Sexually transmitted infections

Within the past 7 years, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile infections has significantly increased. Risk factors for MRSA infection include previous antibiotic therapy and living arrangements such as prisons or military barracks that involve close, frequent contact with infected persons. Treat stable patients with MRSA skin infections with oral antibiotics in addition to incision and drainage; hospitalization and intravenous antibiotics are recommended for patients whose condition is unstable or who are unlikely to adhere to an oral regimen. A new strain of C difficile, BI/NAP1, has been associated with recurrent infection; more severe disease that mandates urgent colectomy; and dramatically higher mortality in vulnerable populations, such as older adults. Although oral metronidazole has been the mainstay of treatment of C difficile infection, oral vancomycin may be slightly more effective in patients with severe disease.

HOUSTON -- Human papillomavirus (HPV) infections are likely buoying up oropharyngeal cancer rates while other head and neck cancers decline, researchers said.

BALTIMORE -- When treating hepatitis B and HIV co-infection, physicians should use caution with the antiviral drug entecavir (Baraclude), researchers here said.

The incidence offluoroquinoloneresistantgonorrheacontinues torise in the UnitedStates, and the CDC isnow urging physicians toprescribe cephalosporinsfor patients with gonococcalinfections.

HOUSTON -- Patients with hepatitis C virus infection may have a 20% to 30% increased risk of developing non-Hodgkin's lymphoma, researchers here reported.

I read with interest the case of lymphogranuloma venereum (LGV) featured in Dr Henry Schneiderman's recent "What's Your Diagnosis?" column (CONSULTANT, February 2007, page 187). As one who has had a career-long interest in sexually transmitted disease, I feel compelled to make a few remarks regarding this case.

Yesterday, my laboratory reported to me that a pharyngeal swab tested positive for chlamydial infection (detected by DNA testing). This was not the first time I diagnosed sexually transmitted pharyngeal chlamydial infection in a patient. Readers beware: it does happen.

ATLANTA -- After a decade of decline, syphilis rates rose by 19% from 2000 through 2003, largely because of cases among men who have sex with men, according to a CDC study.

ATLANTA -- The rate of fluoroquinolone-resistant gonorrhea has become so high in the U.S. that physicians have been urged to switch to the last line of defense, the cephalosporins.

BOSTON -- Co-infection with HIV and either hepatitis B or C remains a clinical challenge, but new therapies appear to have increased the opportunities for effective treatment.

The Advisory Committee on Immunization Practices recommendsthe zoster vaccine for persons aged 60 years and older, whether ornot they have had a previous episode of herpes zoster.

It is sometimes difficult for women with genital warts to visualize their lesions. Offer patients a hand-held mirror so that they can see what the lesions look like, and recommend that they use a similar mirror at home to monitor the lesions' size and number.

This infection is caused by reactivationof varicella-zoster virus (VZV),which may remain latent in thedorsal root and cranial nerve gangliafor decades. Reactivation oftenoccurs for no apparent reason, althoughstress and immunosuppressionmay increase the risk.

This infection is caused by reactivationof varicella-zoster virus (VZV),which may remain latent in thedorsal root and cranial nerve gangliafor decades. Reactivation oftenoccurs for no apparent reason, althoughstress and immunosuppressionmay increase the risk.

LONDON -- Treating herpes simplex with valacylovir (Valtrex) reduces the levels of HIV in women who are infected with both viruses, according to researchers here.

SEATTLE -- For women, infection with a common sexually transmitted disease sharply increases the risk of contracting HIV, according to researchers here.

BOSTON -- A history of gonorrhea may translate into a twofold increased risk of bladder cancer for men, researchers here reported.

Liver disease, particularly hepatitis C, has emerged as a major cause of morbidity and mortality for people with HIV/AIDS in the era of potent antiretroviral therapy. Mortality is increased in patients with HIV–hepatitis C virus (HCV) coinfection compared with that in patients with HIV alone.1,2

Tinidazole (Tindamax), from PresuttiLaboratories, Inc., has been approvedfor treatment of trichomoniasis, giardiasis,intestinal amebiasis, and amebicliver abscess. A single 2-g doseis recommended for patients with trichomoniasisor giardiasis; in amebicdysentery, the recommended dosageis 2 g/d for 3 days. Patients with amebicabscess from amebic hepatitis require2 g/d for 3 to 5 days.

A 35-year-old woman has a lifelong history of recurrent blisters on the handsand feet that heal without scarring. No other family members have this condition,and she has no children. She is visiting your office for the first time toseek new treatment options.

In response to Dr Joseph Schube’s inquiry about a puzzlingurine culture that showed &#946-hemolytic streptococci (CONSULTANT,July 2002, page 974), I suggest that he consider oralintercourse as a possible source of the infection.

My patient is a woman in her midtwentieswho recently presented with anerythematous, slightly pruritic lesionon her thigh.

An estimated 20million Americansare currentlyinfectedwith humanpapillomavirus (HPV). Assuch, HPV is now the mostprevalent sexually transmitteddisease (STD) in thiscountry. Answers to commonquestions like the onesabove are therefore of particularinterest to physicians.The issue of when and howto use testing for HPV hasbecome especially crucial.

For nearly 3 years, my patient has had frequent recurrences (now, almost monthly)of erythematous, slightly pruritic lesions on the lower back, inguinal area, orbuttocks-but never on the genitalia.

For several months, a 26-year-old man has had persistent bumps on his scalpand the back of his neck. Some hair loss has also occurred at the site.

Accurate diagnosis of nonviralinfectious diseases ofthe vagina is largely contingenton the clinician’s abilityto do a sophisticated wetmount/potassium hydroxide (KOH)preparation examination-more specificallywhat is termed a “level II wetmount examination” (Table). Clinicalassessment in conjunction with a properwet mount/KOH analysis will usuallyidentify the causative organism orsuggest exclusion of diagnostic possibilities(Figure).

The emphasis in this clinically focused text is on syndromesand patient care rather than on pathogens. Among the topicscovered are antimicrobial pharmacokinetics and pharmacodynamics;head and neck infections; upper respiratory tractinfections; bronchitis and pneumonia; endocarditis; pericarditisand myocarditis; peritonitis, liver abscess, and biliary tractinfections; viral hepatitis; CNS infections; skin and soft tissueinfections; animal and human bites; osteomyelitis and infectiousarthritis; foot infections in patients with diabetes; scarletfever and toxic shock syndromes; fever of unknown origin;bacterial, viral, and protozoal diarrhea; obstetric-gynecologicinfections; urinary tract infections; sexually transmitted diseases;infectious complications of HIV infection; tuberculosis;tropical diseases; zoonoses; bioterrorism; and fungal infections.Color and black-and-white photographs, photomicrographs,CT scans, radiographs, drawings, tables, and flowchartshighlight seminal points in the text.

A 36-year-old womanhas had a rash on her hands and feetfor the past week. She denies recentillness, pruritus, fever, chills, sorethroat, and abdominal discomfort.She is currently in a monogamousrelationship with her fiancé.

A 60-year-old woman reportsthat she has felt intermittent“fullness” in her face for the past day.This sensation is present when sheis supine on the examination table.She denies shortness of breath, dysphagia,and chest discomfort. Thepatient has a 25 pack-year history ofcigarette smoking.

BOSTON -- An investigational immunomodulator has shown early antiviral activity in patients with difficult-to-treat chronic hepatitis C infections.