Most data of genital herpes have been collected in STD clinics in the USA where unrecognized forms accounted for 80% of HSV-2 infections. Our aim was to study the clinical features in an outpatient clinic of dermatology.The charts of 170 patients, previously monitored prospectively for a HIV prevalence study, with culture-confirmed genital herpes or herpetic infection with HSV-2 at any other site presenting between 1995 and 1999 were analyzed.111 (65%) men and 59 (35%) women were identified with a mean age of 44 years. Only 49% had a typical cluster of genital lesions. Eighty-six (51%) presented with either lesions at extragenital sites [mostly the buttocks 33/170 (19%), thigh 10/170 (6%), anal region 9/170 (5%) and fingers 8/170 (5%)] or showed morphologically atypical forms of isolated genital lesions [single ulcer 16/170 (9%), erosion 6/170 (4%), crust 3/170 (2%) and fissure, edema or erythema each 1/170 (1%)]. Women significantly presented more often with extragenital infections of HSV-2 [36/59 (61%)] than men [18/111 (16%)].More than half of the patients with genital herpes of a mainly immunocompetent population presented with atypical manifestations. The underdiagnosis of genital herpes seems largely due to misinterpretation of atypical genital and extragenital lesions.
We report on 2 cases of patients with warts underlying the proximal nail fold which presented as tender erythematous nodules. The remarkable feature in both cases was a significant oedema of the proximal nail fold, resembling a reaction to a foreign body. One patient responded well to mild keratolytic treatment. The second patient was treated surgically with crescentic excision of the distal portion of the proximal nail fold. It is important to recognise this tumour variant in order to avoid unnecessary or excessive intervention.
Die Venerologie der letzten 30 Jahre wurde von der AIDS-Pandemie geprägt. Im Gefolge der AIDS-Prävention wurde weltweit ein Rückgang der venerischen Infektionen beobachtet. Im letzten Jahrzehnt kam es zu erneutem Anstieg der Syphilisinzidenz, vorerst in Osteuropa, dann auch im übrigen Europa. In der Syphilisdiagnostik wurden neue spezifische IgM-Tests eingeführt. Vor rund 30 Jahren begann die weltweite Ausbreitung der penizillinresistenten Gonokokkenstämme. Hochspezifische PCR-Tests für Gonokokken, Chlamydia trachomatis, Herpes simplex und Haemophilus ducreyi, wurden eingeführt. Bei den humanen Papillomviren wurden immer neue Serotypen entdeckt. Derzeit sind es schon über 100. Eine enge Assoziation bestimmter HPV-Typen mit intraepithelialen Neoplasien der Genitalregion, sowie mit invasiven ano-genitalen Carcinomen wurde erkannt. In der Therapie weckte Azithromycin, das gegen verschiedene STD-Erreger wirkt und die perorale Scabiesbehandlung mit Ivermectin, neue Hoffnungen.
Part 1 Advances in diagnosis: laboratory diagnosis of syphilis, J.Ch. Meyer gonorrhoea, I. Lind chancroid, A. Eichmann chlamydia trachomatis infections in women, H. Schubiner and W. LeBar bacterial vaginosis, J. Martius genital candidosis, A. Stary diagnosis of genital herpes simplex infections, R.N. Thin viral hepatitis, R. Joeres and E. Richter human papillomavirus infections, R. Rudlinger and M. Norval diagnozing sexually transmitted diseases in HIV-positive patients, N.S. Penneys. Part 2 Advances in treatment: gonorrhoea - single-dose oral treatment, P.K. Kohl et al chancroid, D. Abeck and R.C. Ballard nongonococcal urethritis, P. Nickel and H. Naher bacterial vaginosis, J. Martius chalmydia trachomatis - a major cause of mucopurulent cervicitis and pelvic inflammatory disease in women, J. Paavonen genital candidosis, U. Lauper genital herpes, K.R. Beutner clinical aspects of genito-anal papillomavirus infection with a focus on when and how to investigate, G. von Krogh scabies treatment - current considerations, M. Orkin and H.I. Maibach infestations - pediculosis, T.L. Meinking and D.Taplin treating sexually transmitted diseases in pregnancy, K. Vetter. Part 3 New substances and methods: application of DNA-based technologies in the diagnosis of sexually transmitted diseases, P.-A. Mardh and M.A. Domeika azithromycin, R.B. Johnson otraconazole and therapy of fungal infections, J. Van Cutsem fluconazole - its properties and efficacy in vaginal candidiasis, P.F. Troke aciclovir and its L-valyl ester, valaciclovir, M.L. Smiley and A. Murray use of penciclovir and famciclovir in the management of genital herpes, S.L. Sachs podophyllotoxin in the treatment of genital warts, K.R. Beutner interferons, G. Gross laser therapy, E.E. Kung permethrin, D. Taplin and T.L. Meinking.
In addition to the habitual skin manifestations, the following forms of organic involvement were found (with decreasing frequency) in 33 patients with progressive systemic sclerosis treated from 1972-1986 at the Clinic of Rheumatology, University Hospital of Zürich: blood vessels 29, lungs 18, digestive system 11, joints 11, bones 8, lacrimal and salivary glands 7, musculature 3, heart 3, kidneys 2, cranial nerves 1 and peripheral neuropathy 1.-A 65-year-old patient with classic progressive systemic sclerosis and visceral involvement of the esophagus and the lungs showed, as a principal sign, unilateral neuropathy of the trigeminal nerve involving all three branches as well as absent corneal reflex. Electromyographic examination afforded evidence of a sensory neuropathy of the trigeminal nerve. Chemical laboratory tests revealed a typical high titre of antinuclear antibodies. In addition to autoimmunological causes, proliferation of fibrous structures of the perineurium and vascular lesions are discussed in connection with these complications.-The subsequent history of 37 patients with localized scleroderma and 4 patients suffering from progressive systemic sclerosis, treated at the Clinic of Dermatology, University Hospital of Zürich from 1980-1985 provided no evidence of a cranial nerve involvement. The fact that during the period 1975 to 1985 only one patient treated at the Clinic of Neurology of Zürich University Hospital showed signs of disturbances of pupil motility confirms the very rare involvement of the nervous system in progressive systemic sclerosis.
Cutaneous manifestations are common in patients with HIV infection and mainly due to the immunodeficiency. In the initial stage of HIV infection, we frequently observe a rash of macular lesions. During the asymptomatic phase, the patients may typically show the following skin diseases: seborrhoic dermatitis, acneiform folliculitis, persistent herpes simplex, and infections with the human papilloma virus. In ARC and AIDS patients, 3 groups of skin disorders are found: cutaneous infections, skin tumors, and other mixed skin diseases. Herpes simplex and herpes zoster may develop into ulcerating and necrotising forms especially in patients with advanced immunodeficiency. The most frequent skin tumors in AIDS patients are the disseminated Kaposi's sarcoma and non-Hodgkin's lymphoma. More than 50% of the AIDS patients treated with trimethoprim/sulfamethoxazole developed a severe drug eruption. African and Caribbean patients with AIDS frequently suffer from pruritic skin lesions, the pathogenesis of which is not known. Aside from these cutaneous manifestations, a variety of other skin disorders have been reported in patients with HIV infection, ARC, or AIDS; future research will furnish definite proof whether they are correlated with HIV infection.
