An overview of sexually transmitted diseases. Part III ... - Dermatology

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424 Czelusta, Yen-Moore, and Tyring J AM ACAD DERMATOL SEPTEMBER 2000 reinfected from other untreated personal contacts or from improper cleaning of bedding and clothing. The CDC recommendation for HIV-infected patients with crusted or papular scabies is for “consultation with an expert.” 1 Five percent permethrin cream is the best topical agent currently available for treatment of crusted or papular scabies. 300 Although topical lindane preparations have been used frequently in published reports, this medicine has the potential for serious neurotoxicity. In crusted scabies, deep fissures often enhance the systemic absorption of lindane resulting in potentially high serum concentrations of the neurotoxin. Furthermore, many HIVpositive patients have AIDS-related neurologic changes, which may predispose them to any neurotoxic effects. At least one death in an HIV-infected patient with scabies has been attributed to lindane. 290 For these reasons, permethrin is the preferred treatment in HIV-positive patients. 300 Taplin and Meinking, 300 among others, have recommended ivermectin as an oral alternative to topical therapies for the treatment of scabies. Several studies 302-305 document the safety and efficacy of ivermectin in the treatment of scabies, including one such study that evaluated the medicine’s effects on HIV-positive patients who were taking multiple medications including antiretrovirals and antifungals. 305 However, no reports have directly compared the efficacy of ivermectin with the currently recommended regimens (permethrin or lindane), and it is not yet approved by the FDA for this purpose. In the treatment of crusted scabies, it is also clear that patients benefit from keratolytic agents (eg, 6% salicylic acid) or, if possible, manual debridement. This serves to decrease the patient’s mite load and to facilitate the penetration of topical medications. Some researchers support combined topical permethrin, keratolytics, and oral ivermectin as a potential regimen in the management of these patients. 298,300 It is believed that the combination of topical therapy and oral therapy maximizes the penetration of antiscabietic medications into the crusts. Therapy for the infestation in crusted or papular scabies needs to be persistent because the high mite burdens in these patients are difficult to eradicate. Special attention should be paid to the head and neck as well as underneath the fingernail. Skin scrapings should be collected often, and treatment continued until repeated scrapings yield no mites. Permethrin treatments may be needed 2 to 3 times per week for up to 6 weeks to eradicate the menace. A unique complication that accompanies crusted scabies is bacteremia. This is seen when the patients have severe fissuring associated with their crusts and has led to the patients’ death on several occasions. Streptococcal, 268 staphylococcal, 271 and Pseudomonas spp 274,284 have caused bacteremia in patients with crusted scabies, and antibiotic prophylaxis appropriate to the bacterial flora profile of the hospital is highly recommended in these cases to avoid this complication. 283,288,299,300 Pediculosis pubis Very little has been written about the effect that HIV infection has on infestation with Phthirus pubis. It appears that the ectoparasite behaves the same clinically regardless of HIV serostatus. The CDC recommends the same treatment for HIV-positive patients with pediculosis pubis as it does HIV-negative patients. 1 Permethrin 1% cream rinse applied for 10 minutes, lindane 1% shampoo applied for 4 minutes, or pyrethrins with piperonyl butoxide applied for 10 minutes are all appropriate therapies when accompanied by appropriate decontamination of bedding and clothing. Pediculosis of the eyes should be treated with an occlusive ophthalmic ointment twice daily for 10 days. In summary, STDs may enhance both the acquisition and the transmission of HIV. This relationship is especially true of STDs causing genital ulcers. STDs in HIV-seropositive persons may differ qualitatively or quantitatively, or both, in both clinical and laboratory parameters from STDs in immuncompetent persons. Such measures as education, which may lead to early recognition of the signs and symptoms of STDs, have the potential to positively affect the HIV epidemic. Therefore enhanced efforts should be devoted to the prevention and treatment of STDs. REFERENCES 1. Centers for Disease Control and Prevention. 1998 Guidelines for the treatment of sexually transmitted diseases. MMWR 1998;47(RR-1):1-116. 2. Centers for Disease Control and Prevention. HIV prevention through early detection and treatment of other sexually transmitted diseases—United States. MMWR 1998;47(RR- 12):1-24. 3. Wasserheit JN. Epidemiological synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis 1992;29:61-77. 4. Greenblatt RM, Lukehart SA, Plummer FA, Quinn TC, Critchlow CW, Ashley RL, et al. Genital ulceration as a risk factor for human immunodeficiency virus infection. AIDS 1988;2:47-50. 5. Kreiss JK, Koech D, Plummer FA, Holmes KK, Lightfoote M, Piot P, et al. AIDS virus infection in Nairobi prostitutes. N Engl J Med 1986;314:414-8. 6. 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J AM ACAD DERMATOL VOLUME 43, NUMBER 3 8. Plummer FA, Simonsen JN, Cameron DW, Ndinya-Achola JO, Kreiss JK, Gakinya MN, et al. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis 1991;163:233-9. 9. Telzak EE, Chaisson MA, Bevier PJ, Stoneburner RL, Castro KG, Jaffe HN. HIV-1 seroconversion in patients with and without genital ulcer disease. Ann Intern Med 1993;119:1181-6. 10. Grosskurth H, Mosha F, Todd J, Mwijarubi E, Klokke A, Senkoro K, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomized controlled trial. Lancet 1995;346:530-6. 11. Plummer FA, Wainberg MA, Plourde P, Jessamine P, D’Costa LJ, Wamola IA, et al. Detection of human immunodeficiency virus type 1 (HIV-1) in genital ulcer exudate of HIV-1-infected men by culture and gene amplification. J Infect Dis 1990;161:810-1. 12. Kreiss JK, Coombs R, Plummer F, Holmes KK, Nikora B, Cameron W, et al. 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Haemophilus ducreyi elicits a cutaneous infiltrate of CD4 cells during experimental human infection. J Infect Dis 1996;173: 394-402. 19. Hook ED, Cannon RD, Nahmias AJ, Lee FF, Campbell CH, Glasser D, et al. Herpes simplex virus infection as a risk factor for human immunodeficiency virus infection in heterosexuals. J Infect Dis 1992;165:251-5. 20. Boulos R, Ruff AJ, Nahmias A, Holt E, Harrison L, Magder L, et al. Herpes simplex virus type 2 infection, syphilis, and hepatitis B virus infection in Haitian women with human immunodeficiency virus type 1 and human T lymphotrophic virus type 1 infections. J Infect Dis 1992;166:418-512. 21. Stamm W, Handsfield H, Rompalo A, Ashley R, Roberts P, Corey L. The association between genital ulcer disease and acquisition of HIV infection in homosexual men. JAMA 1988;260: 1429-33. 22. Holmberg SD, Stewart JA, Gerber AR, Byers RH, Lee FK, O’Malley PM, et al. Prior herpes simplex virus type 2 infection as a risk factor for HIV infection. JAMA 1988;259:1048-50. 23. Keet IP, Lee FK, van Griensven GJ, Lange JM, Nahmias A, Coutinho RA. HSV type-2 and other genital ulceration infections as a risk factor for HIV-1 acquisition. Genitourin Med 1990;66:330-3. 24. Gadkari DA, Quinn TC, Gangakhedkar RR, Mehendale SM, Divekar AD, Risbud AR, et al. HIV-1 DNA shedding in genital ulcers and its associated risk factors in Pune, India. J Acquir Immune Defic Syndr Hum Retrovirol 1998;18:277-81. 25. Quinn TC, Cannon RO, Glasser D, Groseclose SL, Brathwaite WS, Fauci AS, et al. The association of syphilis with risk of human immunodeficiency virus infection in patients attending sexually transmitted diseases clinics. Arch Intern Med 1990;150: 1297-302. Czelusta, Yen-Moore, and Tyring 425 26. Quinn TC, Glasser D, Cannon RO, Matuszak DL, Dunning RW, Kline RL, et al. Human immunodeficiency virus infection among patients attending clinics for sexually transmitted diseases. N Engl J Med 1988;318:197-203. 27. Mertz KJ, Weiss JB, Webb RM, Levine WC, Lewis JS, Orle KA, et al. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis 1998;178:1060-6. 28. O’Farrell N, Windsor I, Becker P. HIV infection among heterosexual attenders at a sexually transmitted diseases clinic in Durban. S Afr Med J 1991;80:17-20. 29. O’Farrell N. Global eradication of donovanosis: an opportunity for limiting the spread of HIV-1 infection. Genitourin Med 1995;71:27-31. 30. Kinghorn GR. Genital herpes: natural history and treatment of acute episodes. J Med Virol 1993;Suppl 1:33-8. 31. Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, et al. Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 1981;305:1439-44. 32. Schomogyi M, Wald A, Corey L. Herpes simplex virus-2 infection: an emerging disease? Infect Dis Clin North Am 1998;12: 47-61. 33. Quinnan G, Masur H, Rook AH, Armstrong G, Fredrick WR, Epstein J, et al. Herpesvirus infections in the acquired immunodeficiency syndrome. JAMA 1984;252:72-7. 34. Maier J, Bergman A, Ross M. Acquired immunodeficiency syndrome manifested by chronic primary genital herpes. Am J Obstet Gynecol 1986;155:756-8. 35. Skinhoj P. Herpesvirus infections in the immunocompromised patient. Scand J Infect Dis 1985;47(Suppl):121-7. 36. Bagdades E, Pillay D, Squire S, O’Neil C, Johnson MA, Griffiths PD. Relationship between herpes simplex virus ulceration and CD4+ cell counts in patients with HIV infection. AIDS 1992; 6:1317-20. 37. Augenbraun M, Feldman J, Chirgwin K, Zenilman J, Clarke L, DeHovitz J, et al. Increased genital shedding of herpes simplex virus type 2 in HIV-seropositive women. Ann Intern Med 1995; 123:845-7. 38. Centers for Disease Control. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41(RR- 17):1-19. 39. Tayal SC, Pattman RS, McLelland J, Sviland L, Snow MH. An indolent penile herpetic ulcer in a patient with previously undiagnosed human immunodeficiency virus infection. Br J Dermatol 1998;138:334-6. 40. Horner P, Harris J. A herpes simplex skin ulcer in a patient with AIDS: an unusual presentation. Int J STD AIDS 1990;1:288-9. 41. Gretzula J, Penneys N. Complex viral and fungal skin lesions of patients with acquired immunodeficiency syndrome. J Am Acad Dermatol 1987;16:1151-4. 42. Smith K, Skelton H, Frissman D, Angritt P.Verrucous lesions secondary to DNA viruses in patients infected with the human immunodeficiency virus in association with increased factor XIIIa–positive dermal dendritic cells. J Am Acad Dermatol 1992;27:943-50. 43. Tong P, Mutasim D. Herpes simplex virus infection masquerading as condyloma acuminata in a patient with HIV disease. Br J Dermatol 1996;134:797-800. 44. Smith K, Skelton H, James W, Angritt P. Concurrent epidermal involvement of cytomegalovirus and herpes simplex virus in two HIV-infected patients. J Am Acad Dermatol 1991;25:500-6. 45. Husak R, Tebbe B, Goerdt S, Wolfer LU, Zeichardt H, Stoffler- Meilicke M, et al. Pseudotumor of the tongue caused by her-
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