Genital ulcers - 2012 review from Am Fam Physician

Here is an excerpt from a review article in the official AAFP journal American Family Physician:

Causes of genital ulcers

Herpes simplex virus (HSV) infection and syphilis are the most common causes of genital ulcers in the U.S.

Other infectious causes include:

- chancroid
- lymphogranuloma venereum (LGV)
- granuloma inguinale (donovanosis)
- secondary bacterial infections
- fungi

Noninfectious etiologies of genital ulcers include:

- sexual trauma
- psoriasis
- Behçet syndrome
- fixed drug eruptions



CDC Streaming Health | This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

Diagnosis

The following tests should be considered in all patients:

- serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum
- culture or polymerase chain reaction test for herpes simplex virus (HSV)
- culture for Haemophilus ducreyi in settings with a high prevalence of chancroid

No pathogen is identified in up to 25% of patients with genital ulcers.

Treatment

The first episode of herpes simplex virus infection is usually treated with 7-10 days of oral acyclovir (5 days for recurrent episodes). Famciclovir and valacyclovir are alternative therapies.

One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis.

Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin.

Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline.

Treatment of noninfectious causes of genital ulcers varies by etiology, of course. Topical wound care for ulcers caused by sexual trauma. Subcutaneous pegylated interferon alfa-2a is considered for ulcers caused by Behçet syndrome.

References:

Diagnosis and management of genital ulcers. Roett MA, Mayor MT, Uduhiri KA. Am Fam Physician. 2012 Feb 1;85(3):254-62.

Number of HIV/AIDS cases is increasing in Louisville area

The number of newly diagnosed AIDS and HIV cases in Louisville is increasing even as the fear of the deadly disease wanes. The number of newly diagnosed cases in Jefferson County rose from 80 in 2005 to 107 cases in 2008, The Courier-Journal's Laura Ungar reports. The number of new HIV cases increased from 136 cases to 154 in the same period.

"People think it's a disease of the past. Unfortunately it's very much alive," said Janet Mann, director of program development for AIDS Interfaith Ministries of Kentuckiana.

"People think: All I have to do is take a few pills every day. But it still kills people ... and it affects quality of life," said Bobby Edelen (left, by C-J's Kylene Lloyd). Edelen has lived with the disease that causes AIDS for 21 years. "Every day is not a picnic."

Complacency, drug use and lack of education are causing the numbers to increase, health officials say. But while numbers rise, there is less money to deal with the growing need. HIV/AIDS funding to the Kentucky Department of Public Health dropped from $11 million in 2008 to $9.4 million in 2010.

There is still no cure for HIV/AIDS, but there is medicine that can "keep people somewhat healthy by preventing the virus from reproducing or by blocking it from entering cells," Ungar reports. But people respond to medicine in different ways. "Taking meds for HIV is similar to cancer patients taking chemotherapy. Some are able to take it. Some are deathly sick," Edelen said. (Read more)

Gonorrhea Getting Harder to Treat - Antibiotic Resistance Pushing Gonorrhea Toward Superbug Status

Gonorrhea is a common sexually transmitted bacterial infection. If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women. Treatment for gonorrhea usually consists of a single dose of one of two antibiotics, cefixime or ceftriaxone.

The current drugs of choice, ceftriaxone and cefixime, are still very effective but there are signs that resistance, particularly to cefixime, is emerging and soon these drugs may not be a good choice.

Only one remaining class of antibiotics is recommended for the treatment of gonorrhea - cephalosporins. Historically, gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Thus, it is critical to continuously monitor antibiotic resistance in Neisseria gonorrhoeae.

As a side note that highlights the prevalence of the problem, there are at least 10 songs titled "Gonorrhea" by various artists in the Amazon.com MP3 music store.



CDCStreamingHealth | April 16, 2010: This video, produced by Be Smart. Be Well., raises awareness of Sexually Transmitted Diseases (STDs): 1) What are they? 2) Why they matter? and, 3) What can I do about them? Footage courtesy of Be Smart. Be Well. http://www.besmartbewell.com, featuring CDC's Dr. John Douglas, Division of Sexually Transmitted Disease Prevention.

References:

Gonorrhea Getting Harder to Treat. WebMD.
Sex infection gonorrhea risks becoming "superbug". Reuters.
Antibiotic Resistant Gonorrhea. CDC.

Sexually Transmitted Diseases (STDs) - Diagnosis and Management Slideshow from Medscape http://goo.gl/uzwA

Rock star Ozzy Osbourne to CNN: "Between drugs and STDs, I'm lucky to be alive today"

"Ozzy Osbourne, the former front man of rock group Black Sabbath, says that after decades of living a life of drugs and sex, he's lucky to be alive today.

Osbourne described how he often played a dangerous game when it came to using drugs and having promiscuous sex. "With the drugs, it nearly killed me on a daily basis -- I did a lot of heavy drug taking for a long time and I survived it by the grace of God.

Answering a viewer's question on whether he realized his power to change people's lives, Osbourne replied with shock. "When you're on the inside looking, you don't see it that way," Osbourne said. "But I suppose you're right. I do -- I do have the power to change people's lives."

References:
Ozzy Osbourne: I'm living on borrowed time. CNN.

"Researchers studying Ozzy Osbourne's DNA found that the singer is descendant of Neanderthals" http://goo.gl/7Fa8

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