Clinics in dermatology最新文献

Chancroid, caused by Haemophilus ducreyi, is a sexually transmitted genital ulcerative condition associated with inguinal bubo formation. The relative prevalence of chancroid has dramatically declined based on surveillance findings in those few endemic settings where the appropriate diagnostic tools exist; however, laboratory-based diagnostics are lacking to assist clinical management and support etiological surveillance in most parts of the world. Recent yaws surveys within the Western Pacific region indicate that H. ducreyi has re-emerged as a frequent cause of chronic skin ulceration. Although there have been no antimicrobial susceptibility studies for three decades, it is assumed that a cure remains possible with extended-spectrum cephalosporins, macrolides, or fluoroquinolones. HIV-1-infected patients require careful follow-up due to reports of treatment failure with single dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.

As the dermatology residency match has become increasingly competitive, dermatology applicants are more prolific in their research achievements, including numerous poster presentations, abstracts, and manuscripts. Notably, students often feel compelled to attend as many conferences as possible to showcase their scholarly work and demonstrate their interest in the specialty. Compared with other research deliverables, conference attendance also offers the valuable benefit of networking opportunities. Attending conferences can impose a significant financial burden on students; the cumulative cost of accommodations, registration, and travel for multiple meetings can quickly become burdensome. The ethical considerations of this financial commitment and its implications on the dermatology applicant pool must be recognized as a consequence of the competitive residency application process.

Lymphogranuloma venereum (LGV) is a serious, invasive, ulcerative sexually transmitted infection caused by Chlamydia trachomatis serovar L1, L2, and L3. Until 2003, we saw LGV among the general population of low- and middle-income countries. Since 2003, we have also seen LGV in high-income countries but exclusively in men who have sex with men. The number of patients with LGV has increased in the last decade, and the proportion in men who have sex with men without HIV has increased dramatically. In low- and middle-income countries, LGV affects women and men and often causes genital complaints. In the men who have sex with men in the population in high-income countries, the vast majority of men suffer from anorectal infections that mimic chronic inflammatory bowel diseases like Crohn disease. LGV is not always directly recognized, because the presentations are often nonspecific and additional diagnostics are not distinctive. When sexually transmitted infections are not considered in the diagnostic work-up, consequent delay and inappropriate treatments can occur. In patients with anorectal complaints, a properly conducted sexual history followed by a sexually transmitted infection diagnostics is key to diagnose LGV. Early recognition and adequate antibiotic treatment can prevent complications and unnecessary additional diagnostic procedure, halting further transmission.

The Accreditation Council of Graduate Medical Education (ACGME) requires ethics education for dermatology trainees; yet, less than half of American dermatology residencies currently include ethics in their curriculum. ^{1, 2} Barriers to establishing ethics curricula in dermatology residences include time restraints, lack of useful resources, and lack of faculty with expertise in dermatoethics.² We suggest a hybrid education model, involving a mix of virtual, lecture-based, and case-based didactics to incorporate ethics education longitudinally in dermatology residencies. Subject matter should align with the American Academy of Dermatology subcommittee's six domains of ethics education.

Neisseria gonorrhoeae, a Gram-negative intracellular pathogen, causes gonorrhea. While usually sexually transmissible, it can be acquired by direct inoculation. Untreated gonococcal infections have deleterious impacts, including adverse pregnancy outcomes, ectopic pregnancy, infertility, and even blindness. Extended-spectrum cephalosporins remain the mainstay of therapy, and gonococcal culture is essential to determine susceptibility to these agents. Antimicrobial resistance is a global public health concern, and few new agents are in the pipeline. Gonorrhea control programs rely on health education, access to diagnostic testing (where possible), effective therapy, and partner notification. Introducing inexpensive, sensitive, and specific point-of-care tests will aid antimicrobial stewardship efforts in countries utilizing the syndromic management approach. Targeted vaccination of higher-risk populations with cross-protective outer membrane vesicle-based meningococcal B-vaccines could reduce N. gonorrhoeae transmission in the future. Doxycycline post-exposure prophylaxis may further reduce gonococcal incidence in the short term; however, its long-term impact on the human resistome/microbiome remains unknown.

Dr Heinrich Lahmann was a German physician and health reformer who was especially active in Dresden and the surrounding area during the first half of the 20th century. He was born on December 11, 1860, in Bremen and died in Dresden in 1941. Lahmann was especially well-known for his efforts to improve general health care, promote naturopathy, and his role as a sanatorium director. His work and the institutions he established had a far-reaching impact on the medical landscape of his time. His sanatorium attracted patients from Europe and beyond, where he also tried to apply his therapeutic approach to sexually transmitted diseases and chronic dermatitis.

Chlamydia trachomatis and Mycoplasma genitalium share many similarities, but as much differentiates these two organisms as unites them. These common sexually transmitted bacteria are strongly associated with several acute syndromes in the genito-urinary tract. Although the long-term severe sequelae of Chlamydia trachomatis are well accepted, the data underpinning the complications of Mycoplasma genitalium are less specific and largely observational. Efforts to control Chlamydia trachomatis with comprehensive, large-scale testing programs have yielded limited results, and the control paradigm will shift in the coming years. As diagnostic capabilities for detecting Mycoplasma genitalium have improved, this organism is more widely diagnosed, and the emergence of complex antimicrobial resistance has complicated therapy options. This contribution describes the two organisms' epidemiology, clinical manifestations, and management, and explores new approaches to their control and prevention.

Donovanosis usually causes genital ulcers with a distinct clinical appearance. The condition has been a problem in many developing countries, but recent years have seen a significant global decline in prevalence. It is well on the way to being eradicated. Donovanosis has been known under many different terminologies, and there is still debate about how the causative organism should be classified. Recent news agency and social media reports of an increase in the "flesh-eating infection donovanosis" have been false and unhelpful, only leading to hyperbole and increased stigma among those infected. Donovanosis is a progressive, mildly infectious bacterial infection usually involving the genital area. The causative organism is a gram-negative bacillus, Calymmatobacterium granulomatis. A proposal that the organism be reclassified as Klebsiella granulomatis comb nov was put forward in 1999; however, a consensus is yet to be reached about the definitive nomenclature of the causative agent.¹.

Mpox, a zoonotic orthopoxvirus, originally identified in 1958, exhibits two distinct genetic strains or clades, clades 1 and 2. Before 2022, mpox was predominantly isolated in the endemic regions of West and Central Africa. Sporadic outbreaks of travel-associated clade 2 mpox had previously occurred in nonendemic areas, but persistent human-to-human transmission within nonendemic regions had not been documented until recently.

Herpes simplex virus (HSV) is the most common cause of anogenital ulceration worldwide. There are two distinct viruses: HSV-1 associated with oro-labial cold sores and genital infection and HSV-2 associated with genital infection. Infection is lifelong, and typically presents with painful anogenital ulceration, which may recur after periods of latency. Asymptomatic shedding is common and may lead to transmission to sexual partners. Antiviral suppression with aciclovir, valaciclovir, or famciclovir is useful to treat initial painful episodes or troublesome recurrent infection. Suppressive antiviral therapy, condoms, selective abstinence, and disclosure to sexual partners have all been demonstrated to reduce the risk of transmission.