ABSTRACT
The purpose of this report is to describe the first case of occupational exposure to syphilis. This accident occurred during curettage of a venous ulcer in a 68-year-old woman in Martinique Island. The patient presented primary syphilis without HIV. This case points out the need for enhanced syphilis screening in epidemic areas.
Subject(s)
Curettage , Nurses , Occupational Exposure/prevention & control , Varicose Ulcer/surgery , Aged , Anti-Bacterial Agents/therapeutic use , Female , Humans , Martinique , Operating Rooms , Penicillin G Benzathine/therapeutic use , Syphilis/complications , Syphilis/diagnosis , Syphilis/drug therapy , Treatment Outcome , Varicose Ulcer/complicationsSubject(s)
Trichomonas Infections/diagnosis , Trichomonas Infections/drug therapy , Female , Humans , MaleABSTRACT
BACKGROUND: The outcome for patients with dermatitis artefacta is not well known. The primary objective of this single-centre retrospective study was to describe the initial clinical aspects and the prognosis of the disease. The secondary objective was to describe the somatic and psychological management and long-term treatment of these patients. PATIENTS AND METHODS: Records of patients with dermatitis artefacta followed in the dermatology department over the 15 last years were reviewed independently by 2 dermatologists. Diagnostic criteria consisted of evocative clinical pictures and the exclusion of other forms of dermatosis. Data collection included: file analysis, photographs, review questionnaires sent to general practitioner or completed during a phone call to patients (follow-up data). RESULTS: Thirty-one patient files were selected: 23 women and 8 men, mean age 31 years (SD = 14.8). Clinical aspects included: erythema (50%), ulceration (37%), crust (23%) and blisters (17%). The main sites were the face (67%) and arms (43%). Topical treatment was prescribed in all cases and systemic treatment was prescribed in 23% of cases. Psychological support was offered to 65% of the patients and was accepted by 50%. A follow-up study was performed for 17 patients and showed serious complications in 4 cases consisting of psychosis (n=2) and/or severe self-mutilation (n=3) occurring over several years following diagnosis (5 years for one patient and 12 years for 2 patients). DISCUSSION: The results confirm the usual and characteristics of dermatitis artefacta such as predominance in young female patients, with lesions affecting visible areas (face, upper legs). In contrastwith published studies, no cases of attempted suicide were observed in our series, although severe dermatitis artefacta was evidenced in only a minority of patients.
Subject(s)
Dermatitis/psychology , Factitious Disorders/diagnosis , Adult , Dermatitis/therapy , Factitious Disorders/psychology , Factitious Disorders/therapy , Female , Humans , Male , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Retrospective Studies , Self Mutilation/diagnosis , Self Mutilation/psychologySubject(s)
Cysticercosis/diagnosis , Skin Diseases, Parasitic/diagnosis , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: The aim of this study was to assess the prevalence of sexually transmitted infections among patients attending an anonymous HIV Screening Center. PATIENTS AND METHODS: This prospective study was performed in the HIV Screening Center of University hospital in Reims (France) from May 1997 to December 1997. The inclusion criteria were the asymptomatic clinical presentation and the presence of risk factors for sexually transmitted infections referring to WHO criteria. The methods included clinical examination after application of acetic acid and urethral and endocervical swabs to identify:Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Trichomonas vaginalis in specific culture. Treponema pallidum and HIV-1 infection were both detected by Enzym Linked Immuno Sorbent Assay (ELISA). RESULTS: One hundred and one patients (62 men and 39 women) were included in the study. Their mean age was 27 +/- 4 Years. Risk factors for sexually transmitted infections were: multiple sexual partners 81 p. 100; homo or bisexuality 16 p. 100; intravenous drug use 3 p. 100. The sexually transmitted infections were: HIV-1 infection 1 p. 100;Ureaplasma urealyticum 25 p. 100; genital warts 5 p. 100;Chlamydia trachomatis 3 p. 100; Gardnerella vaginalis 3 p. 100; Mycoplasma hominis 2 p. 100; Treponema pallidum 0 p. 100; Neisseria gonorrhoeae 0 p. 100; Trichomonas vaginalis 0 p. 100. The prevalence of sexually transmitted infections was significantly higher among women (p<0.05). DISCUSSION: Classical sexually transmitted infections and HIV infection were rarely detected in this study; but prevalence of other sexually transmitted infections (genital warts, Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum) was high. Ureaplasma urealyticum is considered as a possible pathogenic agent in pregnant women (preterm delivery, decrease of birth weight, chorioamniotitis). These results suggest that other than sexually transmitted infections in high risk patients attending a HIV Screening Center other sexually transmitted infections should also be systematically screened for.
Subject(s)
HIV Infections/complications , Sexually Transmitted Diseases/epidemiology , Adult , Epidemiologic Studies , Female , France/epidemiology , Humans , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Prevalence , Prospective Studies , Risk Factors , Sex Factors , Substance Abuse, IntravenousABSTRACT
INTRODUCTION: The anonymous and free AIDS screening centers were developed in France in 1987 to incite the general population to undergo screening for HIV infection. The aim of this paper was to conduct a prospective study describing the principle characteristics and level of risk of those consulting a center in the Year 1999. POPULATION AND METHODS: A face to face physician-consultant questionnaire was proposed to all the consultants that Year. It included 20 questions regrouped in general characteristics of the subject, number of previous screenings, reason for screening, type of risk taken, date of last risk taken, and number of sexual partners during the past 12 Months and throughout their life without the use of a condom. RESULTS: Two thousand six hundred seventy-eight persons consulted (sex ratio=1) aged a mean of 25.8 Years. The men were older than the women (respectively 27 versus 24.6; p<0.05). The reason for screening was a decision made by the couple in 44.6 p. 100, an unprotected sexual relationship in 47.6 p. 100 another reason in 7.6 p. 100 and drug abuse in 0.2 p. 100 of cases. The sex mode declared was heterosexual in 94.5 p. 100 and homo or bisexual in 5.4 p. 100. The majority of those consulting (66.2 p. 100) had had between 0 and 2 partners during the past 12 Months; 66 p. 100 had had more than 10 during their life without using a condom. The assessment of the global risk by the physician was: very high in 1 p. 100, high in 2.5 p. 100, moderate in 13.3 p. 100, low in 70.7 p. 100 and nil in 12.5 p. cent. Five HIV infections were diagnosed, all in persons at high or very high risk. DISCUSSION: These results should stimulate the radical differentiation of the management of persons consulting according to the level of risk identified by the medical questionnaire.
