Description of the case: A 46 year-old man with long-standing HIV (human immunodeficiency virus), who was immunosuppressed with a CD4 count of 23/µL and a viral load of 81,000copies/mL, recently re-commenced on anti-retroviral therapy, presented with a single ulcer on the glans penis. The ulcer was initially painless but became painful as it progressed and was associated with inguinal lymphadenopathy.
He was previously known to have Herpes Simplex Virus Type 2(HSV2) affecting the perianal region, with frequent recurrences and associated superimposed bacterial infections that had previously required hospitalisation. Nucleic acid amplification technique (NAAT ) testing at the site was positive for HSV2 and T.pallidum. H.parainfluenzae, with reduced susceptibility to cefotaxime, was also isolated at the site. Serological testing was negative for T.pallidum. Testing did reveal vitamin B12 deficiency. Initial treatment with benzathine penicillin, valaciclovir and ciprofloxacin did not improve the ulcer after three weeks. He was referred to a tertiary centre with presumed acyclovir-resistant HSV2 for consideration of treatment with foscarnet.
Questions for Discussion: This case addresses the challenging problem of recurrent genital ulceration in an immunosuppressed individual, with multiple potential etiologies. It also raises the issue of the development of resistance to commonly used antimicrobials in those with a long history of immunosuppression and the management of resistant organisms.
Literature review: The literature review will examine common causes of genital ulceration in HIV, the sensitivity and specificity of NAAT-based testing and the management of acyclovir- resistant HSV.
Background: STI prevalence is changing. With society aging, life expectancy increasing and changes in sexual practices, STIs in senior citizens are of interest from economic, health related and social burden perspectives. Few studies on STIs in older men greater than 60 years of age exist, hence, a need to obtain further information about this subpopulation.
Conducting clinical audits in the context of continuous quality improvement (CQI) programs in Aboriginal Community Controlled Health Services (ACCHS) has provided valuable information regarding what factors facilitate or create challenges to improving outcomes in sexual health service delivery.
Homosexual men are at increased risk of anal cancer. Screening and treatment of the precursor, HSIL, has been advocated by some, but screening is not recommended in widely-accepted guidelines. We aimed to describe the prevalence, incidence, and clearance rates of anal HSIL, and association with human papillomavirus (HPV) status, in a community-recruited cohort of homosexual men.
HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.
We investigated the association between chlamydia detection and stage in the menstrual cycle to investigate whether chlamydia detection was higher at different stages of the cycle. Electronic medical records for women attending Melbourne Sexual Health Centre March 2011 - 31st December 2012, who were tested for chlamydia by nucleic acid amplification of high vaginal, cervical, or urinary samples, and who recorded a date of last normal menstrual period (LNMP) between 0-28 days were included in the analysis. Logistic regression was used to calculate OR (95%CI) for the association of chlamydia with menstrual cycle adjusted by demographics and behavioural variables.
Chlamydia is prevalent among young Australians. The latest national surveillance report (2011) shows a rate of diagnosis of 1400 per 100,000 population aged 15-29 years. In Victoria, the number of notifications in 2011 was 19,238; 81% in 15-29 year olds; however notifications continue to rise in all age groups. International evidence suggests chlamydia reinfection is responsible for a substantial burden of infections. Given the associated health risks, monitoring reinfection in the population is important to understand disease burden and evaluate interventions. We describe the rate of reinfection and time between infections in Victoria, 2004-2011.