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1/83. Venereal herpes-like molluscum contagiosum: treatment with tretinoin.

    molluscum contagiosum spread by sexual contact may be mistaken for other venereal diseases. The occurrence of a penile lesion resembling herpes progenitalis, and successful therapy of genital mollusca with topical tretinoin (vitamin a acid) is described. ( info)

2/83. Interactions between hiv infection and other sexually transmitted diseases.

    Mechanisms and implications of the interaction between hiv and other STDs such as syphilis, herpes simplex, Chlamydia and neisseria gonorrhoeae infection are presented and relevant case reports and trials described. ( info)

3/83. confidentiality. 13: The notification of infectious diseases.

    Jenny Rose was a paediatric community nurse who regularly visited a child with a chronic lung condition who was being nursed at home. On one visit she noticed that the child's mother, Jane, appeared to be very pale and thin and was told that the mother had a severe gastric disorder with diarrhoea. From the description of the illness, Jenny thought that Jane might be suffering from typhoid. Jane worked as a cook in a restaurant, was unwilling to seek medical advice and intended going to work that night. Jenny was concerned that Jane could have a serious notifiable infectious disease and therefore be a danger to customers in the restaurant. Jane insisted that Jenny should keep the information confidential. Where does Jenny stand? ( info)

4/83. Acute self-limiting hepatitis c after possible sexual exposure: sequence analysis of the E-2 region of the infected patient and sexual partner.

    We describe a case of symptomatic acute infection with HCV in a woman whose sexual partner had chronic hepatitis c. The patient cleared HCV rna 8 weeks after the onset of acute hepatitis and was found to be persistently HCV-rna negative during 90 weeks of follow-up. Part of the E-2 region of HCV was directly sequenced in the patient and her sexual partner. Four local controls with subtype-1a infection and 9 1a isolates obtained from GenBank were analyzed. The average nucleotide divergence between the sequences of the infected patient and her sexual partner was 5.1%, compared with an average nucleotide divergence of 19.4% (range 16.6-21.8%) between the sequences of the patient and those of controls. Comparison of the phylogenetic trees in the partial E-2 region showed that the sequence of the patient was closely related to that of her sexual partner. Our findings suggest that the infection was transmitted to the patient from her sexual partner. The resolution of acute hepatitis c in this case was probably related to the host rather than to intrinsic characteristics of the HCV genome. ( info)

5/83. Using self-administered tampons to diagnose STDs.

    The new nucleic acid amplification techniques (e.g., LCR and PCR) have allowed the introduction of non- and minimally-invasive techniques for the detection of sexually transmitted diseases (STDs). In this article, we describe one of these-the self-administrated tampon method-which we have used to detect the presence of chlamydia trachomatis, neisseria gonorrhoeae, trichomonas vaginalis, and human papillomavirus in women. ( info)

6/83. tuberculosis of the vulva masquerading as a sexually transmitted disease.

    tuberculosis of the vulva is a rare condition usually seen by a gynecologist. We report a case of chronic ulcer on the vulva of four months duration, which, on detailed investigation, turned out to be a case of primary inoculation tuberculosis. The patient was subsequently put on antitubercular therapy with a good the therapeutic response. The rarity of this presentation in dermato-venereology is emphasized. ( info)

7/83. Human-to-human transmission of pseudomonas pseudomallei.

    melioidosis, the clinical manifestation of infection with pseudomonas pseudomallei, has occurred infrequently in American citizens; almost all reported cases have been in vietnam veterans, usually associated with respiratory disease. A vietnam veteran from mississippi developed chronic prostatitis, with no other clinical manifestations, during service in vietnam, and P. pseudomallei was isolated from prostatic secretions 2 years after his return to the united states. The patient had had sexual contact with four women including his wife since his return from vietnam. Vaginal and cervical cultures and serum samples were obtained from the four women, and serum samples and cultures of semen were obtained from the patient. Vaginal swabs and semen cultures were negative for P. pseudomallei. The patient and his wife had hemagglutination titers (greater than 640) diagnostic of P. pseudominallei infection. This occurrence of venereal transmission is the first report of person-to-person spread of P. pseudomallei infection. ( info)

8/83. Rural woman abuse and sexually transmitted disease: an ethical analysis of clinical dilemmas.

    Women who have experienced abuse are often offered individual and group psychotherapeutic interventions to help them overcome psychological aftereffects of abuse and avoid future abusive relationships. Clinical cases that are complicated by the existence of abuse and sexually transmitted diseases (STDs) often involve ethical issues concerning patient privacy and legitimate breaches of confidentiality that can potentially harm the individual. There is little known about the experiences of abused rural women with STDs, underscoring the need for modification of existing interventions for this patient population. This paper presents the application of an ethical framework to an actual case involving an abused rural woman with an STD that utilizes the concepts of casuistry, or case-based reasoning. A methodological tool for ethical analysis of the clinical dilemmas involving evidence-based psychotherapeutic interventions for abused rural women with STDs is used to apply the concepts of casuistry to the development of the taxonomy of cases for clinical practice. ( info)

9/83. Infectious diseases. 6: Sexually transmitted infections: new diagnostic approaches and treatments.

    1. Commercially available nucleic acid amplification assays (eg, polymerase or ligase chain reaction) are now the "gold standard" tests for genital chlamydial infection and also have a role in screening for gonococcal infection. 2. Single-dose oral antibiotics are available for treatment of chlamydia trachomatis, neisseria gonorrhoeae and trichomonas vaginalis infections. 3. Strains of N. gonorrhoeae in urban australia are often penicillin resistant, while strains from South East asia and those in homosexually active men may show high-level resistance to quinolones. 4. Imiquimod, a novel immune-response modifier, is now available for effective, safe, self-administered treatment of genital warts. 5. The Pap smear remains the cornerstone of screening for precursor lesions of cervical cancer, but human papillomavirus genotyping may have a role in clinical decision-making for women with equivocal or early precancerous lesions. 6. Treatment of primary genital herpes changes the clinical course, and long-term suppressive therapy is effective for those with multiple recurrences. New technologies have made diagnosis and screening easier for patients and clinicians ( info)

10/83. Gender gaps, gender traps: sexual identity and vulnerability to sexually transmitted diseases among women in vietnam.

    We conducted a qualitative study to explore the pathways by which traditional gender roles may ultimately affect Vietnamese women's interpretation of sexually transmitted disease (STD) symptoms and health-seeking strategies. Data on gender roles, perceptions of types of sexual relationships, perceptions of persons with STDs, and STD patient experiences were gathered through in-depth interviews and focus groups with 18 men and 18 women in the general population of northern vietnam. A framework integrating Andersen's behavioral model of health services use and Zurayk's multi-layered model was used to conceptualize women's health-seeking behavior for STD symptoms. Both men and women noted clear gender differences in sexual roles and expectations. According to participants, a woman's primary roles in northern vietnam are socially constructed as that of a wife and mother-and in these roles, she is expected to behave in a faithful and obedient manner vis a vis her husband. It emerged that men's marital and sexual roles are less clearly defined by traditional norms and are more permissive in their tolerance of premarital and extramarital sex. For women, however, these activities are socially condemned. Finally, since STDs are associated with sexual promiscuity, both men and women expressed anxiety about telling their partners about an STD; women's expressions were characterized more by fear of social and physical consequences, whereas men expressed embarrassment. Community level interventions that work towards disassociating STDs from traditional social norms may enable Vietnamese women to report possible STD symptoms and promote diagnosis and care for STDs. ( info)
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