Sexually Transmitted Diseases
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
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
Sulfonamides
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
Sulfonamide resistance among strains of H. ducreyi is now sufficiently common as to argue against the use of these agents for chancroid (Dangor et al., 1990; Plourde et al., 1992; CDC, 1993b). Rates of resistance to cotrimoxazole vary according to geographical location but appear to be high in many parts of Africa and the USA (Dangor et al., 1990; Plourde et al., 1992). Plourde et al. (1992) described a 30% rate of culture-proven failure with cotrimoxazole vs. 3% failure with fleroxacin for the treatment of chancroid in Nairobi. The CDC (2006) no longer recommends cotrimoxazole for the treatment of chancroid but instead suggests azithromycin, ceftriaxone, erythromycin, or ciprofloxacin. Cotrimoxazole is an alternative agent for granuloma inguinale, but doxycycline is recommended (CDC, 2006).
Vulvar therapies
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents transmission to others. Recently, Haemophilus ducreyi has shown resistance to many pharmacologic agents, such as trimethoprim–sulfametrole, penicillin, and tetracycline, some of which have been used traditionally for its treatment. Worldwide, there have been reports of isolates with intermediate resistance to ciprofloxacin, ceftriaxone, and erythromycin. Current regimens accepted by the World Health Organization (WHO) and CDC are as follows: oral erythromycin (500 mg three or four times a day for 7 days), oral azithromycin (1 g single dose), intramuscular ceftriaxone (250 mg single dose), oral ciprofloxacin (500 mg twice a day for 3 days), oral ciprofloxacin (500 mg single dose), and spectinomycin (2 g single dose intramuscularly) (52,55).
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).
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).
Related Knowledge Centers
- Abscess
- Dysuria
- Bubo
- Lymphadenopathy
- Dyspareunia
- Syphilis
- Chancre
- Sexually Transmitted Infection
- Inguinal Lymph Nodes
- Sinus