythromycin base 500 mg orally four times a day for at least 3 weeks and until all lesions have
completely healed
OR
 Trimethoprim-sulfamethoxazole one double-strength (160 mg/800 mg) tablet orally twice a day
for at least 3 weeks and until all lesions have completely healed

The addition of another antibiotic to these regimens can be considered if improvement is not
evident within the first few days of therapy. Addition of an aminoglycoside to these regimens is
an option (gentamicin 1 mg/kg IV every 8 hours).
 Lymphogranuloma Venereum (LGV)

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Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3. The
most common clinical manifestation of LGV among heterosexuals is tender inguinal and/or
femoral lymphadenopathy that is typically unilateral.

A self-limited genital ulcer or papule

LGV can be an invasive, systemic infection, and if it is not treated early, LGV proctocolitis can
lead to chronic colorectal fistulas and strictures; reactive arthropathy has also been reported.

Genital lesions, rectal specimens, and lymph node specimens (i.e., lesion swab or bubo aspirate)
can be tested for C. trachomatis by culture, direct immunofluorescence, or nucleic acid detection

Treatment cures infection and prevents ongoing tissue damage, although tissue reaction to the
infection can result in scarring. Buboes might require aspiration through intact skin or incision
and drainage to prevent the formation of inguinal/femoral ulcerations.

Recommended Regimen

 Doxycycline 100 mg orally twice a day for 21 days

Alternative Regimen

 Erythromycin base 500 mg orally four times a day for 21 days

Syphilis

Darkfield examinations and tests to detect T. pallidum directly from lesion exudate or tissue are
the definitive methods for diagnosing early syphilis

A presumptive diagnosis of syphilis requires use of two tests: a nontreponemal test (i.e.,
Venereal Disease Research Laboratory [VDRL] or Rapid Plasma Reagin [RPR]) and a
treponemal test (i.e., fluorescent treponemal antibody absorbed [FTA-ABS] tests, the T.
 pallidum passive particle agglutination [TP-PA] assay, various enzyme immunoassays [EIAs],
chemiluminescence immunoassays, immunoblots, or rapid treponemal assays).

Treatment
Penicillin G, administered parenterally, is the preferred drug for treating persons in all stages of
syphilis. The preparation used (i.e., benzathine, aqueous procaine, or aqueous crystalline),

Recommended Regimen for Adults*

 Benzathine penicillin G 2.4 million units IM in a single dose

*Recommendations for treating syphilis in persons with HIV infection and pregnant women are
discussed elsewhere in this report (see Syphilis among Persons with HIV infection and Syphilis
During Pregnancy).
Available data demonstrate that use of additional doses of benzathine penicillin G, amoxicillin, or
other antibiotics do not enhance efficacy when used to treat primary and secondary syphilis,
regardless of HIV status (406,407).

Recommended Regimen for Infants and Children

 Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single
dose

Recommended Regimens for Adults*

Early Latent Syphilis

 Benzathine penicillin G 2.4 million units IM in a single dose

Available data demonstrate that additional doses of benzathine penicillin G, amoxicillin, or other
antibiotics in early latent syphilis do not enhance efficacy, regardless of HIV infection (406,407)

Late Latent Syphilis or Latent Syphilis of Unknown Duration

 Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM
each at 1-week intervals
*Recommendations for treating syphilis in persons with HIV infection and pregnant women are
discussed elsewhere in this report (see Syphilis in Persons with HIV infection and Syphilis During
Pregnancy).

Recommended Regimens for Infants and Children

Early Latent Syphilis

 Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single
dose
 Late Latent Syphilis

 Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered
as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million
units)
For those with penicillin allergy

The only acceptable alternatives for the treatment of latent syphilis are doxycycline (100 mg
orally twice daily) or tetracycline (500 mg orally four times daily), each for 28 days. The efficacy
of these alternative regimens in persons with HIV infection has not been well studied. These
therapies should be used only in conjunction with close serologic and clinical follow-up,
especially in persons with HIV infection.
18003159999

Dr Nandakishore SK

MBBS(Mysore Medical College),

MS (General Surgery) (Bangalore Medical College and Research Institute),
DNB (Genitourinary Surgery, Andrology and Renal Transplantation) (National Board Examinations,
New Delhi),
MD (Fellowship in Endourology, Laparoscopy and Robotic urology) (Hadassah Hebrew University,
Jerusalem, Israel- WCE, NY,11783, USA)

Consultant - Urology
Dr. Nandakishore SK is an well experienced urologist, trained under international repute urologists Dr
Mahesh R Desai and Dr Manohar T- associated with Columbia Asia hopsitals since 2011 and is adept
in performing various endourologic, laparoscopic procedures for urological disorders including kidney
stones, cancer, bladder cancer, prostate cancer, PUJ obstruction, etc.
He has performed more than 500 laparoscopic procedures and close to 1500 procedures for kidney
stones. Dr. Nandakishore is among the few experts in the field of Minimally Invasive Surgery for
genitourinary tract diseases including stones, malignancy and reconstruction.
Dr.Nandakishore has performed more than 2000 laser surgeries, which includes majority of RIRS in
India. He is also well versed in performing laser prostatectomy by HoLEP (Holmium Laser Enucleation
of the Prostate) technique through a minimally invasive approach and via Green light laser.
He has as well done many upper and lower tract reconstruction and has special interest in urethroplasty,
penile implant and urinary incontinence surgeries.
He has elaborate knowledge of male sexual health and male reproduction – and has been trained under
international repute andrologist, Dr Rupin Shah. He has done various microsurgical ablation and
reconstruction surgeries related to fertility.
Dr. Nandakishore has featured in more than 10 publication across national and international journals.
He has various honours, awards and fellowships to his credit. He has been a delegate, faculty in various
national and international conferences. and an expert reviewer for various national and international
journals
Dr. Nandakishore is involved in research activities in the field of recurrent urinary tract infection – basic
science research involving biofilms over the catheters . He was involved in basic science research of
renal stones.
He is member of various medical associations – like Indian Medical Association, Urological Society of
India, South Asian society of sexual medicine.

Experience

Total Surgical Experience: More than 15 years

 Senior Resident, 2001 – 2002, Dept. Of Urology, St. John’s Medical College and Hospital, Bangalore,
Karnataka, India.
 Senior Resident, Jan2003 – Jun 2003, Dept. Of Urology, Malabar institute of medical sciences, Calicut,
Kerala, India.
 Research post in Urology – Jun 2003 – Dec 2003, Muljibhai Patel urological hospital, Nadiad, Gujarat,
India.
 Registrar in Urology – Jan 2004 – May 2007, Muljibhai Patel urological hospital, Nadiad, Gujarat, India.
 Junior consultant urologist at Malabar institute of medical sciences, Calicut, Kerala, India - June 2007 to
June 2007
 Junior consultant urologist at PVS Hospital, Calicut, Kerala, India (Feb 2009 – Jun 2009)
 Fellow in Endourology and Laparoscopic Urology in Hadassah Hebrew university medical school, Ein
Kerem, Jerusalem, Israel ( July 2009- June 2011) – affliated to World Congress of Endourology-
NY,11783, USA
 Consultant Urologist at Columbia Asia Hospitals, Bangalore (Since July 2011)

PUBLICATION

https://www.researchgate.net/profile/Nandakishore_Shapur3/publications

Pretransplant Nephrectomy In Adult Polycystic Kidney.BJUI, Volume 101, Number 1, January 2008
, Pp.94 -97
Testicular plasmacytoma in a previously treated multiple
myeloma. Is testis a sanctuary site? JCO Sep 20, 2010:e456-e458; published online on August 2,
2010;
Shapur N, Pode D, Katz R, Shapiro A, Yutkin V, Pizov G, Appelbaum L, Zorn K, C, Duvdevani M,
Landau E, H, Gofrit O, N, Predicting the Risk of High-Grade Bladder Cancer Using Noninvasive Data.
Urol Int 2011;87:319-324\
Shapur, N.K., Katz, R., Pode, D., Shapiro, A., Yutkin, V.,Pizov, G., Appelbaum, L., Zorn, K.C.,
Duvdevani, M., Landau, E.H. and Gofrit, O.N., 2011. Is radical cystectomy mandatory in every patient
with variant histology of bladder cancer. Rare tumors, 3(2).
 X-ray diffraction and SEM study of kidney stones in Israel: quantitative analysis, crystallite size
determination, and statistical characterization.
Vladimir Uvarov , Inna Popov, Nandakishore Shapur, Tamer Abdin, Ofer N. Gofrit, Dov Pode,Mordech
ai DuvdevaniEnvironmental Geochemistry and Health, December 2011, Volume 33, Issue 6, pp 613-
622
Crystallite size-- is it a new predictor for renal stone burden? Nandakishore K Shapur, Vladimir
Uvarov, Inna Popov, Ran Katz, Ofer N Gofrit, Ezekiel H Landau, Dov Pode, Mordechai Duvdevani.
Urology 2012 Nov 15;80(5):980-5. Epub 2012 Sep 15.

Sustained release varnish containing chlorhexidine for prevention of biofilm formation on urinary
catheter surface: in vitro study. Nandakishore K Shapur, Mordechai Duvdevani, Michael
Friedman, Batya Zaks, Irit Gati, Eran Lavy, Ran Katz, Ezekiel H Landau, Dov Pode, Ofer N
Gofrit, Doron Steinberg J Endourol 2012 Jan;26(1):26-31. (SECOND PRIZE - Essay of fellowship –
submitted to Endourology society)

Evaluation of Urinary Catheters Coated with Sustained- Release Varnish of Chlorhexidine in

Mitigating Biofilm Formation on Urinary Catheters in Dogs. G. Segev1,*, T. Bankirer1, D. Steinberg2,M.
Duvdevani3, N.K. Shapur3, M. Friedman4 and E. Lavy1, Journal of Veterinary Internal Medicine
Volume 27, Issue 1, pages 39–46, January/February 2013