Newer methods of diagnosis and treatment of the sexually transmitted diseases.
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Venereal diseases, or sexually transmitted diseases as they are more aptly named, are emerging as a major medical problem. Although syphilis and gonorrhoea are the traditional venereal diseases, it is now widely accepted that sexual transmission occurs, at least to some degree, in a wide range of relatively common infective disorders. For the family physician coping with this group of diseases, there are a number of problems which include diagnostic difficulties, adequate supervision of treatment and general care and confidentiality within the family situation.
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Auto-inoculation from a genital ulcer suspected of being ulcus molle gave redness after 24 hours and after 48 hours vesicles and pustules appeared. Cultivation from the auto-inoculation after the 48 hours was positive for herpes simplex virus type 2. Our observation underlines two points: auto-inoculation for the diagnosing of Haemophilus ducreyi infection may be mimicked by herpes simplex infection, and the incubation period of herpes simplex can be shorter than the 4-5 days usually given.
A case of Hemophilus ducreyi infection clinically resembling granuloma inguinale is reported. Culture of the causative organism permitted a definitive diagnosis to be made. Combined treatment with tetracycline and sulphamethizole/trimethoprim rapidly cleared the infection.
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This article reviews some of the more recent developments relating to the clinical usage of erythromycin. The bactericidal and tissue-penetrating properties of this antibiotic are described and the suggestion that erythromycin has a very useful spectrum of activity in respiratory tract infections is supported by a variety of studies. We examine the increasing application of erythromycin in an extending number of problems such as sexually acquired disorders, a variety of diseases produced by infection with Legionella species and the enteritides associted with Campylobacter and Shigella species. The influence of erythromycin in particular, and of antimicrobial agents in general, on the immune system of the host is discussed. The immunomodulatory capacity of the antibiotics used deserves more attention. The interactions of erythromycin with theophylines and with carbamazepine are noted and amplified, and the consequences of the binding of erythromycin to plasma alpha 1-glycoprotein are examined. After some 3 decades of use, this remarkably safe antibiotic continues to display activities which deserve the attention of the clinician.
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The clinical concept of sexually transmitted diseases describes a common mode of transmission of pathogens spanning the full spectrum of medical microbiology. These organisms have few common biologic characteristics aside from their ability to colonize or invade particular anatomic sites. New information on the biology of sexually transmitted pathogens has led to improved diagnostic and therapeutic strategies. Understanding that patients with sexually transmitted pathogens may be asymptomatic or may be simultaneously infected with multiple organisms has important implications for epidemiologic control of these diseases.
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