Genital ulcers and concomitant complaints in men attending a sexually transmitted infections clinic: implications for sexually transmitted infections management.
ABSTRACT Although genital herpes has emerged as the most common cause of genital ulcers in Southern Africa, treatment for herpes is not available routinely in the region. This study was performed to determine the etiology of genital ulcers in men in Durban and assess other sexually transmitted infections-related symptoms, presentation, and treatment patterns in this group.
Polymerase chain reaction (PCR) tests were performed on specimens from consecutive male patients with genital ulcers to detect sexually transmitted pathogens. PCR was also performed for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis on urethral specimens from consecutive subjects with dysuria or urethral discharge. Antibody tests for syphilis and herpes simplex virus type-2 (HSV-2) and human immunodeficiency virus antibodies were performed.
Of 162 patients enrolled with genital ulcers, 77.7% were human immunodeficiency virus-positive and 84.6% had antibodies to HSV-2. PCR results showed the following prevalences: HSV-2 53.7%, lymphogranuloma venereum 13.6%, Treponema pallidum 3.7%, Hemophilus ducreyi 1.2%, mixed infections 6.2%, and no pathogens identified 33.3%. One case of donovanosis was diagnosed clinically. In men with HSV-2 ulcers, delay before attendance recorded for 68 men was 1 to 3 days (24%), 4 to 7 days (47%), 8 to 14 days (12%), 15 to 30 days (12%), and >30 days (6%). History-taking using prompting increased the sensitivity but decreased the specificity and positive predictive value of reported genital ulceration when assessed against ulcers seen on examination.
Men at risk of genital ulcers should be asked about relevant symptoms with and without prompting and examined clinically to maximize the likelihood of correct diagnosis and treatment. The finding of a high prevalence of HSV-2 and associated dysuria cautions against providing empirical treatment for gonorrhoea and chlamydia in ulcer patients with dysuria but without urethral discharge. Innovative strategies to limit the burden of HSV-2 infection in this population are required.
Conference Paper: UV written gratings in air-silica microstructure optical fibers[Show abstract] [Hide abstract]
ABSTRACT: Summary form only given. We review recent results on air-silica microstructure fiber (ASMF) gratings and describe their properties in various waveguides. Data obtained from such gratings show that ASMF fiber modes are well described by conventional scalar beam propagation methods. We also examine potentially useful properties of microstructure fiber gratings, such as insensitivity to external index and the formation of hybrid polymer-silica waveguides.Lasers and Electro-Optics, 2002. CLEO '02. Technical Digest. Summaries of Papers Presented at the; 02/2002
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ABSTRACT: This review was prompted by a sustained outbreak of lymphogranuloma venereum that has been observed among men who have sex with men (MSM) worldwide since 2004. Recent developments in the epidemiology, diagnosis and management of the infection are summarized. Between the early 1980s and 2003, lymphogranuloma venereum was rarely seen in the developed world. In 2003, a cluster of cases was seen in the Netherlands occurring mostly in HIV-positive MSM with high levels of sexual risk. With the assistance of novel molecular diagnostic techniques, more than a thousand cases of Chlamydia trachomatis L2 serovar disease have now been reported in MSM worldwide. Almost all have presented with rectal infection, usually manifesting as severe proctitis, with ulcer adenopathy syndrome seldom seen. Oral doxycycline remains the recommended treatment and has proven effective in the recent outbreak. Conflicting data exist regarding the prevalence of asymptomatic infection, and our understanding of the exact modes of transmission remains incomplete. Lymphogranuloma venereum appears to have reestablished endemicity among MSM populations in many industrialized nations. In the relative absence of recent publications from its traditional endemic regions it can be assumed that these populations remain afflicted by the infection as well.Current Opinion in Infectious Diseases 03/2009; 22(1):57-66. DOI:10.1097/QCO.0b013e328320a8ae · 5.03 Impact Factor
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ABSTRACT: Sexually transmitted diseases (STDs) are a common public health problem and as such may be more common in a surgical practice than is believed. The recognition that a virus can be responsible for a cancer has profound significant public health implications. This article reviews the presentation and management of the more common perianal STDs including human immunodeficiency virus, as well as the pathogenesis and management of anal intraepithelial neoplasia.Surgical Clinics of North America 02/2010; 90(1):99-112, Table of Contents. DOI:10.1016/j.suc.2009.09.005 · 1.93 Impact Factor