Related Therapeutic strategies

Herpes simplex virus (HSV) occurs in 2 common locations: orofacial (usually due to HSV-1) and genital (usually due to HSV-2).

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Seborrheic dermatitis can be limited to the scalp, but it also can involve the face and any hairy or intertriginous area and rarely can even progress to a generalized erythroderma.

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Chancroid

Timothy Berger Bruce Wintroub

Saturday, January 01, 2011

The diagnosis of chancroid is usually clinical, although improved culture techniques allow isolation of the causative organism H. ducreyi. The therapeutic strategy is to eliminate the pathogenic microorganism.

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Therapeutic Strategies

Lymphogranuloma Venereum

Timothy Berger Bruce Wintroub

Wednesday, May 12, 2010

Lymphogranuloma venereum is a chronic sexually transmitted infection that occurs in 3 stages. The primary stage is cervicitis, proctitis, or a transient genital papule. The secondary stage is bilateral inguinal or pelvic adenopathy. If untreated, lymphatic damage can occur, resulting in genital fibrosis and lymphedema. The tertiary stage is very difficult to manage, so identification of infected patients at earlier stages is critical. There is an ongoing epidemic of chlamydial proctitis in South Africa, Europe, and the United States among men who have sex with men. The diagnosis is difficult to confirm, as serologic tests do not distinguish prior exposure. Newer tests identifying nuclear components of the infectious agent are becoming available, and can be performed on histological material.

Initial Steps

  1. Doxycycline 100 mg twice daily for 3 weeks.

Alternative Steps

  1. Oral erythromycin 500 mg 4 times daily for 3 weeks.
  2. Initial anecdotal reports suggest that azithromycin as a single dose of 1 g orally may be effective for early disease.

Subsequent Steps

  1. Fluctuant nodes should be aspirated, not incised and drained.
  2. Surgical excision of lymph nodes or extensive lymphedema can be performed and may lead to significant functional and cosmetic improvement.

Pitfalls

  1. Surgery should not be performed during active phases of the disease, and when performed, should be preceded and followed by 2 weeks of antibiotic treatment.

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