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Las manifestaciones dermatologicas son frecuentes durante la infeccion por el virus de la inmunodeficiencia humana. Estan presentes en todas las etapas de la enfermedad, desde la primoinfeccion hasta el sindrome de inmunodeficiencia adquirida. Pueden ser la primera manifestacion de la enfermedad y tambien tienen un valor pronostico. Las dermatosis observadas son de varios ordenes, principalmente tumorales, infecciosas y iatrogenicas. Los tumores estan dominados por la enfermedad de Kaposi (neoplasia oportunista y multifocal) y los canceres mucosos inducidos por papilomavirus oncogenicos. Las infecciones son principalmente virales (herpes, herpes zoster, virus del papiloma humano, etc.) y micoticas (candidiasis, dermatofitosis, etc.), con menos frecuencia bacterianas (estreptococos, estafilococos) y aun mas raramente parasitarias (escabiosis). Las enfermedades de transmision sexual (sobre todo la sifilis) estan en aumento. Las intolerancias medicamentosas son frecuentes y a menudo de expresion dermatologica. Las toxidermias (exantema maculopapuloso, sindromes de Stevens-Johnson y Lyell y sindrome de hipersensibilidad medicamentosa) se observan con sulfonamidas y algunos antirretrovirales. El sindrome lipodistrofico (signos de atrofia periferica e hipertrofia central asociados en diversos grados) se ha vuelto mas infrecuente. El sindrome de reconstitucion inmunitaria tambien puede tener una expresion dermatologica.

We evaluated the utility of the commercial Allplex genital ulcer real-time PCR multiplex assay for detecting Treponema pallidum, herpes simplex virus 1 (HSV-1) and 2 (HSV-2), and Chlamydia trachomatis serovar L (lymphogranuloma venereum [LGV]) DNA in mucosal and genital ulcers in the context of suspected syphilis. In total, 374 documented genital and mucosal ulcers from patients with and without syphilis presenting at several sexually transmitted infection (STI) centers in France from October 2010 to December 2016 were analyzed at the National Reference Center (CNR) for Bacterial STIs at Cochin Hospital in Paris. T. pallidum subsp. pallidum detection results were compared with the final diagnosis based on a combination of clinical examination, serological results, and in-house nested PCR (nPCR). Detections of HSV and LGV were validated against reference methods. We found that 44.6% of the 374 samples tested were positive for T. pallidum subsp. pallidum, 21% for HSV, and 0.8% for LGV. No positive results were obtained for 30.7% of samples, and 4.8% presented coinfections. For T. pallidum subsp. pallidum detection, the overall sensitivity was 80% (95% confidence interval [CI], 76.1 to 84.1%), specificity was 98.8% (95% CI, 97.7 to 99.9%), positive predictive value was 98.8% (95% CI, 97.7 to 99.9%) and negative predictive value was 80.2% (95% CI, 76.2 to 84.2%), with a rate of concordance with the reference method of 92.5% (k = 0.85). This PCR multiplex assay is suitable for T. pallidum subsp. pallidum detection in routine use and facilitates the simultaneous rapid detection of a broad panel of pathogens relevant in a context of suspected syphilis lesions.

The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: -The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM) -The development of dual treponemal and non-treponemal point-of-care (POC) tests -The progress in non-treponemal test (NTT) automatization -The regular episodic shortage of benzathine penicillin G (BPG) in some European countries -The exclusion of azithromycin as an alternative treatment at any stage of syphilis -The pre-exposure or immediate post-exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis.

Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed ‘mollusca’, seen as dome-shaped, smooth-surfaced, pearly, firm, skin-coloured, pink, yellow or white papules, 2 - 5mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.

TREATMENT OF THE INITIAL INFECTION OR FIRST CLINICAL EPISODE OF GENITAL HERPES: An initial infection or first clinical episode of genital herpes is treated with oral aciclovir 200mg×5/d for 5 to 10 days depending on clinical status. The recommended dosage for valaciclovir is 1g×2/d and treatment duration is identical to that for aciclovir. TREATMENT OF HERPES RECURRING DURING PREGNANCY: There are no studies of the efficacy of antiviral therapy on the symptoms of genital recurring during pregnancy. However, initial anti-viral treatment using aciclovir or valaciclovir may be given where warranted by symptoms (i.e. duration and severity of symptoms). Valaciclovir may be used instead (equivalent efficacy but better safety data for aciclovir). Valaciclovir may be given at a dosage of 1×500mg b.i.d. p.o. for 5 days. PROPHYLACTIC ANTI-VIRAL TREATMENT DURING PREGNANCY: In female patients presenting an initial infection or infection recurring during pregnancy, although there is no demonstrated benefit for prophylactic treatment in reducing the risk of neonatal herpes, anti-viral prophylaxis is recommended after 36 WA (weeks' amenorrhoea) to limit the need for Caesarean section due to herpetic lesions. The recommended antivirals are aciclovir at a dosage of 400mg t.i.d p.o. or valaciclovir at a dosage of 500mg b.i.d. p.o. until delivery.

Scabies is caused by Sarcoptes scabiei var. hominis. The disease can be sexually transmitted. Patients' main complaint is nocturnal itch. Disseminated, excoriated, erythematous papules are usually seen on the anterior trunk and limbs. Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulphur 6-33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight). Partner management needs a look-back period of 2 months. Screening for other STI is recommended. Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces. Written information should be provided to suspected cases.

RESUME La syphilis est reapparue a la fin des annees 90 et continue de progresser. Elle touche actuellement dans 90% des cas, des patients homosexuels masculins. Les bonnes intentions dont se gargarisent les autorites de sante ne sont malheureusement pas suivies d’actions coordonnees et efficaces. Au contraire, plusieurs faits recents contribuent a laisser s’epanouir l’epidemie du fait de decisions irresponsables: insuffisance de la surveillance epidemiologique, suppression du fond noir de la nomenclature, arret de fabrication de la benzathine-penicilline G (BPG), future suppression du Centre National de Reference (CNR) de la syphilis

Resume Introduction Les condylomes sont un des premiers motifs de consultation dans les centres de maladies sexuellement transmissibles (MST). Depuis 2007, la vaccination contre les papillomavirus humains (PVH) est autorisee en France. L’objectif de notre etude etait de determiner la prevalence des condylomes et le profil clinique et epidemiologique des patients avec condylomes consultant dans des centres de MST. Patients et methodes Etude observationnelle prospective multicentrique, non interventionnelle, analysant les donnees epidemiologiques et cliniques des patients porteurs de condylomes ainsi que les traitements utilises dans 15 centres de MST entre le 1 er janvier et le 31 mars 2012. Resultats Ont ete inclus 372 hommes et 111 femmes ; l’âge moyen etait de 31,2 ans. Les femmes etaient plus jeunes que les hommes (respectivement 28,9 et 31,7 ans, p p p = 0,004, respectivement). Trois femmes avaient ete vaccinees : deux par Gardasil ® et une par Cervarix ® . Le traitement de premiere intention etait la cryotherapie dans les deux groupes. Conclusion Un examen complet, notamment anal, doit etre effectue chez les femmes et chez les HSH. Une globalisation de la vaccination anti-HPV devrait permettre une reduction des infections et l’implantation d’une strategie globale de controle de la maladie.

Introduction La syphilis reste un probleme de sante publique dans la plupart des pays occidentaux et le nombre de cas a augmente depuis 2000. La benzathine penicilline G (BPG) est le traitement de reference de la syphilis precoce, mais les ruptures de stock recentes renforcent la necessite de valider des traitements alternatifs. Le but de cette etude etait d’evaluer la presence des marqueurs genomiques de la resistance de Treponema pallidum subs pallidum (TPA) aux macrolides et a la doxycycline en France. Materiel et methodes Des prelevements de lesions genitales, anales, orales et cutanees ont ete obtenus aupres de patients atteints de syphilis precoce ayant consulte dans 9 CeGIDD. Tous les echantillons analyses etaient positifs en nPCR pour tpp47. Les mutations de resistance aux macrolides A2058G et A2059G sur le gene de l’ARN ribosomal 23S et les mutations ponctuelles de resistance a la doxycycline 926–928, 939, 965–967 et 1058 sur le gene de l’ARNr 16S ont ete recherchees par amplification genomique et sequencage. Resultats Cent quarante-six prelevements provenant de 146 patients ont ete collectes entre octobre 2010 et janvier 2017. La majorite etait des hommes (80 %) ; l’âge moyen etait de 39 ans. La part d’hommes ayant des rapports sexuels avec des hommes etait de 80 % et le nombre de seropositifs pour le VIH de 33 %. Les syphilis primaires representaient 63,7 % des echantillons. Nous montrons que 85 % (88/104) des ADN amplifies et sequences possedent la mutation A2058G conferant une resistance aux macrolides. En revanche, pour un taux d’amplification/sequencage du gene de l’ARNr 16S de 87 % (127/146), aucune mutation ponctuelle conferant une resistance a la doxycycline n’a ete detectee. Discussion Nos resultats confirment qu’en France, comme dans d’autres pays occidentaux, la resistance aux macrolides est tres repandue. C’est la raison pour laquelle les macrolides ne peuvent etre recommandes comme traitement alternatif a la BPG. A l’inverse, notre etude confirme l’absence de mutations de resistance de TPA aux cyclines. Ces resultats sont en accord avec les travaux de precedentes etudes asiatique, italienne et espagnole. Bien que n’offrant pas l’avantage d’un traitement minute, l’absence de resistance genomique souligne que la doxycycline peut representer une alternative a la BPG pour le traitement de la syphilis precoce. La surveillance de la sensibilite des souches de TPA aux cyclines doit cependant etre renouvelee du fait de la proposition recente d’utilisation de la doxycycline en prophylaxie post exposition des infections sexuellement transmissibles bacteriennes (PEP) dans le cadre de la prophylaxie pre-exposition de l’infection a VIH (PrEP).

Introduction Depuis que l’examen au microscope a fond noir a ete retire de la nomenclature, il n’existe aucun examen accredite et rembourse pour le diagnostic direct de la syphilis. Des techniques de PCR monoplex sont cependant utilisees par de nombreux laboratoires. L’objectif de ce travail etait d’evaluer un test multiplex a partir de lesions cutaneo-muqueuses documentees chez des patients suspects de syphilis. Materiel et methodes Les ecouvillons ont ete collectes chez des patients consultant dans 7 CeGIDD repartis sur toute la France. Le diagnostic de syphilis precoce reposait sur les criteres du CDC. Les extraits d’ADN ont ete testes avec le kit Allplex Genital ulcer Assay (Seegene) permettant de detecter les virus HSV1 et 2, VZV, CMV et les bacteries T. pallidum, H. ducreyi et C. trachomatis serovar L. Resultats L’etude a porte sur 389 patients dont 137 syphilis primaires, 13 syphilis primo-secondaires, 67 syphilis secondaires et 172 patients n’ayant pas la syphilis avec une sensibilite (Se) de 80 % et une specificite (Sp) de 99 %. Syphilis primaire : 96 lesions genitales, TP 79 pos (Se 82 %), HSV (8), CMV (1), LGV (2), 6 neg pour tous les microbes et co-infection (Co-I) TP/LGV (1), TPA/HSV (5) ; 22 lesions anales, TP 15 pos (Se 71 %), HSV (4), CMV (1), LGV (2) et Co-I TP/CMV (1), TP/HSV (3) ; 15 lesions buccales, TP 11 pos (Se 85 %), HSV (3), 1 neg et Co-I TP/HSV (1) ; 4 lesions cutanees, TP 3 pos (Se 75 %), 1 neg. Syphilis primo-secondaire : 10 lesions genitales, TP 7 pos (Se 70 %), HSV (1), CMV (1), 1 neg et Co-I TP/CMV (1) ; 1 lesion anale TP pos (Se 100 %) ; 2 lesions buccales TP pos (Se 100 %). Syphilis secondaire : 28 lesions genitales, TP 20 pos (Se 83 %), HSV (2), CMV (1), 5 neg et Co-I TP/CMV (1), TP/HSV (1) ; 17 lesions anales, TP 10 pos (Se 67 %), HSV (3), CMV (2), 2 neg et Co-I TP/CMV (1), TP/HSV (1) ; 12 lesions buccales, TP 10 pos (Se 91 %), HSV (1), 1 neg et Co-I TP/HSV (1) ; 10 lesions cutanees, TP 7 pos (Se 78 %) et 3 neg. Les 172 lesions des patients n’ayant pas la syphilis correspondaient a : HSV (37 %) dont 48 esions genitales, 14 anales, 1 buccale et 1 cutanee ; CMV (2,3 %) dont 2 genitales et 2 anales ; VZV (0,6 %) 1 genitale et LGV (0,6 %) 1 anale. Discussion La sensibilite et la specificite de detection du genome de TP par ce test multiplex sont comparables au test de nested PCR valide (Se 84 % et Sp 100 %) et utilise en routine par le CNR IST bacteriennes expertise syphilis. Le mutiplexage permet d’identifier des co-infections principalement par HSV et d’identifier sur les lesions cutaneo-muqueuses non syphilitiques une part importante due aux virus herpes et dans une moindre mesure, au CMV, VZV et LGV. Conclusion L’utilisation d’une PCR multiplex est interessante pour detecter, non seulement T. pallidum, mais aussi pour le diagnostic de co-infections a herpes rencontrees dans les ecouvillons de patients presentant des ulcerations cutaneo-muqueuses.

Le uretriti maschili possono essere gestite in medicina ambulatoriale, a condizione che la prescrizione degli esami complementari sia precisa e dettagliata, specificando i microrganismi da ricercare e le tecniche da utilizzare. La chiave di volta di questa gestione e, oltre alla competenza del prescrittore, la qualita del laboratorio scelto. I centri di informazione, di screening e di diagnosi delle infezioni sessualmente trasmissibili (CIDDIST) hanno il vantaggio di fondere la qualita della dotazione tecnica, la gratuita e l’anonimato.

Las uretritis en el varon pueden tratarse de forma ambulatoria con la condicion de que la solicitud de pruebas complementarias sea precisa y detallada, especificando los microorganismos que hay que buscar y las tecnicas que deben utilizarse. La piedra angular del tratamiento es, ademas de la competencia del prescriptor, la calidad del laboratorio seleccionado. Los centros especializados en las infecciones de transmision sexual presentan la ventaja de combinar la calidad tecnica, el anonimato y, en muchos paises, la gratuidad.

Reprinted and translated from Journal of the European Academy of Dermatology and Venereology 28 (2014) “2014 European guideline on the management of syphilis” pp. 1581-1593, Copyright 2014 with permission © 2014 European Academy of Dermatology and Venereology. Background. Syphilis remains a major public health problem in Europe (both in Eastern Europe since the 1990’s and in Western Europe since the re-emergence of the disease in the late 1990’s-early 2000’s). Methods. This guideline is an update of the IUSTI: 2008 European guideline on the management of syphilis and is produced by the European Guideline Editorial Board (http://www.iusti.org/regions/Europe/pdf/2013/Editorial_Board.pdf) and EDF Guideline Committee. Results . It provides recommendations concerning the diagnosis and management of syphilis in Europe. Major advances include (1) broader use of PCR, immunohistochemistry, subtyping of the etiological agent Treponema pallidum subspecies pallidum, new treponemal tests, and rapid-point-of-care (POC) tests detecting both treponemal and non-treponemal antibodies, (2) more flexible options for screening (TT-treponemal test – first or NTT – non treponemal test – first or both TT and NTT), and (3) procaine penicillin is no longer the first line therapy option in any phase of the disease, i.e. long acting penicillin G (i.e. benzathine penicillin G-BPG) is the only first line therapy regimen in early syphilis and in late latent syphilis. Conclusions . Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe.

These 5 cases of atypical inflammatory lymphogranula venereum (LGV) serovar L2b presenting initially with edema and persistent painful ulceration illustrate that clinical manifestations of LGV in the current outbreak in men who have sex with men reflect the influence of both the serovars virulence and the host immune system and are not confined to proctitis. L2b serovar could have a particular high virulence profile, and the need for awareness of LGV as a cause of genital ulceration is crucial.

Las causas de balanitis son diversas. Se distinguen balanitis de origen infeccioso, irritativo, alergico o traumatico, balanitis inflamatorias y balanitis precancerosas. Estas diversas etiologias se trataran sucesivamente, desde el punto de vista del diagnostico positivo y del tratamiento, asi como de los aspectos morfologicos normales de la region balanoprepucial, ya que pueden ser objeto de consulta por parte de los pacientes y a veces les producen ansiedad. Tambien se consideraran la dinamica balanoprepucial y las diferencias significativas desde el punto de vista medico entre los hombres circuncidados y los que no lo estan. Las lesiones precancerosas de la region balanoprepucial, aunque infrecuentes, constituyen un dificil problema diagnostico y un desafio terapeutico. El principal problema radica en el diagnostico precoz con el fin de evitar la evolucion hacia el temible carcinoma epidermoide. Asimismo, el liquen escleroatrofico, que puede transformarse en carcinoma epidermoide, debe vigilarse de por vida. De este modo, cualquier lesion fija, cronica o sospechosa debe biopsiarse rapida y sistematicamente.

Introduction La syphilis est une pathologie de presentation tres polymorphe et parfois trompeuse. Nous rapportons un cas de syphilis secondaire maligne mimant un lymphome. Observations Une patiente âgee de 46 ans, ayant pour antecedent une toxicomanie sevree et un alcoolisme chronique, se presentait en consultation pour des lesions cutanees evoluant depuis un mois, associees a une alteration de l’etat general avec amaigrissement de 5 kg, des sueurs nocturnes profuses et une aphonie progressive. L’examen clinique mettait en evidence des lesions papulonodulaires centimetriques tres infiltrees predominant au visage mais presentes sur tout le tegument, dont deux etaient ulcerees avec une bordure tres infiltree. Il n’y avait pas d’atteinte palmoplantaire. On observait une hypertrophie gingivale et de multiples erosions superficielles de toute la muqueuse buccale s’etendant jusqu’au cavum et aux cordes vocales. L’examen genital et anal etait normal. Il existait de nombreuses adenopathies axillaires, cervicales et sus-claviculaires, supra-centimetriques fermes et indolores. L’examen neurologique et le fond d’œil etaient normaux. La biopsie cutanee montrait un infiltrat dermique dense polymorphe associant des lymphocytes de taille irreguliere, des histiocytes, des polynucleaires neutrophiles et des nappes de plasmocytes. En immunohistochimie il existait un marquage intense par l’anti-treponeme. La biopsie ganglionnaire montrait une hyperplasie folliculaire d’allure reactionnelle. La serologie syphilis etait tres fortement positive avec un TPHA a 1/10 240 et un VDRL a 1/256. La serologie VIH etait negative. Le diagnostic de syphilis secondaire maligne avec atteinte laryngee etait porte. Sous antibiotherapie adaptee, l’evolution etait rapidement favorable apres une reaction d’Herxheimer initiale. A 3 mois, le VDRL etait divise par 32 ( Fig. 1 et 2 ). Discussion La syphilis maligne est une forme nodulaire et ulceree inhabituelle de syphilis secondaire pouvant simuler d’autres pathologies notamment un lymphome, mais egalement une infection cutanee bacterienne, fongique ou a mycobacterie, ou un pityriasis lichenoide et varioliforme aigu. Il s’agit classiquement de papules qui evoluent vers des ulcerations avec une bordure infiltree et un centre necrotique. Elle s’accompagne frequemment de signes generaux (fievre, alteration de l’etat general, poly-adenopathies). La reponse a la benzathine-benzylpenicilline G est generalement tres bonne, avec cependant une reaction d’Herxeimer classiquement decrite. Depuis l’emergence du VIH, cette forme est de plus en plus rapportee : elle est 60 fois plus frequente chez ces patients. Conclusion La recherche de syphilis doit etre systematique devant des lesions papulonodulaires infiltrees associees a des signes generaux, meme en l’absence d’infection par le VIH.

Introduction Les metastases des cancers urologiques (vessie, prostate) peuvent se localiser au gland sous forme de nodules douloureux. Parfois revelatrices de la maladie, le risque de retard diagnostique par leur meconnaissance est eleve. Observations Un homme de 69 ans suivi pour un carcinome urothelial de vessie pT1 de haut grade non infiltrant traite par resection transuretrale de vessie et instillation endovesicale de BCG, presentait des lesions nodulaires irregulieres tres douloureuses du sillon coronal et une induration ligneuse des corps caverneux, compliquees d’un priapisme et d’une dysurie depuis 3 mois. L’IRM du penis montrait des images nodulaires du gland vascularisees en peripherie avec extension aux corps caverneux (hyposignal marque apres injection) et une hypertrophie prostatique heterogene irreguliere. Le taux d’antigene prostatique specifique (PSA) etait a 494 ( Fig. 1 et 2 ). Discussion Les etiologies a evoquer devant des nodules chroniques durs et douloureux du penis sont infectieuses (syphilis, tuberculose), inflammatoires (sarcoidose), neoplasiques primitive (carcinome epidermoide avance, lymphome) ou secondaire. Les principales origines de metastases peniennes sont urologiques : vessie, prostate, rein, testicule et moins frequemment digestives : colorectales plus qu’hepatiques. Les reelles metastases de carcinome de prostate au penis sont rares, classiquement sous forme de nodules erythemateux tres douloureux du gland (diffusion par voie lymphatique ou veineuse retrograde par la veine dorsale). L’extension par contiguite via les corps caverneux est plus frequente, compliquee dans 50 % des cas de priapisme a bas debit (ischemique), dysurie, douleurs et retention aigue d’urine. Les options therapeutiques dependent de l’etat general du patient, des symptomes, des localisations metastatiques : hormonotherapie, chimiotherapie voire penectomie. Le pronostic est defavorable, avec un gain de survie non negligeable en cas de traitement. Conclusion Nous rapportons un cas de metastases du penis revelant un adenocarcinome de prostate multi-metastatique rappelant l’importance de rechercher une neoplasie sous-jacente devant des nodules peniens apres 40 ans.

We report the first case of chancroid seen at our clinic in 14 years. It was diagnosed by nuclear acid amplification test in a male patient returning from Madagascar. Although the disease is considered on the verge of disappearance even in tropical countries, its real potential for reemergence – due to new strains of Haemophilus ducreyi, underreporting and a lack of widespread use of molecular testing – could be underestimated.

Background In patients with human immunodeficiency virus (HIV) infection, genital herpetic lesions may be extensive and tend to persist for longer periods; in addition, atypical hypertrophic, ulcerative, or pseudotumor forms have been reported, frequently showing resistance to acyclovir (ACV) treatment. Methods Between 2003 and 2011, 10 HIV-1-infected patients presenting with chronic pseudotumoral anogenital herpes simplex type 2 (HSV-2) infections were studied. Results All patients developed chronic, hypertrophic HSV-2 anogenital lesions with multilesional presentation in 7 cases and involvement of 2 anatomical sites in 6 of them. At the time of diagnosis, the median CD3(+)CD4(+) absolute blood count was 480.5 cells/µL (range, 165-632 cells/µL), whereas the plasma HIV load was undetectable in all cases. Histopathologic analysis of lesion biopsies showed a moderately dense dermal polytypic plasma cell infiltrate. Detection of HSV-2 by culture and/or polymerase chain reaction was positive for all patients, with evidence for ACV-resistant strains in 6 of 8 cases. In addition, viral resistance to ACV was found only in HSV-2 isolated from ulcerative lesions, whereas purely pseudotumoral ones harbored sensitive strains. Durable control was observed with HSV DNA polymerase inhibitors in only 2 cases, and the immunomodulators imiquimod and thalidomide allowed 5 patients to reach sustained complete response. Conclusions HSV-2-related pseudolymphoma in HIV-infected patients is characterized by a predominant polyclonal lymphoplasmacytic infiltration, and is frequently refractory to antiherpetic drugs. Immunomodulatory therapeutic strategies using thalidomide showed consistent efficacy, and should be considered early during the course of disease.

Two major Treponema pallidum subtypes, 14 d/g and 14 d/f, were identified in a population of 119 patients with syphilis in Paris, France, characterized by a high proportion of men who have sex with men. A new subtype named 11 q/j was characterized, and a reinfection case was determined in 1 patient having consecuitve syphilis infection at 19-month interval.

Bacterial culture remains the gold standard for symptomatic infection. Nucleic Acid Amplification Tests (NAATs) have better sensitivity and specificity for rectal and pharyngeal specimens. A bacterial culture with antibiogram must be done for all NAAT positive specimens in order to modify antibiotics prescription if needed. We must fear a diffusion of extensively drug-resistant Neisseria gonorrhoeae in the future. Nevertheless, ceftriaxone 500 mg intramuscular with 1 g of azithromycin against Chlamydia trachomatis remains the treatment of N. gonorrhoeae infections. Screening of partners of identified cases and other STDs is the main measure to add to the treatment of gonorrhea.

Pediculosis pubis is caused by Phthirus pubis. The disease can be sexually transmitted. Patients main complain is of itch in the pubic area. The parasite can be spotted with the naked eye and blue macules can be observed in the pubic area. First line therapy consists of permethrin or pyrethrins with piperonyl butoxide. Second line therapy contains phenothrin, malathion and oral ivermectin. Partner management needs a look-back period of time of 3 months. Pubic lice incidence is increased in populations groups living in crowded spaces with scarce sanitary conditions as in time of war or disaster.

Background Treponema pallidum subsp. endemicum (TEN) is the causative agent of endemic syphilis (bejel). An unusual human TEN 11q/j isolate was obtained from a syphilis-like primary genital lesion from a patient that returned to France from Pakistan. Methodology/Principal findings The TEN 11q/j isolate was characterized using nested PCR followed by Sanger sequencing and/or direct Illumina sequencing. Altogether, 44 chromosomal regions were analyzed. Overall, the 11q/j isolate clustered with TEN strains Bosnia A and Iraq B as expected from previous TEN classification of the 11q/j isolate. However, the 11q/j sequence in a 505 bp-long region at the TP0488 locus was similar to Treponema pallidum subsp. pallidum (TPA) strains, but not to TEN Bosnia A and Iraq B sequences, suggesting a recombination event at this locus. Similarly, the 11q/j sequence in a 613 bp-long region at the TP0548 locus was similar to Treponema pallidum subsp. pertenue (TPE) strains, but not to TEN sequences. Conclusions/Significance A detailed analysis of two recombinant loci found in the 11q/j clinical isolate revealed that the recombination event occurred just once, in the TP0488, with the donor sequence originating from a TPA strain. Since TEN Bosnia A and Iraq B were found to contain TPA-like sequences at the TP0548 locus, the recombination at TP0548 took place in a treponeme that was an ancestor to both TEN Bosnia A and Iraq B. The sequence of 11q/j isolate in TP0548 represents an ancestral TEN sequence that is similar to yaws-causing treponemes. In addition to the importance of the 11q/j isolate for reconstruction of the TEN phylogeny, this case emphasizes the possible role of TEN strains in development of syphilis-like lesions., Author summary Treponema pallidum subsp. endemicum (TEN) is an uncultivable pathogenic treponeme that causes bejel (endemic syphilis), a chronic human infection mostly affecting children under 15 years of age, occurring mainly in several African and Middle East countries. In this work, we characterized a TEN 11q/j isolate from France that was obtained from an adult male with genital lesions, who was suspected of having syphilis and who received benzathine penicillin G. DNA sequencing of the isolate revealed two loci that were, rather than to TEN, related either to T. pallidum subsp. pertenue or to T. pallidum subsp. pallidum and likely resulted from recombination events. The recombination event in TP0488 as well as the recombination in TP0548, of the 11q/j, helped clarify the phylogeny of the TEN strains indicating that the recombination in TP0548 took place in a treponeme that was ancestral of Bosnia A and Iraq B, but was not an ancestor of the 11q/j isolate. In contrast, a recombination event in TP0488 appeared in the ancestor of the 11q/j isolate after separation of the ancestral treponeme of Bosnia A and Iraq B. This case also points to a possible role of TEN strains in development of syphilis-like lesions in countries with endemic syphilis.

On the occasion of the 70th annual meeting of the American Academy of Dermatology in San Diego the ILDS Executive Committee hosted a cocktail reception in the evening of 18 March. The reception, held at the Marriott Hotel on an evening of several competing attractions, was well attended by friends of the ILDS, who stopped by for a drink and a chat. Jean Bolognia and Chris Griffiths acted as official ILDS meeters and greeters for the guests. Our president, Wolfram Sterry gave a short speech of welcome and provided an update for those present on the recent achievements of and plans for the ILDS. The announcement of the Berlin summit was particularly well received by our member societies. Jerry Shapiro then took the floor to apprise us of the arrangements for the Vancouver World Congress, these too were greeted with enthusiasm...

Background: Community-acquired methicillin-resistant Staphylococcus aureus (caMRSA) skin and soft-tissue infections are a major cause for concern. Communities of men who have sex with men (MSM) in the USA being prone to caMRSA epidemics, we investigated whether MSM attending our sexually transmitted disease clinic were carriers of or infected by caMRSA. Methods: 300 MSM were prospectively recruited, interrogated and examined. Swabs of their nares and of their pubic and perineal skin were taken and cultured. Results: No evidence of carriage or infection by caMRSA was found. Nasal carriage of methicillin-sensitive S. aureus was within French estimates. Perineal carriage significantly correlated with the number of sexual partners. Conclusion: Although caMRSA carriage or infection does not seem to affect Paris MSM, prospective sampling may not be the best method to monitor them. The correlation between number of partners and perineal carriage suggests that thorough hygiene after intercourse could limit the spread of S. aureus in MSM with multiple partners.

Background Four epidemiologic forms of Kaposi's sarcoma have been described, all of which are associated with the human herpesvirus-8. In western countries, human herpesvirus-8 is more prevalent in homosexual men than in the general population, and anecdotal cases of Kaposi's sarcoma in HIV-negative homosexual men have been reported. Patients and methods We included HIV-negative homosexual and bisexual male patients with histologically proven Kaposi's sarcoma in a retrospective study. Clinical data were collected using a standardized form. Risk factors for human herpesvirus-8 infection and for the development of Kaposi's sarcoma were systematically recorded. Results Between 1995 and 2007, 28 men met the defined inclusion criteria. Mean age at first symptoms of Kaposi's sarcoma was 53 years. Clinical presentation resembled classical Kaposi's sarcoma, with limited disease in most patients. No cellular or humoral immunodeficiency was observed. Serologic tests for human herpesvirus-8 (latent immunofluorescence assay) were positive in 88% of patients, and only two patients displayed human herpesvirus-8 viremia at the time of Kaposi's sarcoma diagnosis. Three patients developed lymphoproliferative disorders (Castleman disease, follicular lymphoma and Burkitt lymphoma). In this population, alpha-interferon was well tolerated and gave a complete response, but most patients require only local treatment, if any. Conclusion Kaposi's sarcoma may develop in homosexual or bisexual men without HIV infection. This type of Kaposi's sarcoma has clinical features in common with classical Kaposi's sarcoma but occurs in younger patients. Its prognosis is good, as Kaposi's sarcoma is generally limited, but clinicians should be aware of the association with lymphoproliferative diseases, which may affect prognosis.

First HSV-1 genital episodes in HSV-2 infected patients however, had never been demonstrated until the 2 cases we observed. This scarcity could reflect the lower impact of HSV-2 on western populations but questions the existence of cross-protection between viral types.

During the last decade, the incidence of male urethritis stopped declining in France. Risk factors associated with unprotected intercourse have been extensively studied in men who have sex with men, but not in men in general. The purpose of the study was to determine major risk factors for urethritis among men and to describe the sociodemographic and medical characteristics of this population in 2005. We conducted a prospective case-crossover study of sexual behaviors among men with acute urethritis attending at general practitioners or sexually transmitted infection (STI) clinics in France. Each patient filled out a selfcompleted questionnaire focusing on sociodemographic characteristics, and on sexual behaviors for the month before urethritis onset and for the preceding 3 months. The doctor reported medical information on a separate questionnaire. Between January and September 2005, 121 cases of male urethritis, defined as recent-onset pain on micturition and/or purulent or mucoid discharge, were included. Median age was 33 years, 22.3% were MSM, 55.1% were single, and 72.0% had at least high school education. Conditional logistic regression analysis showed that intercourse with only casual partners or with both casual and steady partners (OR = 2.6, CI 95%: 0.8-8.7, and OR = 8.7, CI 95%: 2.7-28.0), as well as inconsistent condom use (OR = 5.8, CI 95%: 1.7-19.2) significantly increased the risk of male urethritis. STI prevention campaigns should continue to focus on consistent condom use and should not neglect men over 30 years of age.