Please Sign In or Create an account
WHODUNIT: framed, guilty or an accessory after the act?

WHODUNIT: framed, guilty or an accessory after the act?

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.

Speakers: Vinita Rane
Areas of Interest / Categories: AIDS 2014

AIDS 2014

Immune Control of the HIV reservoirs

Prevalence of Sexually Transmitted Infections (STIs) and patient characteristics of older men over 60 years of age attending a public STD clinic in South Australia

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 to improve sexual health service delivery in primary health care services: Successes, challenges and lessons learnt

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.

High prevalence, incidence and clearance of anal high-grade squamous intraepithelial lesions (HSIL) in homosexual men: early evidence from the Study of the Prevention of Anal Cancer (SPANC)

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.

Online banner advertising: not the preferred medium for promoting a publicly funded sexual health clinic targeting men who have sex with men

Based on evidence of the success of utilising online campaigns to access MSM, RPA Sexual Health, a publically funded sexual health service (PFSHS) in the inner-west of Sydney, trialled two clinic advertising campaigns over a three year period. Both campaigns were developed with community consultation, targeting MSM and were predominantly online. They were evaluated and compared to measure their success and the effectiveness of advertising a PFSHS online.

The conscience clause in relation to termination of pregnancy service

Background: Medical termination of pregnancy (MTOP) has been available and successfully used as an option for women internationally since 1988. The regimen for MTOP results in abortion in 99% of cases. Since Mifepristone’s recent availability in Australia, Marie Stopes International has performed more than 10,000 MTOP procedures in Australia since 2009. In Victoria, the Law Reform Commission removed pregnancy termination (“abortion”) from the criminal statutes in August 2008, which provided women and health care professionals with protection from criminal prosecution for their legal involvement in termination of pregnancy (TOP).

HIV and syphilis co-infections and re-infections: trends from Victoria

Since 2009, the Victorian syphilis enhanced surveillance system has been collecting HIV status and syphilis re-infection status for infectious syphilis cases. Baseline data from 2009 showed that 31% of the infectious syphilis cases were HIV positive and 18% reported were re-infections. This suggested that syphilis transmission among a pool of HIV positive MSM was making a considerable contribution to the syphilis epidemic in Victoria. We analysed the data from 2009 to 2012 to determine whether this pattern of transmission is continuing. Notification data for infectious syphilis between 2009 and 2012 were reviewed by HIV infection status, syphilis re-infection status and risk factor exposures.