Epidemiological and clinical characteristics of patients attending STI clinics in Tuscany, Italy: a multicenter report on new infections in 2011.

AIM: The aim of this study was to assess the demographic, behavioral and clinical features associated with newly diagnosed sexually transmitted infections (STIs) among attendees from four STI Clinics during 2011 in Tuscany, Central Italy. METHODS: Electronic and non-electronic medical records of attendees were reviewed to collect socio-demographical and anamnestic characteristics of patients, and to assess the annual incidence and distribution of STIs. RESULTS: The study included 1293 subjects, for a total number of 1394 newly diagnosed STIs. The male/female ratio was about 2:1, and Italian nationality accounted for 84.1% of the sample. MSM represented the 25.9% of the male population. Condom use was very poor in the large majority of our sample. Genital warts and non-gonococcal cervicitis and urethritis were the most frequent STIs. Anamnestic STIs were recorded in 350 subjects. When stratified for sexual preference, men who have sex with men were found at four to ten fold increased risk for syphilis, gonorrhoeae and HIV infection. New diagnoses of syphilis, gonorrhoea, urethritis and molluscum were strictly associated with infections by the same pathogens in the past (re-infections). CONCLUSIONS: Results show that STIs in Tuscany involve a mixed young to adult population, composed by both heterosexual and homosexual subjects who practice unprotected sex and do not seem to be conscious of the associated risks, as demonstrated by the high rates of coinfections and reinfections. These findings reinforce the need for greater education and prevention efforts for HIV and other STIs among the Tuscan population.

Social and behavioral determinants as risk of sexually transmitted diseases. Report by a sample from the Sexually Transmitted Disease Unit in Florence, Italy.

AIM: Sexually transmitted infections (STIs) are increasing worldwide, mostly due to changing sexual behavior s (larger numbers of sexual partners, concurrent relationships, increasing proportion of adolescents engaging in sexual intercourse at young age, and inconsistent condom use with new partners). In Italy, few data are available about STI spread, since most infections are not subjected to mandatory notification. METHODS: In this article, the occurrence of STIs in a random sample attending a STI Unit in Florence, Italy, is reported. Results were obtained through the administration of an anonymous questionnaire that patients could complete spontaneously in the waiting room while waiting for the visit. Self-reported questions allowed to collect information about socio-demographic and clinical data, sexual behavior and perception of risk. RESULTS: Overall, 469 patients (321 males, 148 females) participated in the study. Age ranged from 16 to 70 years. Male patients who referred to engage sexual intercourse with men (MSM) were 133; females who had sex with women (FSF) were 5, while 24 patients declared to have sex with both males and females (bisexual); 59.7% (N.=280) of participants reported they had a stable relationship, but 20% of these reported they had had sex with more than five partners during the last 12 months. The use of condoms is declared to be very infrequent, especially in the two extreme age ranges. Fifty percent of patients had been diagnosed an STI in their life, particularly syphilis (39.3%), genital warts (64.6%) and chlamydial infections (42.9%). Among those subjects who had contracted an STI (including non-curable viral infections, i.e., HIV and herpes genitalis) 32.4% referred they never used condoms. CONCLUSION: The authors discuss their results compared to the existing literature, and focus on identification of risk factors associated with self-reported STIs. Although conducted on a small population, this study provides a basis for targeting prevention and control strategies on our high-risk patients.

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.

Primary tuberculosis of the penis.

We present a case of primary tuberculosis of the inner lining of the prepuce in a 63-year-old man. The condition resembled carcinoma. The diagnosis was based on histopathology and on M. tuberculosis culture. Successful treatment was by a combined medical and surgical approach. The rarity of the case is emphasized.

[Sexually transmitted diseases in adolescents: clinico-epidemiologic findings]. / Le malattie a trasmissione sessuale negli adolescenti: rilievi clinico-epidemiologici.

Estimates of the global prevalence and incidence of sexually transmitted diseases in adolescents are limited. Recent prevalence estimates report over 333 million cases of the four major curable STDs in adults between the ages of 15 and 49: 12 million cases of syphilis, 62 of gonorrhoea, 89 of chlamydia, and 170 of trichomoniasis. The vast majority of these cases are in developing countries such as East Asia and Pacific, Sub-Saharan Africa, Latin American and Caribbean where syphilis and gonorrhoea still have a high prevalence. However, CT genital infection is the most commonly reported bacterial STD. In 1996 this infection had been the most common of the nationally notifiable infectious disease in the United States and was estimated that there were 2.5-3.3 million new cases per year. It resulted that African-American adolescents 14 to 19 years of age have the highest rates of STDs of any racial/ethnic group of adolescents. In addition, viral "non-curable" STDs have become a prominent public health issue over recent years due to a marked increase in prevalence of HSV and HPV infections. In the United Kingdom the annual number of genital herpes has almost tripled during the past 15 years. It is now evident that the high rate of HSV asymptomatic infection plays an important and complex role in estimating epidemiological data. To date, HPV genital infection probably represents the most frequent STD. The young age of sexual activity onset and lifetime number of sexual partners are considered the highest behavioral risk factors.

Desmoplastic trichoepithelioma.

A 20-year-old male presented with a 4 year history of a solitary nodule, 8 mm in diameter on the left temple. It was covered by normal skin, with a central depression and elevated borders. Histopathology showed numerous horn cysts amidst nests and strands of basaloid cells surrounded by a dense fibrous stroma. The clinical and histopathological features were characteristic of desmoplastic trichoepithelioma.

Functional characterization and modulation of cytokine production by CD8+ T cells from human immunodeficiency virus-infected individuals.

CD8+ T-cell clones were generated from peripheral blood mononuclear cells (PBMC) of three human immunodeficiency virus (HIV)-seronegative individuals and six HIV-seropositive individuals and assessed for their cytokine secretion profile, cytolytic potential, and chemokine production. While the great majority of CD8+ T-cell clones generated from HIV-seronegative individuals produced interferon (IFN)-gamma, but not interleukin-4 (IL-4), that is a type 1 cytotoxic (Tc1) profile, high numbers of CD8+ T-cell clones generated from HIV-seropositive individuals produced IL-4 in addition to IFN-gamma or IL-4 alone, thus showing a type 0 cytotoxic (Tc0)- or a type 2 cytotoxic (Tc2) profile, respectively. Tc0/Tc2 cells displayed lower cytolytic activity than Tc1 cells, including a reduced ability to lyse autologous targets pulsed with HIV or HIV peptides. By contrast, the production of chemokines RANTES and macrophage inflammatory protein-1alpha was comparable in Tc1, Tc0, and Tc2 clones irrespective of whether they were derived from HIV-seronegative or HIV-seropositive individuals. When CD8+ T-cell clones were generated from PBMC cultures of HIV-seronegative individuals conditioned with IL-4 plus an anti-IL-12 antibody (Ab), a shift towards the Tc0/Tc2-like profile was observed. Conversely, the addition to PBMC cultures of IL-12 plus an anti-IL-4 Ab shifted the differentiation of CD8+ T cells from HIV-infected individuals towards the Tc1-like profile, whereas IL-12 or anti-IL-4 Ab alone had a lower Tc1-promoting effect. Irradiated PBMC from HIV-infected individuals, used as feeder cells, shifted the differentiation of CD8+ T cells from a healthy HIV-seronegative individual towards the Tc0/Tc2-like profile. On the other hand, a shift towards the Tcl-like profile was noted in CD8+ T-cell clones generated from the skin specimens of two HIV-seropositive patients with Kaposi's sarcoma, successfully treated with IFN-alpha, in comparison to CD8+ clones generated from the same skin areas before treatment. The IFN-alpha-induced Tc1 shift could be prevented by the incubation of skin-infiltrating CD8+ T cells with IL-4 before cloning. Taken together, these data indicate that both defective production of IL-12 and abnormal IL-4 production in bulk PBMC populations of HIV-infected individuals may contribute to the development of high numbers of CD8+ T-cell clones showing a Tc0/Tc2-like phenotype and reduced cytolytic potential against HIV itself. They also suggest that the cytokine profile of CD8+ T-cell clones can be modulated by cytokines (or anticytokine Ab) both in vitro and in vivo.

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).

No relationship between skin-infiltrating TH2-like cells and allergen-specific IgE response in atopic dermatitis.

More than 500 CD4+ T-cell clones (TCCs) derived from the skin of eight patients with atopic dermatitis (AD), two patients with nonatopic dermatologic disorders, two patients with allergic rhinitis, and one healthy nonatopic donor were analyzed for both their pattern of cytokine production and their antigen specificity. The proportions of TCCs from patients with AD producing interleukin-4 in response to stimulation with phorbol 12-myristate 13-acetate plus anti-CD3 antibody were higher, whereas the proportions of interferon-gamma--producing TCCs were lower than those of control subjects. In two patients with AD, the majority of TCCs had a TH2/TH0-like phenotype, whereas in six patients with AD a TH1/TH0-like phenotype was prevalent. TCCs with a TH2/TH0-like phenotype were also isolated from the healthy skin of two patients with allergic rhinitis and one nonatopic donor. In contrast, no TH2-like TCCs were derived from the skin of the two patients with dermatologic disorders of nonallergic origin. No unambiguous correlations was found between the proportions of TCCs producing interleukin-4 or interferon-gamma (or of TCCs with TH2- or TH1-like profile) and the level of total serum IgE, suggesting that CD4+ T cells infiltrating the atopic skin do not play a major role in the production of serum IgE antibodies. When TCCs from five patients with AD were examined for their specificity, the proportions of allergen-specific (Dermatophagoides pteronyssinus and Lol p 1) clones were consistently 6% or lower even in patients with high titers of ryegrassor D. pteronyssinus-specific IgE antibodies. Because similar percentages of allergen-specific TCCs were found in skin from two healthy control subjects, the role of aeroallergens in favoring and maintaining skin lesions in patients with AD remains unclear.

Th2-like CD8+ T cells showing B cell helper function and reduced cytolytic activity in human immunodeficiency virus type 1 infection.

We analyzed at clonal level the functional profile of circulating or skin-infiltrating T lymphocytes from two individuals infected with the human immunodeficiency virus type 1 (HIV-1), suffering from a Job's-like syndrome (eczematous dermatitis, recurrent skin and sinopulmonary infections, and hypergammaglobulinemia E) and showing virtually no circulating CD4+ T cells. Most of the CD3+ T cell clones generated from both patients were CD4- CD8+ TCR alpha beta +. The others were CD4- CD8- TCR alpha beta + which exhibited reduced mRNA expression for the CD8 molecule or no mRNA expression for either CD4 or CD8 molecules. The great majority of both CD4- CD8+ and CD4- CD8- did not produce interferon (IFN) gamma and exhibited reduced cytolytic activity. Rather, most of them produced large amounts of both interleukin (IL) 4 and IL-5 and provided B cell helper function for IgE synthesis. These data suggest that a switch of cytolytic CD8+ T cells showing a Th1-like cytokine secretion profile to cells that make Th2-type cytokines, exhibit reduced cytolytic potential, and provide B cell helper function can occur in the course of HIV-1 infection. These cells may contribute to the reduced defense against viral infections and intracellular parasites and account for the elevated IgE serum levels, eosinophilia, and the allergic-like clinical manifestations seen in a proportion of HIV-1-infected individuals.

Bilaterally impacted maxillary canines: a case report in an adult.

A case of bilateral maxillary canine impaction with incomplete lateral incisor transposition in an adult is reported. The case was treated by relocating the canines in their correct position in the arch. The impacted teeth were driven through the sockets of the extracted deciduous teeth. The periodontal status during and after relocation of the transposed impacted canines was evaluated. Remineralization of bone between the lateral incisor and the canine was observed during treatment on the left side, while it was delayed on the right. Two years after the end of treatment, no loss of periodontal attachment could be detected and probing depth was less than 2 mm on the treated teeth.