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Background Diagnoses of bacterial sexually transmitted infections (STIs) have increased in France since the 2000s. The main strategy to control STI transmission is recommending/facilitating access to condom use, testing, and antibiotic treatments. Aim This study analyses the evolution of STI testing in the private sector in France from 2006 to 2020. Methods National health insurance reimbursement data were used to determine numbers and rates of individuals aged ≥ 15 years tested for diagnoses of chlamydia, gonorrhoea and syphilis in the private sector in France and to describe their evolution from 2006 to 2020. Results Upward tendencies in testing were observed from 2006 to 2019 for all three STIs. The highest testing rates were identified in people aged 25‒29-years old. The observed testing-increase from 2017 to 2019 was twice as high in young people ( Conclusion Improvements found in STI testing rates may have resulted from better awareness, especially among young people and health professionals, of the importance of testing, following prevention campaigns. Nevertheless, testing levels remain insufficient considering increasing diagnoses. In 2020, the COVID-19 pandemic had a considerable impact on STI testing. Partner notification and offering diverse testing opportunities including self-sampling are essential to control STI epidemics particularly in exposed populations.

Chemsex involves mental and sexual health risks for users, which generate specific needs in primary care. The aim of this study is to evaluate the role of the general practitioner (GP) in the identification of disorders and first aid offered to MSM chemsex users (CUs). Data were collected with a self-administered questionnaire offered to MSM patients consulting in six Parisian STI clinics. The primary endpoint was the number of GP visits reported by patients in the past 12 months between CUs and control. Three hundred sixty-four MSMs were included between October and December of 2018: 94 CUs (25.9%) and 270 control. The multivariate analysis showed no statistically significant difference in the number of GP visits in the past 12 months (3.27 vs 2.66, p = 0.205). CUs had a higher number of sexual partners (p

Introduction Several therapeutic options are available to manage anogenital warts (AGWs). However, no hierarchy of treatments is provided in the latest European and American recommendations. This study aimed to determine the efficacy and safety of local treatments for the management of AGWs. Methods A search was conducted through 12 databases from inception to August 2018. All randomized controlled trials (RCTs) in which at least one parallel treatment group composed of immunocompetent adults with AGWs received at least one provider-administered or patient-administered treatment were included. Risk of bias assessment and meta-analyses of aggregated study data were performed on the basis of the Cochrane Handbook, and quality of evidence evaluation followed the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Primary endpoints were complete clearance and recurrence at 3 months. Results Seventy RCTs (9931 patients) were included. All but four RCTs had a high risk of bias. CO2 laser was slightly more efficacious than cryotherapy [risk ratio (RR) 2.05; 95% confidence interval (CI) 1.61–2.62], with fewer recurrences at 3 months (RR 0.28; 95% CI 0.09–0.89). Electrosurgery was slightly more efficacious than cryotherapy. No differences in efficacy or side effects were found between cryotherapy and imiquimod or trichloroacetic acid. Podophyllotoxin gel was slightly more efficacious than podophyllotoxin cream. 5-Fluorouracil (5-FU) was slightly more efficacious and caused less erosion than CO2 laser (RR 1.37; 95% CI 1.11–1.70). Conclusion The vast majority of included RCTs had a low level of evidence, thereby preventing the establishment of a hierarchy of treatments. Nevertheless, our results provide an overview of the main AGW treatments available for general practitioners and specialists. While provider-administered treatments are superior, patient-administered treatments (e.g., imiquimod, podophyllotoxin) are useful solutions for compliant patients. Protocol registration PROSPERO-CRD42015025827. Electronic supplementary material The online version of this article (10.1007/s13555-019-00328-z) contains supplementary material, which is available to authorized users.

Letter; International audience

Giant condyloma acuminatum, also known as Buschke-Lowenstein tumor (BLT), is a rare disease of the anogenital region. BLT is considered a locally aggressive tumor of benign histological appearance, but with the potential for destructive growth and high recurrence rates. BLT development is strongly associated with infection with low-risk human papillomaviruses (HPVs), mostly HPV-6 and -11. Immunity to HPVs plays a crucial role in the natural control of various HPV-induced lesions. Large condyloma acuminata are frequently reported in patients with primary (e.g., DOCK8 or SPINK5 deficiencies) and secondary (e.g., AIDS, solid organ transplantation) immune defects. Individuals with extensive anogenital warts, including BLT in particular, should therefore be tested for inherited or acquired immunodeficiency. Research into the genetic basis of unexplained cases is warranted. An understanding of the etiology of BLT would lead to improvements in its management. This review focuses on the role of underlying HPV infections, and human genetic and immunological determinants of BLT.

Introduction Les histoplasmoses cutanees (HC) sont les mycoses opportunistes d’importation les plus frequentes en France metropolitaine, notamment chez le patient VIH. Il existe 2 variants : Histoplasma capsulatum var capsulatum et var duboisii. La contamination se fait via l’inhalation de spores aeroportees presentes dans les excrements d’oiseaux ou de chauves-souris. La lesion elementaire est une ulceration granulomateuse ou vegetante cutaneo-muqueuse, mais des atteintes pulmonaires et multiviscerales sont possibles. Nous rapportons 2 cas d’HC a H. capsulatum var capsulatum de presentation clinique trompeuse, evocatrice de carcinome epidermoide cutane (CE). Materiel et methodes Cas no 1 : Mr A, 71 ans, diabetique, adresse pour une suspicion de CE de la verge devant une ulceration preputiale chronique associee a une AEG, une dysphonie et des troubles digestifs. Apres elimination d’un herpes, d’une syphilis et d’une donovanose, un CE de la verge etait suspecte. Le bilan d’extension (TDM, endoscopie ORL et digestive devant l’AEG) trouvait une ulceration colique et de la corde vocale. L’anatomopathologie des 3 lesions ne revelait pas de proliferation maligne mais un infiltrat histiocytaire organise en granulomes comme decrit dans les HC. La PCR et le Grocott etaient positifs avec identification de levures dans les macrophages. Un traitement IV par amphotericine B etait instaure pendant 10 jours relaye par itraconazole pour 1 an. L’evolution etait favorable a 3 mois. Cas no 2 : Mr. M, 30 ans, seropositif VIH avec 34 CD4/mm3, consultait pour une lesion ulcero-crouteuse de la levre evoluant depuis 2 mois. Les hypotheses diagnostiques etaient infectieuses (HSV, syphilis, leishmaniose) ou tumorale. Le bilan d’extension (TDM corps entier) etait negatif. L’histologie montrait une proliferation epidermique pseudo carcinomateuse et un infiltrat granulomateux sous-jacent. L’analyse mycologique (Grocott et PCR) retrouvait une HC a Histoplasma capsulatum var capsulatum. L’evolution etait spontanement favorable parallelement a la restauration immunitaire sous tritherapie. Une surveillance rapprochee etait instauree. Discussion Si dans le cas no 1 a la presentation clinique inquietante, l’histologie granulomateuse fut l’element cle du diagnostic, dans le second cette derniere demeurait compatible avec une proliferation epitheliomateuse. Le traitement systemique est necessaire lorsque l’atteinte est multiviscerale (1ercas) mais la restauration immunitaire chez l’ID peut suffire pour les atteintes limitees non graves, avec un suivi rapproche (2e cas). Ceci illustre l’importance d’une demarche diagnostique rigoureuse devant une ulceration cutaneo-muqueuse chronique consistant en la recherche simultanee d’une infection par les prelevements microbiologiques adequats et d’une cause non infectieuse (notamment neoplasique) par l’histologie en gardant a l’esprit qu’elle peut parfois etre trompeuse notamment chez l’ID.

Introduction L’incidence de la syphilis augmente depuis plusieurs annees. Son diagnostic repose sur des methodes indirectes serologiques et les signes cliniques. T. pallidum (TP) n’est pas cultivable en routine et la microscopie a fond noir n’etant plus a la nomenclature, le developpement de techniques de diagnostic direct reposant sur l’amplification genomique est essentiel. L’objectif de ce travail etait la mise au point et la validation d’un test PCR pour TP a partir de lesions cutaneo-muqueuses documentees chez des patients suspects de syphilis. Materiel et methodes (ou observation(s) si cas clinique(s)) La PCR en temps reel (qPCR) TaqMan a amplifiee les genes polA et tpp47 et a ete validee sur les extraits d’ADN d’ecouvillons collectes chez des patients consultant dans 7 CeGIDD repartis sur toute la France. Le resultat de la qPCR a ete confronte au diagnostic final de syphilis defini par les criteres du CDC. La qPCR a ete etalonnee par le clonage des genes polA et tpp47. Resultats (si adapte) L’etude a porte sur 320 patients dont 112 syphilis primaires, 63 syphilis secondaires et 145 patients sans syphilis. La qPCR avait une sensibilite globale (Se) de 83 % et une specificite globale (Sp) de 100 % ainsi qu’une VPP de 100 % et une VPN de 83 % avec des Ct moyens de 31,4 pour polA et de 30,9 pour tpp47. En comparaison, la detection par qPCR etait equivalente a celle de polA seule (Se : 82 %) mais meilleure que tpp47 seule (Se : 77 %). Les Sp separees des 2 genes etait de 97 %, alors qu’elle etait de 100 % avec la qPCR. En detail, syphilis primaire : 84 lesions genitales, TP 71 pos (Se 85 %) ; 16 lesions anales, TP 13 pos (Se 81 %) ; 10 lesions buccales, TP 8 pos (Se 80 %) ; 2 lesions cutanees, TP 2 pos (Se 100 %). Syphilis secondaire : 31 lesions genitales, TP 25 pos (Se 80 %) ; 13 lesions anales, TP 10 pos (Se 77 %) ; 12 lesions buccales, TP 10 pos (Se 83 %) ; 7 lesions cutanees, TP 6 pos (Se 86 %). Les 145 lesions des patients sans syphilis correspondaient a 100 lesions genitales, 27 anales, 15 buccales et 3 cutanees. La concordance globale avec la PCR nichee (nPCR) de reference (Se 85 % ; Sp 100 %) etait de 95,9 % avec un indice kappa de 0,92. L’etalonnage montrait une limite de detection a 30 pg d’ADN/ml ou 2 copies/ml. Discussion La qPCR sur TP a ete validee (Se 83 % et Sp 100 %) et est comparable au test de nPCR (Se 84 % et Sp 100 %) utilise en routine au CNR IST bacteriennes. La qPCR a l’avantage d’etre plus rapide que la nPCR avec un risque de contamination moindre. En parallele, l’etalonnage de la qPCR nous permettra d’evaluer le nombre de copies de TP au sein d’echantillons divers (prelevement sanguin, LCR). Le CNR a donc mis en place sur des echantillons documentes une qPCR performante pour la detection du genome de TP. L’utilisation d’une qPCR en routine au CNR permettra de detecter tres specifiquement l’ADN de TP avec une prise en charge plus rapide sur un volume d’echantillons plus important.

Background Koebner phenomenon (KP) affects from a quarter to a third of the patients with psoriasis and can occur on tattoos Material and methods We retrospectively reviewed a case series of seven tattooed patients with an isomorphic response on their tattoos or partial psoriasis patches on their tattoos. We collected the demographic data, the past history of psoriasis, the clinical presentation, and the outcomes. We also performed a review of the literature. We tried to classify the different clinical profile of KP/psoriasis on tattoos accordingly. Results Six men and one woman with a median age of 36 ± 6.4 years old were included. Five disclosed a KP in a recent tattoo within days to 1 month after its completion. Fifteen additional cases were collected from the literature (8 men, median age 22 ± 8.2 years old). The delay of psoriasis flare-up after tattooing was rather short, from a few weeks to several months. We found a high variability in the clinical presentation with five clinical subtypes/profiles of psoriasis on tattoos. A possible confusion between “genuine” KP on tattoos and the coincidental occurrence of psoriasis patches on tattoos is possible in some cases of the literature. Patients were mainly managed locally, rarely by systemic treatments or biologics. Conclusion Koebner phenomenon on tattoos may occur in patients with psoriasis under various forms. The evolution is benign, and psoriasis is not a contraindication for tattooing, but patients need proper counseling before getting tattooed.

Two novel human gamma-papillomavirus genomes (HPV_MTS3, and HPV_MTS4) were isolated from the skin of an immunosuppressed, late-onset Epidermodysplasia Verruciformis patient and fully cloned. The L1 open reading frames of HPV_MTS3 and HPV_MTS4 were 77% and 91% identical to their closest HPV full genome isolates w18c39 and EV03c60, which belong to the species gamma-22and gamma-7 of the genus Gammapapillomavirus, respectively.

BackgroundHuman papillomavirus (HPV) infection is more frequent in men having sex with men (MSM) who are living with human immunodeficiency virus (HIV) than in MSM without HIV. There are currently no data regarding HPV infections in preexposure prophylaxis (PrEP)-using MSM.MethodsMSM living without HIV who were enrolled in the Agence Nationale de Recherches sur le SIDA et les Hépatites Virales "Intervention Préventive de l'Exposition aux Risques avec et pour les hommes Gays" PrEP study were prospectively enrolled. Anal, penile, and oral samples were collected at baseline and every 6 months for HPV detection and genotyping. Anal swabs for cytology were obtained at baseline and at 24 months.ResultsWe enrolled 162 participants. The prevalences of any HPV genotypes at baseline were 92%, 32%, and 12% at the anal, penile, and oral sites, respectively. High-risk (HR) HPV genotypes were observed in 84%, 25%, and 10% of anal, penile, and oral baseline samples, respectively. Nonavalent HPV vaccine genotypes were observed in 77%, 22%, and 6% of anal, penile, and oral baseline samples, respectively. Multiple infections were observed in 76%, 17%, and 3% of cases at the anal, penile, and oral sites, respectively. The most frequent HR genotypes were HPV 53, 51, and 16 in anal samples; HPV 33, 39, and 73 in penile samples; and HPV 66 in oral samples. The incidence of any HPV genotype at the anal site was 86.2/1000 person-months and the incidence of HR-HPV genotypes was 72.3/1000 person-months. The baseline cytology was normal in 32% of cases and was classified as atypical squamous cells of undetermined significance, low-grade squamous intra-epithelial lesion, high-grade squamous intra-epithelial lesion (HSIL), and atypical squamous cells that cannot exclude HSIL in 23%, 40%, 5%, and 1% of cases, respectively.ConclusionsPrEP users have a similar risk of HPV infection as MSM living with HIV and the risk is much higher than that previously reported in MSM living without HIV.

Background Most European countries are still facing a high burden of sexually transmitted infections (STIs) cases each year. Available literature has found associations between time preference, i.e. the relative weight given by individuals to future outcomes compared to present ones, and various health behaviours such as tobacco or alcohol consumption, vaccination or participation in cancer screening programmes. Our objective is to investigate the role of future preference in risky sexual behaviours. Methods We conducted a cross-sectional study using self-administered questionnaires in three HIV testing centres in Paris. We collected data on sexual behaviours, risk perceptions, risk attitude, future preference (Considerations of Future Consequences scale) and socioeconomic and demographic variables. Full data for variables used in regression analyses were available for 1090 respondents. We study factors associated with condom use at the first sexual encounter, with the frequency of condom use and with the number of sexual partners. Results In the full sample, future preference is positively correlated with both measures of condom use while it is negatively correlated with the number of sexual partners. Decomposing the analysis by risk group, our results indicate that future preference has more impact on sexual behaviours, especially condom use, among men who have sex with men compared to heterosexual men and, to a lesser extent, compared to heterosexual women. Conclusion If future time perspective is confirmed as a determinant of safer sexual behaviours, prevention campaigns could be shifted towards greater information on short-term consequences of STIs.

Diagnoses of bacterial sexually transmitted infections (STI) have been increasing in France since their resurgence in the late 1990s. This article presents recent epidemiological trends until 2016 and the patients’ characteristics. STI surveillance relies on sentinel networks: a clinician-based network RésIST (clinical, biological and behavioural data for early syphilis and gonorrhoea), the lymphogranuloma venereum (LGV) network (clinical, biological and behavioural data for rectal LGV, and the laboratory networks Rénachla and Rénago (demographic and biological data for chlamydial infections and gonorrhoea, respectively). Here we describe trends between 2014 and 2016, using data from diagnostic centres which participated regularly during the study period. The number of early syphilis, gonorrhoea and LGV diagnoses increased between 2014 and 2016, particularly in men who have sex with men. An increase in syphilis and gonorrhoea cases was also observed in heterosexuals. Nevertheless, we observed a drop in 2016 for syphilis and chlamydial infections after two decades of increases. Under-reporting and shortage of benzathine penicillin in 2016 may explain this latest evolution. Regular screening of patients and partners, followed by prompt treatment, remains essential to interrupt STI transmission in a context where human immunodeficiency virus (HIV) prevention has expanded towards biomedical prophylaxis.

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.

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.

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.300 MSM were prospectively recruited, interrogated and examined. Swabs of their nares and of their pubic and perineal skin were taken and cultured.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.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.

Resume Introduction Les vascularites systemiques peuvent parfois revneler une hemopathie maligne. Observation Nous rapportons l'observation d'une patiente de 77 ans ayant un livedo racemosa, une polyradiculonevrite aigue et une hemorragie meningee, en rapport avec une vascularite necrosante prouvee sur une biopsie cutanee. Malgre un traitement par corticoides et cyclophosphamide, on a assiste a une aggravation de la polyradiculonevrite, puis au deces de la patiente par detresse respiratoire aigue. Une cryoglobulinemie de type II a ete mise en evidence 2 jours avant le deces et l'autopsie a revele un lymphome lymphoplasmocytique touchant la rate et infiltrant les racines nerveuses ainsi que des lesions de vascularites necrosantes. Conclusion Cette observation montre que les vascularites necrosantes touchant les vaisseaux de petit calibre peuvent etre associees a une cryoglobulinemie de type II.

Some studies (mostly retrospective) have pointed to an increasing frequency (up to 60%) of herpes simplex virus type 1 (HSV-1) in genital herpes (GH), but they were biased towards severe or atypical cases. We wished to evaluate the frequency of HSV-1 in patients attending our clinic for both first and recurrent episodes of GH. All patients (men and women) with genital lesions compatible with GH were included in a prospective study between May 1999 and April 2002. For all patients a standardized questionnaire, clinical examination, MRC5 culture (Dade Behring), polymerase chain reaction (PCR)-herpes consensus (Argène Biosoft) in case of negative culture and type-specific herpes serology HSV-1 and HSV-2 (Elisa Eurobio) were obtained. Predictive factors associated with HSV-1 and HSV-2 GH were studied by uni- and multivariable analyses. In all, 255 patients had a positive culture ( n = 216) or PCR ( n = 39). A total of 248 patients had typable herpes (148 men and 100 women). Median age was 33 (27–43); 20% had anal herpes; 48% had clinically recurrent lesions; 21% were HIV +; 20% of men were homosexual; 77% practised oral sex. In all, 36 were HSV-1 (14.5%): more in women, 25/100 (25%), than in men, 11/148 (7.5%) (odds ratio [OR]: 4 [1.8–9.1], P = 0.008). HSV-1 accounted for 23% of cases of first clinical episodes (women: 31.5%;men: 14.7%) ( P = 0.02) and 6% of clinically recurrent episodes (women: 15%;men: 1.2%) (OR: 3.8 [1.6–9.1], P = 0.0033). Serological study was done in 239: primary infection was disclosed in 33 (HSV-1: 61%), HSV-2 non-primary first episode in 22 and recurrence in 184 (HSV-1: 8%). In all, 37% of recurrent episodes presented as a first clinical episode. HSV-1 was linked in men with homosexuality ( P