Biomedical subjects
Publications and source records attributed to D M Buntin.
STDs have worldwide distribution and result in immense social and economic cost. Knowledge of the clinical signs, symptoms, current clinical tests, and treatment recommendations is important for all health care professionals.
This article will review the 1993 STD Treatment Guidelines of particular importance to dermatologic clinical practice. Topics include STD/HIV prevention, management of sexual partners, STD in persons with HIV co-infection, genital ulcer disease (GUD) including syphilis, herpes simplex virus (HSV) infection, lymphogranuloma venereum (LGV) and chancroid, therapy of nongonococcal (NGU) and chlamydial urethritis and cervicitis, gonococcal (GC) infections, HPV infection, hepatitis B virus (HBV) infection, pediculosis pubis, and scabies.
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This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.
This review highlights recent developments in the epidemiology, pathogenesis, diagnosis, and treatment of nonbacterial sexually transmitted infections. Genital herpes simplex, anogenital human papillomavirus disease, molluscum contagiosum, pediculosis pubis, and scabies are discussed.
The purpose of this study was to determine the efficacy and safety of 0.5% podofilox solution (Condylox) for the treatment of genital warts in women. Thirty-seven women with anogenital warts applied the solution to the surface of these warts twice daily for 3 days, followed by 4 drug-free days. A minimum of two and a maximum of four treatment cycles were given. The subjects were evaluated weekly for the first 4 weeks and again at 6 and 10 weeks. At the end of 10 weeks, the mean number of warts per patient was reduced from 6.27 to 1.1, and half of the patients were completely cleared of warts. Only eight of 37 subjects (21.6%) developed new warts during the study period. Approximately 15% of patients reported "severe" local reactions to the treatment after the first treatment cycle, but this was reduced to only 5% by the last treatment cycle. During the same period, the patients reporting no side effects increased from 44 to 86%. The only woman who discontinued the study did so because of dizziness and epigastric discomfort, probably unrelated to drug use. Thus, 0.5% podofilox solution appears to be an effective treatment for condylomata acuminata, with acceptable side effects that are local and temporary.
The prevalence of Epstein-Barr virus (EBV) type B, which was previously found mainly in equatorial Africa, was investigated with the polymerase chain reaction in a population of healthy adults in Memphis, Tennessee. EBV was detected in the throat washings of 34 (22%) of 157 randomly selected donors, 14 (41%) of whom had type B virus and 17 (50%) type A; 3 donors (9%) had both strains. 18 additional adults with human immunodeficiency virus (HIV-1) infection and 6 severely immunocompromised children were also investigated. Results indicated that type B EBV is widespread in nature and may be reactivated by immunodeficiency.
The dermatologic findings indicative of STDs are invaluable clues to accurate diagnosis. The sexual consorts of confirmed and suspected STD patients must be promptly evaluated and treated of disease spread is to be curtailed. It is important to remember that some patients will present with more than one STD (Fig. 36). Sexually transmitted diseases in black patients may be atypical or exaggerated because of the host's unique tissue response. Every patient should be counseled regarding "safer sex."
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Of two patients with discoid lupus erythematosus with eyelid involvement, one, a 42-year-old man, had a one-year history of persistent periorbital edema and a violaceous discoloration as the sole manifestation. Although treatment with corticosteroids and antihistamines failed to produce improvement, the patient had an excellent clinical response to systemic hydroxychloroquine therapy. Histologic examination with immunofluorescent staining demonstrated deposition of immunoglobulins at the dermoepidermal junction. The second patient, a 37-year-old woman, had a hyperpigmented lesion on her forearm as the initial symptom but later developed similar lesions elsewhere, including her lower eyelid. Treatment with hydroxychloroquine again produced an excellent response.
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Twenty-eight patients with severe cutaneous infections received cefoperazone, 2 grams intramuscularly twice a day for seven days. A wide range of gram-positive and gram-negative pathogens were isolated from admission cultures. All patients showed rapid clinical improvement. Two patients did not complete the full course of therapy because of intervening medical problems unrelated to the antibiotic. No significant side effects were noted. Relapses or reinfections occurred in two patients. In conclusions, cefoperazone is a safe and effective antibiotic for use in skin infections requiring parenteral therapy.
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