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Deciphering venereal dermatological trends: Male genital health across ages
*Corresponding author: Ravneet Kaur Buttar1, Department of Dermatology, Government Medical College, Patiala, India. drravbuttar@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Rajenesh A, Buttar RK, Chopra D, Gupta S, Sidhu RD. Deciphering venereal dermatological trends: Male genital health across ages. RMC Glob J. 2025;1:70–75. doi: 10.25259/RMCGJ_2_2025
Abstract
Objectives
A significant portion of cases in the skin OPD (outpatient department) involves venereal dermatoses in males. It is essential to thoroughly comprehend the patterns of venereal dermatoses to enhance clinical diagnosis and treatment approaches. To analyze the pattern of venereal dermatoses in males of different age groups in our part of the country.
Material and Methods
A descriptive (observational) study was conducted, which included all male patients with genital dermatoses visiting the outpatient department of Skin and Venereal Disease and referred cases from the Urology department in a tertiary care center in North India over 12 months. A thorough history and general physical examination were done. Tzanck smear, Gram staining, KOH (potassium hydroxide test), HIV (human immunodeficiency virus) serology, and skin biopsy were performed as required.
Results
A total of 310 cases of venereal dermatoses were enrolled in the study. The mean age of patients presenting was 32.21 ± 9.53 years. 237 (76.45%) were married, and 73 (23.55%) were unmarried. 297 (95.81%) cases of venereal dermatoses were heterosexual, 1 (0.32%) case was not sexually active, 6 (1.94%) cases were bisexual, and 6 (1.94%) were homosexual. 126 (40.65%) cases were of genital warts, which was the most common venereal dermatoses, followed by herpes genitalis (29.68%) and molluscum contagiosum (27.10%). The penis was the most common site involved in 275 (88.70%) cases, and 285 (91.93%) patients had lesions exclusively on genitalia.
Conclusion
Understanding the various male genital dermatoses across age groups is crucial for effective clinical management, which will ultimately improve patient outcomes and reduce the burden of venereal dermatoses in the population.
Keywords
Genital dermatoses
Male genital dermatoses
Sexually transmitted diseases
Sexually transmiited infections
Veneral dermatoses
INTRODUCTION
Genital dermatology covers a broad range of lesions and rashes affecting the genital region, including both sexually transmitted and non-sexually transmitted skin conditions.1 Male genitalia, being a sexual organ, harbor many sexually transmitted infections (STIs). STIs are a group of communicable diseases that are transmitted mainly by sexual contact. STIs are a global problem of great magnitude.2
STIs continue to be a major public health problem with a significant burden on society, even after so many healthcare programs have been organized by governmental and non-governmental organizations, and awareness has been created among the general public about STIs.3 When genital dermatoses are observed in a child, sexual abuse should be considered a possibility. Early identification can help alleviate symptoms, restore self-esteem and sexual health, and enhance quality of life.4,5
The stigma surrounding STIs often prevents individuals from seeking early consultation at STI clinics. Consequently, they may unknowingly become carriers and spread the infection asymptomatically. Therefore, it is crucial to gather data on the prevalence and patterns of various STIs and other skin conditions.6
The common venereal dermatoses include bacterial infections—syphilis, chancroid, gonorrhea, lymphogranuloma venereum, donovanosis; viral infections—herpes genitalis, genital warts (HPV), molluscum contagiosum, HIV, HTLV; fungal infections—candidiasis, protozoal infections—trichomonas, parasitic infestation—pediculosis pubis.7
MATERIAL AND METHODS
This observational cross-sectional study involved male patients with venereal genital dermatoses attending the dermatology outpatient or inpatient department and referred cases from the urology department, Rajindra Hospital, Patiala, over a period of 12 months (January–December 2021).
The study included all male patients with genital dermatoses who consented to participate. Detailed patient history was taken, including onset and duration of symptoms, sexual contact, sexual behavior, marital status, contraceptive use, etc. A thorough clinical examination, including a general physical examination and cutaneous and mucosal examinations, was conducted to determine the type of venereal disease and assess the distribution of lesions. Other investigations (Tzanck smear, Gram staining, KOH, and HIV serology) were performed as required. Specific investigations, such as skin biopsies, were performed whenever indicated with the assistance of the urology department. The data collected were entered into an MS Excel sheet and analyzed statistically using IBM SPSS version 22.
RESULTS
A total of 310 individuals were enrolled in the study. The mean age of patients who presented to us was 32.21 ± 9.53 years. The median age was 30 years, and the age range spanned from 18 to 62 years. In the age group of 1–20 years, there were 30 individuals, constituting 9.68% of the total sample. The majority of individuals fell into the 21–40 years age bracket, with 204 individuals, representing 65.81% of the total. For the 41–60 years age group, there were 73 individuals, accounting for 23.55% of the total. In the 61–80 years age group, only three individuals were recorded, making up 0.97% of the total [Table 1].
| Age group (years) | Venereal | |
| Frequency | Percentage | |
| 1–20 | 30 | 9.68% |
| 21–40 | 204 | 65.81% |
| 41–60 | 73 | 23.55% |
| 61–80 | 3 | 0.97% |
| Total | 310 | 100% |
| Mean ± SD | 32.21 ± 9.53 | |
| Median | 30.00 | |
| Range | 18–62 | |
SD: Standard deviation.
237 (76.45%) were married, and 73 (23.55%) were unmarried. 297 (95.81%) cases were heterosexual, 6 (1.94%) cases were bisexual, 6 (1.94%) were homosexual, and 1 (0.32%) case was not sexually active [Figure 1].
- Sexual behaviour among patients.
Genital warts constituted the maximum number of cases, i.e., 126 (40.65%), followed by 92 (29.68%) cases of herpes genitalis and 84 (27.10%) cases of genital molluscum contagiosum. 3 (0.97%) cases of pediculosis pubis, 2 (0.65%) of primary syphilis, 2 (0.65%) of urethral discharge, and one (0.32%) case of chancroid were seen [Figure 2].
- Prevalence of venereal dermatoses in males (n = 310). n represents number of cases enrolled in the study.
The study included 95 cases of ulcerative venereal dermatoses. Herpes genitalis was the most common, with 92 cases, accounting for 96.84% of the total. Primary syphilis and chancroid were observed in two (2.10%) and one (1.05%), respectively.
A total of 110 (35.48%) individuals reported to the outpatient departments experiencing symptoms for less than 10 days. 184 (59.35%) reported within 10–30 days of the onset of symptoms. Symptoms lasting 1–3 months were reported by 41 individuals (13.23%). Only 4 (1.29%) reported symptoms persisted for 3–6 months of the total. A single individual (0.32%) reported symptoms lasting over 6 months [Table 2].
| Duration of symptoms | Venereal (n = 310) | |
| Frequency | Percentage | |
| <10 days | 110 | 35.48% |
| 10–30 days | 184 | 59.35% |
| 1–3 months | 41 | 13.23% |
| 3–6 months | 4 | 1.29% |
| >6 months | 1 | 0.32% |
The penis was the site of involvement in 275 (88.70%) cases, the scrotum in 4 (1.29%) cases, and both of them were involved in 31 (10%) of the cases [Figure 3]. 285 (91.93%) patients had lesions exclusively on the genitalia. 15 (4.83%) had perianal involvement along with genital lesions. Ten (3.22%) cases involved both genital and other cutaneous sites.
- Distribution of genital dermatoses based on site involved (n = 310).
The most common venereal dermatoses in every age group except the 61–80-year-old age group was genital warts, accounting for 15 (50%) in the 0–20-year-old age group, 71 (34.8%) cases in the 21–40-year-old age group, and 39 (53.4%) cases in the 41–60-year-old age group, while in patients with 61–80-year-old age group, the most common venereal dermatoses was herpes genitalis, accounting for two cases (66.7%). The prevalence of venereal dermatoses varied across different age groups [Table 3].
| Age groups | 0–20 years (n = 30) | 21–40 years | 41–60 years | 61–80 years | Total | ||||
| Frequency | Percentage | Frequency | Percentage | Frequency | Percentage | Frequency | Percentage | ||
| Chancroid | 0 | 0 | 1 | 0.49% | 0 | 0 | 0 | 0 | 1 |
| Genital molluscum | 9 | 30% | 63 | 30.8% | 12 | 16.4% | 0 | 0 | 84 |
| Genital wart | 15 | 50% | 71 | 34.8% | 39 | 53.4% | 1 | 33.3% | 126 |
| Herpes genitalis | 6 | 20% | 62 | 30.3% | 22 | 30.1% | 2 | 66.7% | 92 |
| Pediculosis pubis | 0 | 0 | 3 | 1.47% | 0 | 0 | 0 | 0 | 3 |
| Primary syphilis | 0 | 0 | 2 | 0.98% | 0 | 0 | 0 | 0 | 2 |
| Urethral discharge | 0 | 0 | 2 | 0.98% | 0 | 0 | 0 | 0 | 2 |
| Total | 30 | 100% | 204 | 100% | 73 | 100% | 3 | 100% | 310 |
In the 0–20 years age group (n = 30), no cases of chancroid were reported. Genital molluscum was observed in nine cases, accounting for 30% of the group. Genital warts were present in 15 cases, representing 50% of the group, while herpes genitalis affected six individuals, constituting 20%. No cases of pediculosis pubis, syphilis, or urethral discharge were reported in this age group.
For individuals aged 21–40 years, one case of chancroid was reported (0.49%), while genital molluscum affected 63 individuals (30.8%). Genital warts were observed in 71 cases (34.8%), and herpes genitalis in 62 cases (30.3%). Three cases of pediculosis pubis (1.47%), two cases of syphilis (0.98%), and two cases of urethral discharge (0.98%) were recorded.
In the 41–60 years age group, no cases of chancroid were reported. Genital molluscum affected 12 individuals (16.4%), while genital warts affected 39 individuals (53.4%). Herpes genitalis was present in 22 cases (30.1%). No cases of pediculosis pubis, syphilis, or urethral discharge were reported in this age group.
In the 61–80 years age group, no cases of chancroid or genital molluscum were reported. Genital warts affected one individual (33.3%), while herpes genitalis affected two individuals (66.7%). No cases of pediculosis pubis, syphilis, or urethral discharge were reported in this age group.
DISCUSSION
In our study, 310 male patients presented with genital dermatoses. The earliest age for presentation of genital dermatoses was as early as 18 years to as late as 62 years. The mean age was 32.21 ± 9.53 years. The majority of the patients were married, constituting 76.45% of the total cases. 23.55% of patients were unmarried. The majority of the cases were seen in the 21–40 years age group, 204 (65.81%) cases, followed by 73 (23.55%) cases in the 41–60 years age group, 30 (9.68%) cases in the 0–20 years age group, and 3 (0.97%) cases in the 61–80 years age group.
Sexual behavior
The majority of the patients were heterosexual, i.e., 297 (95.81%) cases. 1 (0.32%) patients were not sexually active, 6 (1.94%) patients were bisexual, and 6 (1.94%) patients were homosexual. In another study by Devi et al.,8 the predominant mode of contact was heterosexual (89.6%), followed by bisexual (4.6%), and homosexual (1.6%). In a study by Suvirya et al.9 maximum number of cases of venereal dermatoses were seen in the heterosexual group (84.1%) followed by homosexuals (15.9%).
Frequency of venereal dermatoses
There were 310 cases of venereal dermatoses in our study. Out of 310 males with venereal dermatoses,126 (40.6%) cases were of genital warts, 92 (29.6%) cases were of herpes genitalis, 84 (27%) cases were of genital molluscum, 3 (0.96%) cases were of pediculosis pubis, two (0.64%) cases were of urethral discharge, 2 (0.64%) cases were of syphilis, and one (0.32%) case was of chancroid.
The most common sexually transmitted infection that manifested as genital dermatoses in the present study was genital warts, which was in concordance with the study by Swamiappan et al.3 in 2016 and Gupta et al.10 in 2019. There were 34.36% cases of genital warts followed by herpes genitalis (32%), as reported by Swamiappan et al.3 However, in other studies by Anirudh et al.,11 Sonkar et al.,12 Singhal et al.,13 Thakur et al.,14 and Vora et al.,15 herpes genitalis was found to be the most common among viral sexually transmitted infections. Viral STIs were predominant than the bacterial STIs in our study, which was in concordance with past studies by Anirudh et al.,11 Sonkar et al.,12 Gupta et al.,10 Singhal et al.,13 Swamiappan et al.,3 and Vora et al.15 Primary syphilis presented as the classical single indurated, painless genital chancre found in only two cases (0.64%), which was much less as compared to 21 cases (50%) in a study by Jain et al.16 and 21 cases (13.08%) by Nishal et al.17
Prevalence of ulcerative venereal dermatoses
In the current study, the prevalence of ulcerative venereal dermatoses was 95 (30.56% of cases). There were 29.6% cases of herpes genitalis, 0.64% cases of syphilis, and 0.32% cases of chancroid. In a study by Survirya et al.,9 genital ulcer diseases (herpetic + non-herpetic) constituted 6.4% of cases. Our study was comparable to the study by Thakur et al.14 in which genital ulcer disease constituted 31.5% of total STI cases.
In our study, herpes genitalis was the most common ulcerative STI, manifesting as venereal dermatoses observed in 29.6% of cases. Similarly, herpes genitalis was the most common (ulcerative) STI, seen in 27% of cases in the studies by Sonkar et al.12 and 21.75% of cases in a study by Goel et al.18
The prevalence of non-ulcerative venereal dermatoses was 215 (69.44%) in the present study. There were 126 (40.6%) cases of genital warts, followed by 84 (27%) cases of genital molluscum, 3 (0.96%) cases of pediculosis pubis, and 2 (0.64%) cases of urethral discharge. This was in comparison to a study by Goel et al.18 in which genital warts were present in 10.61% of cases, followed by genital molluscum (6.11%) in the non-ulcerative group of venereal dermatoses.
Distribution according to site involved
In the case of venereal dermatoses, the penis was involved in 275 (88.70%) cases, the scrotum in 4 (1.29%) cases, and both of them were involved in 310 (10%) cases, respectively. We could not find any studies to compare the same.
Distribution according to genital and extragenital sites involved
In the case of venereal dermatoses, 91.93% of cases involve only the genitalia. 15 (4.83%) and 10 (3.22%) cases of venereal dermatoses had anogenital and other cutaneous sites involvement, respectively. In a study by Chugh et al.19 extragenital involvement were seen in 3.7% of cases.
Age wise distribution
In the present study, the most common age group involved was the 21–40 years age group (65.80%), cases of venereal dermatoses. 9.67% of cases of venereal dermatoses were seen in the 0–20 years age group. 23.54% and 0.96% of cases were seen in the 41–60-year-old and 61–80-year-old age groups, respectively.
In patients aged less than 20 years, 21–40 years, and 41–60 years, the most common venereal dermatoses were genital warts (50%, 34.8%, and 53.4%, respectively). In patients aged 61–80 years, the most common venereal dermatoses was herpes genitalis (66.7%).
In a study by Goel et al.,18 the most common age group involved was 25–45 years (45.11% cases). In a study by Arakkal et al.,20 70.19% of the cases belonged to the 21–40 years age group. In a study by Thakur et al.,14 the majority of cases were in the 16–30 years age group, i.e., 464 cases (46.4%), followed by the 31–45 years age group, i.e., 426 cases (42.6%), which includes mostly sexually active individuals. Our study was in concordance with studies by Vora R et al.,15 Swamiappan et al.,3 Arakkal et al.,20 Thakur et al.,14 Goel et al.,18 Anirudh et al.11 where the maximum number of STIs were found in the reproductive age group (21–40 years), followed by the 41–60 year age group.
CONCLUSION
The findings of this study highlight the significance of comprehending the patterns of venereal dermatoses in males, particularly within our regional context. By identifying the prevalence and specific characteristics of various genital dermatoses, this research provides valuable insights that can inform and refine diagnostic and therapeutic strategies. This knowledge is essential for clinicians to deliver more precise and effective care, ultimately enhancing patient outcomes. Additionally, the data obtained can guide public health initiatives aimed at reducing the incidence and impact of venereal dermatoses, promoting better sexual health, and improving the overall quality of life for affected individuals. The emphasis on thorough clinical evaluation and targeted diagnostic testing further highlights the importance of a systematic approach in managing these conditions, reinforcing the necessity for continued research and education in this vital area of dermatology.
Ethical approval
The research/study approved by the Institutional Review Board at Baba Farid University of Health Sciences, Faridkot, number BFUHS/2k21p-TH/14768, dated 15th December 2021.
Declaration of patients consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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