Genital ulcer infections in the female patient and the vaginitides.

This article discusses genital ulcers caused by sexually transmitted diseases in female patients, and the etiology, morphology of the ulcerations, diagnostic work-up, and current treatment. The article also discusses patients with a vaginal discharge, laboratory work-up, diagnoses, and treatment.

Perianal Bowen's disease associated with anorectal warts: a case report.

The occurrence of anogenital warts has increased both in clinic and in private practice. Both sexes and all races are affected, with the highest prevalence in patients aged 15 to 40 years. The etiologic agent, the human papillomavirus (HPV), has been classified by DNA hybridization techniques into at least 42 types, of which types 16 and 18 are considered to carry a high risk for cancer. A patient who had been seen intermittently over a period of 26 years with perianal and anal warts that responded to treatment finally developed two granulomatous nodules morphologically different from the previous lesions. A biopsy confirmed that the nodules were typical of Bowen's disease, a precancerous lesion, and they were surgically excised. Thus, anogenital warts that fail to respond to conventional therapy or change in appearance warrant a biopsy and, where the technique is available, DNA typing to identify the viral pathogen.

Facts about gonorrhea and dentistry.

This article reviews gonorrhea and discusses various misconceptions that have appeared in the dental literature and in verbal presentations about gonorrhea and dentistry. Facts are presented and some conclusions are offered for the dental profession.

The diagnosis and treatment of chancroid.

Chancroid, a disappearing disease in the United States, was reintroduced into the country in 1980 by immigrants from the Caribbean, Mexico, and Southeast Asia. Point epidemics resulted, each of them associated with prostitution. During the 4-month period between March 1 to June 30, 1985, forty-five patients were diagnosed and treated in Massachusetts, thirty-seven from Boston alone. By means of these case records, the morphologic characteristics, laboratory diagnosis, and treatment regimens are described.

Prevalence of rubella antibodies in Massachusetts schoolchildren.

In 1982, 1,871 (79%) of 2,368 eligible 6th, 10th and 12th grade students in Massachusetts participated in a statewide serosurvey for rubella antibodies. Sera were screened at the Centers for Disease Control (CDC) by a reference hemagglutination inhibition assay at 1:8, equivalent to approximately 15 International Units (IU)/ml. Sera negative by the CDC hemagglutination inhibition assay were retested using an enzyme immunoassay, a passive hemagglutination assay, and a commercial hemagglutination inhibition test. The approximate screening levels were 10 IU/ml, 7.5 IU/ml, and 5 IU/ml, respectively. Overall seroprevalence levels varied from 76.4% screening at 15 IU to 93.1% including seropositives from any of the tests. Persons with a school record of vaccination had significantly higher seroprevalence levels than persons without records. However, only 78.3% of persons with a record had antibody greater than or equal to 15 IU compared with 60.0% without records; considering any detectable antibody, the comparison is 95.6% versus 71.4%. The low titers in vaccinees appeared to be due to a falloff of antibody with time since vaccination. Of students with a single vaccination noted in the record with exact dates, 92.3% who were vaccinated 0-4 years prior to the study had antibody at 15 IU compared with less than 78% of students with antibody who were vaccinated five or more years prior to the study. In contrast, using more sensitive assays, there was no significant decline in seroprevalence with time since vaccination. Revaccination studies and epidemiologic data suggest that almost all persons with detectable antibody whether above or below 15 IU/ml are immune to rubella. Thus, immunity levels in Massachusetts schoolchildren in the 6th, 10th, and 12th grades are probably in excess of 90%.

Treatment of primary and secondary syphilis: serologic response.

Eighty-eight patients with their first attack of primary syphilis and 101 patients with secondary syphilis were treated with penicillin G benzathine, 2.4 million units intramuscularly each week for 2 consecutive weeks, for a total of 4.8 million units. The serum of all patients with primary syphilis became negative within 1 year and of those in the secondary stage, within 2 years. This report confirms three previously published articles on the serologic response to treatment in a grand total of 588 patients with primary syphilis and 623 patients in the secondary stage.

Folliculitis of the buttocks and pinworms. A case report.

Folliculitis, both superficial and deep, has increased in frequency, particularly during the warm months of the year. The frictional trauma from tight-fitting jeans, with overhydration and maceration of the skin, has contributed to the increase. Folliculitis is usually accompanied by pruritus, but when pruritus precedes the folliculitis, there may be another cause in addition to the wearing of tight clothes. Such was the case in our patient who had anal pinworms (Enterobius vermicularis).

The management of warts of the oral cavity.

Heretofore most people affected by warts of the oral cavity were children, but during the past decade adults have become the most frequently seen patients with warts in the mouth. The popularity of fellatio among heterosexuals, teenagers, and adults has contributed to the spread of oral warts. Of epidemiologic interest is the observation that seldom are contacts of patients with oral warts found to have warts also. Seven cases are presented, and the methods of diagnosis and treatment are outlined.

Cutaneous gonococcal abscess: a case report.

A 29-year-old man was diagnosed as having a gonococcal abscess of the prepuce and urethritis. Such abscesses, caused by fetal monitoring during labor of a mother infected with Neisseria gonorrhoeae, have been observed on the scalp of newborns. If antibiotic treatment is to be effective, these abscesses must be excised and drained.

The stigmata of late congenital syphilis: an analysis of 100 patients.

Analysis of the stigmata of congenital syphilis in two study populations indicates that the imprints of the disease are the same, whether the patient population is of Caribbean or of North American origin. If the Columbian theory of origin of syphilis were correct, the longer syphilization of the West Indies might have tended to lessen the effects of the disease by attenuating Treponema pallidum. The presence of yaws and pinta in the West Indies may even have had an immunizing effect. The similar findings in the two population groups suggests that the events postulated by the Columbian theory did not take place.