HIV infection and genital ulcer disease

Between December 1990 and July 1991, 17 male HIV patients between the ages of 21 and 47 years in an Indian hospital were identified and information was obtained on their history, age, source of infection, hospitalization, places and sources of sexual contact, and extramarital sexual contacts. Each patient with a sexually transmitted disease (STD) underwent HIV testing too using ELISA whose results were subsequently confirmed by Western Blot. 15 of the 17 patients also had an associated genital ulcer disease (GUD), which was a significant relationship. 12 had asymptomatic generalized lymphadenopathy and 5 were afflicted with persistent generalized lymphadenopathy. Of the 17 patients, 9 had chancroid, 2 had an early phase of syphilis, 3 had lymphogranuloma venereum, 1 each had candidal balanitis, condylomata acuminata, and acute gonorrhea. Eight patients contracted the HIV infection in Bombay. 14 patients had contracted the disease from prostitutes. Homosexual contacts were denied by all. 13 patients admitted a single instance of extramarital sexual contact. In a study of 123 HIV seronegative prostitutes monitored regularly, HIV seroconversion was significantly associated with GUD. There is convincing evidence that GUD increases the risk of acquiring HIV infection because the breach of mucosal integrity of the genitalia provides a more efficient route for viral entry. Other risk factors documented for sexual transmission of HIV in addition to STDs are: lack of male circumcision, receptive anorectal sexual intercourse, lack of condom use, and advanced HIV-related immunosuppression in the index case. Since GUD predisposes to HIV infection, it is imperative to treat genital ulcer and to increase sex education regarding HIV.     

Oral manifestations of HIV infection

Oral lesions are frequently seen in association with all stages of infection with the human immunodeficiency virus (HIV). Many of these lesions occur as the first clinical sign of HIV infection. These lesions include candidiasis, hairy leukoplakia, warts, ulcers, and an aggressive form of periodontal disease. Careful oral examination may reveal lesions that alter Centers for Disease Control staging.     

Cutaneous manifestations of HIV infection

A total of 32 patients with HIV infection were examined for cutaneous manifestations from September 1994 to December 1995 in the Dermatology and Venereology Department of Wenlock District Hospital, Mangalore. Xerosis was the commonest skin manifestation (50%). Oropharyngeal candidiasis was an indicator of grave prognosis in 4 patients. Seborrhoeic dermatitis, seen is in 15.6%, presented in an atypical, extensive and rapidly evolving form. Infections were atypical, extensive and did not respond to conventional modalities of treatment.     

Cutaneous manifestations of HIV infection

The HIV-infection represents simultaneously a new and important problem. Multiple changes appear on skin and mucous membranes in all stages of the infection. These changes have an essential diagnostic significance especially in the early phase of the infection. The most important changes become represented systematically in relation to the progress of the disease.     

The cutaneous manifestations of HIV infection

Dermatologic disease is extremely common and varied in HIV-infected patients. While some cutaneous findings are nearly exclusive to HIV-seropositive individuals, many are found in the general population. However, HIV-infected individuals often have an increased prevalence or severity, atypical presentations, or difficulty with treatment of the disease. Immune reconstitution with HAART significantly reduces the prevalence of many dermatologic diseases, but also has associated cutaneous side effects. Correct and early diagnosis of skin disease in HIV-infected individuals allows for early management and improved quality of life. Because dermatologic manifestations may be the first clue of HIV infection, offering HIV testing to affected individuals can lead to early diagnosis and treatment of HIV infection and, ideally, a decrease in disease progression and transmission.     

Mucous membrane manifestations in HIV infection

We report the occurrence of mucous membrane manifestations in six patients with HIV-infections: Kaposi sarcomas of the hard palate, of the gingiva, of the larynx and of the glans penis, unusual spreading of condylomata acuminata, bowenoid papulosis, thrush and hairy leukoplakia.     

Cutaneous manifestations of HIV infection in children

The vast majority of children with infection with the human immunodeficiency virus (HIV) develop some form of mucocutaneous disease during the course of their illness. Candidal, fungal, bacterial, and viral infections of the skin and mucous membranes tend to be more severe and less responsive to therapy than in the healthy child. Children with HIV infection are also at risk for drug eruptions, seborrheic dermatitis, and several other inflammatory disorders of the skin. An understanding of the cutaneous manifestations of HIV infection may aid in the early diagnosis and appropriate treatment of this disease.     

Skin manifestations in patients with HIV infection

Cutaneous manifestations are common in patients with HIV infection and mainly due to the immunodeficiency. In the initial stage of HIV infection, we frequently observe a rash of macular lesions. During the asymptomatic phase, the patients may typically show the following skin diseases: seborrhoic dermatitis, acneiform folliculitis, persistent herpes simplex, and infections with the human papilloma virus. In ARC and AIDS patients, 3 groups of skin disorders are found: cutaneous infections, skin tumors, and other mixed skin diseases. Herpes simplex and herpes zoster may develop into ulcerating and necrotising forms especially in patients with advanced immunodeficiency. The most frequent skin tumors in AIDS patients are the disseminated Kaposi's sarcoma and non-Hodgkin's lymphoma. More than 50% of the AIDS patients treated with trimethoprim/sulfamethoxazole developed a severe drug eruption. African and Caribbean patients with AIDS frequently suffer from pruritic skin lesions, the pathogenesis of which is not known. Aside from these cutaneous manifestations, a variety of other skin disorders have been reported in patients with HIV infection, ARC, or AIDS; future research will furnish definite proof whether they are correlated with HIV infection.     

误诊为坏疽性脓皮病的HIV感染合并生殖器疱疹一例

患者男,25岁。肛周、阴囊、腹股沟、大腿溃疡伴触痛2月余。2月余前患者肛周出现红斑,略痛,红斑迅速破溃形成溃疡面,表面可见白色分泌物和渗液。病程中无发热、体重减轻、腹泻等系统症状……     

以生殖器溃疡为特征的性病患者临床和病原学检查

目的 了解以生殖器溃疡为特征的性传播疾病的病种构成及病例的临床特征。方法 按统一标准在南京、大连、深圳性病专科门诊部收集有生殖器溃疡的初诊病例作临床和实验室诊断,统计各病所占比例及临床特征。结果 在有生殖器溃疡的380例性病患者中,检出梅毒患者153例,占40.26%,生殖器疱疹患者167例,占43.95%,未发现软下疳和性病性淋巴肉芽肿患者。溃疡发生的部位在男性以冠状沟为多,占48.67%,女性以大阴唇为多,占50.70%。结论 我国以生殖器溃疡为特征的性病患者以梅毒和生殖器疱疹为主,未发现经实验室确诊的软下疳和性病性淋巴肉芽肿病例。     

Morphologic variants of genital ulcer caused by Haemophilus ducreyi

The typical clinical picture, common variants and frequent complications of chancroid are presented in cases proven by culture. In general, the conventional view of the clinical spectrum of chancroid is substantiated. Certain types such as "chancre mou volant," however, could not be found in the present material. Their existence or association with Haemophilus ducreyi remains speculative.     

Mucocutaneous manifestations of HIV infection in 91 children born to HIV-seropositive women

We examined 91 children under the age of 13 years with definite HIV infection born to HIV-seropositive women. The clinical spectrum of HIV infection in children younger than 13 years who are born to HIV-infected mothers was revised in 1994 into four clinical categories: category N (not symptomatic), category A (mildly symptomatic), category B (moderately symptomatic), and category C (severely symptomatic). Mucocutaneous manifestations were found in 47 (51.6%) of these children. The prevalence of mucocutaneous manifestations in categories A, B, and C were 4%, 62%, and 75%, respectively. The mucocutaneous manifestations in patients in categories B and C were significantly more common than in those category A (p < 0.001). The most common finding was oral candidiasis (36.3%). Drug rash, pruritic papular eruption, herpes zoster, cutaneous candidiasis, Penicillium marneffei infection, and herpes simplex virus stomatitis were found in 6.6%, 5.5%, 4. 4%, 3.4%, and 2. 2% of patients, respectively. All three patients who had disseminated P. marneffei infection were in category C.     

Cutaneous manifestations of infection by nontuberculous mycobacteria

Cutaneous infections by nontuberculous mycobacteria (NTM) are not usual but their relative importance has changed during the last few years and still further changes are expected. This study comprised 13 patients from whom NTM were recovered from skin biopsy specimens, sinus exudates or cutaneous abscesses. All samples were processed according to standard methods, and the isolates were identified by biochemical testing. Skin biopsy specimens, when available, were processed for histopathological study. The clinical records of the patients were reviewed, and the relevant clinical, microbiological and epidemiological data collected. The clinical manifestations were noted to be relatively nonspecific and consisted of draining sinuses, abscesses, ulcers and nodules with multicentric or sporotrichoid patterns. Tissue culture isolated Mycobacterium fortuitum complex in nine patients, M. avium in three, and M. marinum in one. In the nine patients studied by histopathology, various patterns were observed. These included dermo-hypodermal abscesses, suppurative granulomas, tuberculoid granulomas and granulomas with a perifollicular distribution. Cutaneous lesions can thus be the first and the only sign of NTM disease, and culture still remains the definitive diagnostic procedure.     

Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection

BACKGROUND AND OBJECTIVES: While genital ulcers are a risk factor in HIV infection, the association of specific agents of genital ulcer disease (GUD) with HIV infection may vary. GOAL: To determine the etiology of GUD in HIV-infected and HIV-uninfected men attending sexually transmitted disease (STD) clinics in Durban, Johannesburg, and Cape Town, South Africa, and the association of previous and current sexually transmitted infections with HIV infection in men with ulcerative and nonulcerative STDs. STUDY DESIGN: A cross-sectional study of 558 men with genital ulcers and 602 men with urethritis. RESULTS: Patients with GUD were more likely to be infected with HIV than patients with urethritis (39.4% versus 21.4%, P< or =0.001). Herpes simplex virus 2 (HSV-2) was the most common agent identified in ulcer specimens (35.9%), and was detected in a significantly higher proportion of ulcer specimens from HIV-infected patients than in specimens from HIV-uninfected patients (47.4% versus 28.2%, P< or =0.001). Patients infected with HIV-1 were significantly more likely to have HSV-2 infection, as measured by the presence of the antibody to glycoprotein G-2, than patients not infected with HIV (63.1% versus 38.5%, P< or =0.001). Patients infected with HIV-1 were also significantly more likely to have initial HSV-2 infection than HIV-uninfected patients with GUD (50.0% versus 31.6%, P = 0.007). Haemophilus ducreyi was detected in 31.7% of ulcer specimens; prevalence did not vary by HIV-infection status. Treponema pallidum DNA was detected significantly less frequently in ulcer specimens from patients infected with HIV than in specimens from patients not infected with HIV (10.2% versus 26%, P< or =0.001); no association was found between HIV-infection status and fluorescent treponemal antibody absorption test seroreactivity, even when men with M-PCR-positive syphilis lesions were excluded from the analyses. CONCLUSION: The authors found that HSV-2 is a more common etiology of GUD than has been suggested by previous studies conducted in South Africa; serologic evidence of HSV-2 infection and current cases of genital herpes are strongly associated with HIV infection among men who present to STD clinics with GUD or urethritis.