Oral manifestations of sexually transmitted infections.

It's difficult to establish the real risks associated with all forms of oral sex and the contribution they may make to the overall number of newly diagnosed cases of sexually transmitted infections (STIs). This article reviews the literature on the role of oral sex in the transmission of STIs and the corresponding clinical presentations. Oral sex is becoming a common sexual practice between both heterosexual and homosexual couples because it is seen as a safer alternative to penetrative sex and a safer challenge to an individual's hidden identity. Because of the frequency with which oral sex occurs, and the rarity with which it is protected, oral sex may raise justified alarming attention to underestimated orally acquired STIs.

Sexually transmitted diseases syndromic approach: proctitis.

Proctitis is a common problem and is most frequently associated with inflammatory bowel diseases (IBD). However, in the last ten years the incidence of infectious proctitis appears to be rising, especially in men who have sex with men. This may be due to the rise of people participating in receptive anal sex as well as the increase in sexually transmitted infections, such as those from Chlamydia trachomatis, Neisseria gonorrhoeae, Herpes simplex virus and Treponema pallidum. Recent outbreaks of lymphogranuloma venereum among homosexual men throughout Europe highlight the need to consider sexually transmitted infections in the differential diagnosis of proctitis. Symptoms of infectious proctitis can include rectal blood and mucous discharge, anorectal pain, aphtous ulcers and, sometimes, generalized lymphadenopathy and fever. A careful history and physical examination are crucial in establishing a diagnosis, eventually supported by endoscopy, histology, serology, culture and PCR. Treatment with antibiotics or antivirals is usually initiated, either empirically or after establishing a diagnosis. Coinfections, HIV testing, and treatment of sexual partners should always be considered.

Off label treatments of genital warts: the role of photodynamic therapy.

Conventional therapies for genital warts, the clinical expression of low-risk human papillomavirus (HPV) anogenital infection, are not targeted antiviral therapies, but either attempt physical removal of the lesion or induce inflammation and a bystander immune response. Moreover, very few of the current treatments have been tested by rigorous blinded, randomized controlled trials. Therefore, official recommendations are often associated with unsatisfactory response rates and high recurrence rates. It is the purpose of this review to provide a brief overview of the genital wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with this disease. Particular attention will be paid to unconventional and complementary therapies (the so called "off-label" treatments) among which photodynamic therapy has been recently introduced as a promising strategy to both guarantee clearance of the lesion and eradication of the virus itself. Mechanisms of action of PDT are discussed together with a summary of clinical and experimental available evidences.

Immunological activity of photodynamic therapy for genital warts.

BACKGROUND: An increasing body of evidence supports the usefulness of photodynamic therapy (PDT) in the treatment of non-neoplastic pathological conditions, including genital warts. In particular, PDT has demonstrated good clinical cure rates and low recurrence, and is now suggested as a safe alternative means of treating condylomata. OBJECTIVE: To confirm the suitability of aminolaevulinic acid (ALA)-PDT for the treatment of this condition and to investigate the recruitment and significance of immune cells in lesional areas by immunohistochemical analysis at different time intervals after treatment. METHODS: Fifteen subjects with histologically proven, recalcitrant condylomata acuminata of the penis, urethra, vulva or perianal area underwent several cycles of PDT following ALA application. Biopsies were taken at baseline and at different intervals during the trial, and infiltrating immune cells, CD3, CD4, CD8, CD1a and CD68, were evaluated by double immunocytochemical alkaline phosphatase antialkaline phosphatase (APAAP) staining. RESULTS: Our trial provided a complete cure rate of nine of 15 subjects after five PDT sessions. Perianal lesions showed a particularly rapid remission. While progressing towards total lesion clearance, the immunohistochemical pattern was dominated by dense CD4+ T lymphocytes infiltrating the superficial dermis, accompanied by an accumulation of Langerhans cells. Simultaneously, CD8 began to increase in the lesions of responding patients, and Langerhans cells seemed to migrate towards the dermis. CD68+ macrophages apparently did not participate in the immune inflammatory response. CONCLUSIONS: This study, to the best of our knowledge, represents the first attempt to clarify the effect of ALA-PDT on infiltrating immune cells in condylomata acuminata. Our results appear to confirm previously reported clinical data, suggesting that rapid activation of specific immunity in lesional skin, CD4+ T lymphocytes and dendritic cells could be responsible for healing.

Multicentre clinical trial with herpes simplex virus vaccine in recurrent herpes infection.

The aim of this work was to confirm our preliminary clinical and immunological evaluation of the protective effects of a herpes simplex virus (HSV) vaccine derived from killed virus in the treatment of relapsing facial or genital herpes simplex infection. A total of 142 patients were treated with the HSV vaccine and a control group of 50 were treated with intermittent oral acyclovir (ACV). The vaccine reduced annual active disease days in vaccinees to 11.59 (+/- 15.3) after treatment (65.11 +/- 31.64 before treatment) compared to 30.4 +/- 17.49 days after treatment of the control group patients (71.86 +/- 32.5 before treatment).

[A case of recurrent circinate erythematous psoriasis (Lapière)]. / Su di un caso di psoriasi eritematosa circinata recidivante (Lapière).

The Authors report a case of infantile recurrent circinate erythematous psoriasis, as described by Lapière, in a nine year old child. Particular features of the case are the relative rarity of the disease that shows a benign chronic recurrent course.

[Granulosis rubra nasi]. / Granulosis rubra nasi.

The Authors report a case of Granulosis Rubra Nasi, a rare early childhood dermatitis that was also defined as "Acne papulo-rosacea of the nose". The hyperhidrosis the most conspicuous features of the disease and small beads of sweat and erythema on the tip of the nose may often occur. Sometimes small red papules and comedo-like lesions may be present.