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Herpes zoster (HZ) is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus (VZV) (1). It is a frequent medical condition with an incidence rate of 2-3 cases per 1000 person/years in the general population and 7-10 cases per 1000 person/years after the age of 50 (1,2). Risk factors and triggers for reactivation of HZV have not yet been determined precisely, but are likely to include malignancies, immune deficiencies, solid organ and bone marrow transplant recipients, autoimmune diseases, psychological conditions, emotional stress, human immunodeficiency virus (HIV) infection, and other patients receiving immunosuppressive therapies (1,3). A 24-year-old IV drug user presented with grouped clusters of vesicles and erosions on an erythematous, edematous base distributed on the left side of the penile shaft and the left infraumbilical region (Figure 1, a and b), with regional lymphadenopathy. He had prodromal symptoms of pain, dysesthesia and burning a few days prior to the appearance of the skin lesion. The patient reported unprotected sexual contacts a few months before the eruptions. The unilateral distribution was highly suggestive of herpes zoster. A Tzanck smear was performed by obtaining scrapings from the base of a fresh vesicular lesion after it had been unroofed; it showed the characteristic presence of multinucleated giant cells that suggested herpes infection. Polymerase chain reaction (PCR) analysis of vesicular fluid yielded positive results for VZV. A 7-day course of acyclovir (800 mg 5 times a day) was initiated. The patient reported marked improvement on the second day of antiviral therapy. The course was uncomplicated, and the lesions healed without postherpetic neuralgia. Serologic tests for syphilis (VDRL/RPR and TPHA) and hepatitis C and B serologic tests were negative, but HIV test (enzyme immunoassays (EIA) for HIV-1 and HIV-2 antibodies were positive, which was later confirmed with Western blot (WB) tests. Because of the positive HIV test, the patient was referred to the Clinic for Infectious Diseases for further treatment. Herpes zoster is painful vesicular skin eruption with unilateral dermatomal involvement, usually with a severe impact on the quality of life in affected patients (1). The risk for developing HZ during a lifetime in patients exposed to VZV infection is 10-30% (4). However, the risk is higher in immunocompromised patients, particularly in cancer patients and HIV-positive patients (1,5,6). HZ is seen approximately 7 times more frequent in patients with HIV infection (5). Reactivated VZV infection may occur at any stage of HIV infection and may be the first clinical evidence of HIV infection. The development of HZ in immunocompromised individuals can be explain by decline in cell-mediated immunity and CD4 count (6). HZ predominantly affects the thoracic region, followed by the head, cervical, and lumbar regions (1). Sacral dermatomes are involved in only up to 2% of cases (1). HZ involving the penis is rarely reported, with only few case reports in the literature (3,7-9). Birch et al. compared VZV and herpes simplex virus (HSV) in specimens obtained from the genital lesions of adults presenting with presumed genital herpes infection (10). They found VZV in nearly 3% of virus-positive genital specimens, which demonstrates that this virus needs to be considered in the differential diagnosis of genital herpetic lesions (10) and that it is possible that genital HZ infection is underdiagnosed. Tzanck smear is a rapid and inexpensive method, but it cannot differentiate VZV from HSV. Genital HZ could be mistaken for zosteriform HSV infection, so a PCR test should be performed to confirm the underlying diagnosis (1). Genital forms of HZ are rare and sometimes clinically difficult to diagnose, especially when the typical zosteriform distribution is lacking; PCR testing is therefore suggested. HZ is considered a possible HIV indicator; an HIV test should therefore be performed. According to our knowledge and literature search, this is the first case report of penile HZ in an HIV-positive patient.

Background: Anogenital warts (AGW) can cause economic burden on healthcare systems and are associated with emotional, psychological and physical issues. Objective: To provide guidance to physicians on the diagnosis and management of AGW. Methods: Fourteen global experts on AGW developed guidance on the diagnosis and management of AGW in an effort to unify international recommendations. Guidance was developed based on published international and national AGW guidelines and an evaluation of relevant literature published up to August 2016. Authors provided expert opinion based on their clinical experiences. Results: A checklist for a patient's initial consultation is provided to help physicians when diagnosing AGW to get the relevant information from the patient in order to manage and treat the AGW effectively. A number of frequently asked questions are also provided to aid physicians when communicating with patients about AGW. Treatment of AGW should be individualized and selected based on the number, size, morphology, location, and keratinization of warts, and whether they are new or recurrent. Different techniques can be used to treat AGW including ablation, immunotherapy and other topical therapies. Combinations of these techniques are thought to be more effective at reducing AGW recurrence than monotherapy. A simplified algorithm was created suggesting patients with 1–5 warts should be treated with ablation followed by immunotherapy. Patients with >5 warts should use immunotherapy for 2 months followed by ablation and a second 2-month course of immunotherapy. Guidance for daily practice situations and the subsequent action that can be taken, as well as an algorithm for treatment of large warts, were also created. Conclusion: The guidance provided will help physicians with the diagnosis and management of AGW in order to improve the health and quality of life of patients with AGW. © 2019 The Authors Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology

Inflammation is defined as an enabling characteristic of malignant growth. Many proinflammatory mediators have protumor capabilities. In this review we focus on the protumor effect of cytokines and chemokines in breast cancer. We discuss the role of interleukin 1β, interleukin 6, tumor necrosis factor α, CCL2, CCL5, and CXCL12 and its receptor CXCR4 as typical mediators implicated in breast cancer progression. We also analyze the impact of transcription factor NF-κB. Proinflammatory mediators with protumor effects should be considered as therapeutic targets in breast cancer. It is challenging how to find optimal anti-cytokine and anti-chemokine regiments as a part of anticancer therapy.

The aim of the study was to determine the value of the PCR-RFLP method on the part of the gene E1 for genotyping of the HPVs, compared to stendard RFLP method (primers MY09/MY11).

Tinea capitis is a dermatophyte infection of the scalp that predominantely affects children. New therapies for tinea capitis should reduce treatment duration and increase compliance. Two duration-finding trials were performed to investigate the efficacy and safety or terbinafine in tinea capitis caused by either Trichophyton spp. or Microsporum spp. Results from these studies did not convincingly established an optimum treatment duration bur did suggest that 4-6 weeks of therapy would be sufficient for Trichophyton and Microsporum infections, respectively.

Background: Croatia is a South-Eastern European developing country with a low level HIV-epidemic and a centralized system of care for HIV/AIDS, so all patients are treated at one institution. The aim of this study was to compare the survival of patients after AIDS in the pre-HAART era 1986-1996 to the early HAART era 1997-2000. Methods: In this cohort study data were collected retrospectively up to 1998 and prospectively thereafter. Each patient was considered as a censored observation at the time of last contact if lost to follow-up or known to be alive on Dec 31, 2002. Survival times were calculated using the Kaplan-Meier (KM) method. Cox's proportional hazards model was used to examine factors associated with survival. Different survival periods were modeled, according to the log-minus-log survival plot, for the categories of CD4+ cell count and HAART era. Results: Of 144 patients (88 from pre-HAART and 56 from HAART era) 90 died ; 72 (81.8%) and 18 (32.1%) respectively. 17/88, 19.3%, and 48/56, 85.7%, of patients received HAART, respective to study eras. The 1- and 5-year survival probabilities in the pre-HAART era were 52.1% and 15.4% whereas in the HAART era they were 72.8% and 61.9% respectively. In multivariable analysis survival after 6 months was lower for patients in the HAART era (Hazard Ratio [HR] 0.11 ; 95% CI, 0.04-0.29, p

terbinafine, a fungicidal agent against dermatophytes, has the ability to concentrate in hair, nail and skin. Two multicentre, double-blind, duration-finding studies in tinea capitis, investigating the efficacy and safety of terbinafine were recently completed. Thesae two studies constitue the largest randomised double-blind trials performed in the indication tinea capitis. Oral terbinafine was well tolerated and showed good efficacy in tinea capitis caused by both Trichophyton and Microsporum species.

Sexually transmitted diseases (STD) are a great public problem all over the world. Standard treatment of bacterial STDs usually consists of multidose regimens which diminish patient compliance and compromise treatment results. Azithromycin has distinctive pharmacokinetic advantages over other macrolides. Excellent bioavailability and long half life in tissues enables simple dosage regimens such as once a day for 3 days or even as a single dose. Because azithromycin is active against Chlamydia trachomatis and Ureaplasma urealyticum, the greatest advantage of the azithromycin single dose regimen would be the treatment of the nongonorrheic urethritis syndrome. However, much more experience is needed for the use of azithromycin in the treatment of syphilis, chlamydial infections in pregnancy, gonorrhea and bacterial STDs in HIV-coinfected patients as the first choice agent in the treatment of bacterial STD syndrome.