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Venereal diseases
Published in Dinesh Kumar Jain, Homeopathy, 2022
“Disease of chancroid is self limited and systemic spread does not occur. Without treatment, genital ulcers and inguinal abscess have occasionally been reported to persist for years. Local pain is the most frequent complaint” (Eichmann, 1993, p. 2752).
Prevention, Screening, and Treatment of Sexually Transmitted Infections
Published in James M. Rippe, Lifestyle Medicine, 2019
Chancroid is caused by a bacterium, Haemophilus ducreyi, which results in painful genital ulcerations. These, plus tender suppurative inguinal adenopathy, suggest the diagnosis of chancroid. However, it is very difficult to culture. Probable disease requires only an appropriate clinical history with confirmed exclusion of syphilis and HSV.20 In 2013, there were only 10 reported cases of chancroid in the United States. Worldwide, infections with chancroid are decreasing. Lesions present after a four to seven day incubation period and start as an area of erythema that evolves into a pustule and then become non-indurated painful ulcerated lesions. Women usually present with multiple vulvar lesions. Treatment is with a single dose of one gram of azithromycin orally or 250 mg ceftriaxone intramuscularly. Alternatively, ciprofloxacin 500 mg orally, twice a day for three days or erythromycin 500 mg, three times a day for 7 days may be used.20 Patients should be re-examined in three to seven days after initiation of treatment to observe for symptomatic improvement of ulcerations. Sexual contacts should be examined and treated if the sexual contact occurred within the 10 days prior to the start of the patient’s symptoms.50
Sexually Transmitted Diseases
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Lester Gottesman, Christina Cellini
The diagnosis of chancroid is difficult. A recent study in the United States during an outbreak of chancroid in New Orleans demonstrated that only 32% of patients present with the classic clinical findings.7 The most common method of diagnosis is to take a swab of the ulcer for a Gram stain and culture of H. ducreyi (see Figure 86.5). However, a Gram stain is only sensitive in 40%–60% of cases, and culturing H. ducreyi requires a special media that is not readily available and has a sensitivity of <80%.2 There is no FDA-approved PCR test, but it is available in some commercial laboratories. Given this diagnostic difficulty, the CDC considers chancroid to be the probable diagnosis when the following criteria are met: a patient has more than one painful genital ulcer; no evidence of T. pallidum infection by darkfield examination of the ulcer exudate or by a serologic test for syphilis performed at least seven days after appearance of ulcers and the absence of HSV from the ulcer exudate.2
Initiation of HIV pre-exposure prophylaxis among youth in the United States, 2015–2018
Published in AIDS Care, 2023
Joshua A. Barocas, Mam Jarra Gai, Alykhan Nurani, Sarah M. Bagley, Scott E. Hadland
We conducted a retrospective cohort study using the IBM MarketScan Commercial Database, which included all inpatient, outpatient, emergency department, behavioral health, and prescription drug claims from over 150 million unique individuals with employer-provided health insurance between 1 January 2015, and 31 December 2018. We identified adolescents and young adults aged 13–26 years (henceforth referred to as “youth”) who had a likely indication for PrEP based on the presence of ≥1 sexual risk factor and/or a substance use disorder with evidence of injection drug use. We defined sexual risk factors using diagnostic codes for either documented sexual activity with elevated risk for HIV or a sexually transmitted infection based on previously established International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) diagnosis codes (Supplemental Digital Content Table 1). Sexual activity with elevated risk includes the following codes: “high risk sexual behavior” (ICD-9 V69.2), “high risk heterosexual behavior” (ICD-10 Z72.51), “high risk homosexual behavior” (ICD-10 Z72.52), and “high risk bisexual behavior” (ICD-10 Z72.53). Sexually transmitted infections include but are not limited to chlamydia, gonococcal infection, syphilis, chancroid, granuloma inguinale, and various herpes simplex infections. Although Chlamydia infection is not an explicit indication for PrEP in CDC guidelines (CDC, 2021c), we examined it as potentially indicating the need for PrEP since infection suggests sexual activity that could result in HIV exposure.
Genital ulceration in adolescent girls: a diagnostic challenge
Published in Journal of Obstetrics and Gynaecology, 2021
Anastasia Vatopoulou, Konstantinos Dinas, Evangelia Deligeoroglou, Alexis Papanikolaou
Non-sexually acquired acute vulvar ulceration was first described by Benjamin Lipschütz in 1912 in Vienna and it was initially referred as ‘ulcus pseudonereum’. Ιt was named after him and referred in the literature as Lipschütz’s ulcer. The differential diagnosis of acute genital ulcerations includes sexually and non-STIs, treatment with anti-inflammatory non-steroidal agents, autoimmune conditions, local manifestations of systemic illnesses and idiopathic aphthosis. Sexually transmitted infections characterised by genital ulcers include genital HSV infection, syphilis, chancroid, lymphogranuloma venereum and HIV infection. Non-STIs include cytomegalovirus, paratyphoid, influenza A and EBV infection. Hormonal changes may also play a role in genital ulcerations. Finally, leukaemia and other malignancies may have similar genital manifestations (Huppert 2010). In a large retrospective series of 273 patients with genital ulceration, the incidence of Lipschütz’s ulcer was 36% (Schindler Leal et al. 2018).
Latent class analysis of symptoms for sexually transmitted infections among Iranian women: Results from a population-based survey
Published in Health Care for Women International, 2020
Mohammad Javad Tarrahi, Sina Kianersi, Maryam Nasirian
In our study, the genital ulcer was not a powerful symptom in differentiating healthy participants from infected ones because of low reporting frequency. The relative prevalence of genital ulcer varies in different communities and periods (Low et al., 2006; Ray et al., 2009). The STI modeling study in Iran estimated 3.7% and 0.16% of prevalence rates for genital ulcer in men and women respectively in 2014 (Nasirian et al., 2015). The symptom is a very specific sign for STI. In the USA, most young and sexually active patients who present genital ulcer have either genital herpes or syphilis. Other less common infections that cause genital ulcer are chancroid and donovanosis (Centers for Disease Control and Prevention, 2015). Choudhry et al. evaluated that genital ulcer syndrome has a high sensitivity for the diagnosis of herpes simplex virus2 (HSV2) and Treponema pallidum and its specificity reached 99% for these infections (Choudhry et al., 2010).