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3.
Ann Dermatol Venereol ; 146(1): 31-36, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30366717

RESUMO

TREATMENT OF THE INITIAL INFECTION OR FIRST CLINICAL EPISODE OF GENITAL HERPES: An initial infection or first clinical episode of genital herpes is treated with oral aciclovir 200mg×5/d for 5 to 10 days depending on clinical status. The recommended dosage for valaciclovir is 1g×2/d and treatment duration is identical to that for aciclovir. TREATMENT OF HERPES RECURRING DURING PREGNANCY: There are no studies of the efficacy of antiviral therapy on the symptoms of genital recurring during pregnancy. However, initial anti-viral treatment using aciclovir or valaciclovir may be given where warranted by symptoms (i.e. duration and severity of symptoms). Valaciclovir may be used instead (equivalent efficacy but better safety data for aciclovir). Valaciclovir may be given at a dosage of 1×500mg b.i.d. p.o. for 5 days. PROPHYLACTIC ANTI-VIRAL TREATMENT DURING PREGNANCY: In female patients presenting an initial infection or infection recurring during pregnancy, although there is no demonstrated benefit for prophylactic treatment in reducing the risk of neonatal herpes, anti-viral prophylaxis is recommended after 36 WA (weeks' amenorrhoea) to limit the need for Caesarean section due to herpetic lesions. The recommended antivirals are aciclovir at a dosage of 400mg t.i.d p.o. or valaciclovir at a dosage of 500mg b.i.d. p.o. until delivery.


Assuntos
Aciclovir/administração & dosagem , Antivirais/administração & dosagem , Herpes Genital/tratamento farmacológico , Valaciclovir/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Herpes Genital/transmissão , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia
17.
Ann Dermatol Venereol ; 143(11): 675-681, 2016 Nov.
Artigo em Francês | MEDLINE | ID: mdl-27659388

RESUMO

BACKGROUND: Since 2007 in France, human papilloma virus (HPV) vaccination has been licensed for use as a vaccine against HPV 6, 11, 16 and 18. The impact on the epidemiology of external genital warts (EGWs) in a large population remains unclear. OBJECTIVES: To determine epidemiologic and clinical features of patients presenting EGWs in France in the era of HPV vaccination. PATIENTS AND METHODS: In this prospective, observational study, we analyzed clinical features and treatments between January 1st, 2012 and March 31, 2012 for patients consulting for EGWs at 15 STI clinics throughout France. RESULTS: A total of 372 men and 111 women were included; mean age 31.2 years. The women were younger than the men (31.7 and 28.9 years respectively P<0.05). Among the patients, 416 (85.7%) were heterosexual, 13 bisexual and 54 (11.2%) homosexual, including one female. Males reported more sexual partners in the last 12 months (more than 3 partners in 32.6% versus 11.9%, P<0.01). Among the men, 230 had involvement of the penis alone and 46 had involvement of the anus alone. Seventy-six patients had EGWs of the anus, and of these 26 were MSM. In females, 76 had an infection of the vulva alone and 22 co-infection of the vulva and anus. MSM and females were at higher risk than heterosexual males for anal involvement (P<0.0001 and P=0.004, respectively). Three women had been vaccinated: two with Gardasil® and one with Cervarix®. Cryotherapy was the preferred treatment. CONCLUSION: With the advent of HPV vaccination, a global strategy for the prevention and treatment of EGW should be implemented.


Assuntos
Doenças do Ânus/epidemiologia , Condiloma Acuminado/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Masculinos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Ânus/terapia , Condiloma Acuminado/terapia , Crioterapia , Feminino , França/epidemiologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/terapia , Vacina Quadrivalente Recombinante contra HPV tipos 6, 11, 16, 18 , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Parceiros Sexuais , Sexualidade/estatística & dados numéricos , Adulto Jovem
18.
J Hepatol ; 58(4): 690-7, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23220369

RESUMO

BACKGROUND & AIMS: Hepatitis B virus (HBV) infection is a major public health burden in France and worldwide. Routine screening for hepatitis B is not currently recommended in France. Medical experts and public health agencies opinions can differ concerning targeting criteria. Our study aims at developing a risk assessment strategy for identifying possible hepatitis B cases among the patients consulting in a French Sexually Transmitted Infection (STI) clinic. METHODS: 6194 asymptomatic patients requesting an STI screening were also screened for hepatitis B infection. The association between hepatitis B surface antigen (HBsAg) positivity and/or total hepatitis B core antibody (anti-HBc) positivity and self-reported risk factors for hepatitis were analysed. RESULTS: Only male gender, lack of employment, and birth, in medium or high endemic country, were independently associated with HBsAg positivity in multivariate analysis. Sexual behaviour or self-reported vaccination status is therefore not necessary to target high-risk populations. These three simple criteria could save 25% of unnecessary tests and 6-16% undiagnosed hepatitis B compared to usual targeting criteria. CONCLUSIONS: To detect HBsAg carriers, only three simple targeting criteria, without taking into account the self-reported vaccination status or sexual behaviour, could improve screening efficiency and save unnecessary testing.


Assuntos
Hepatite B/prevenção & controle , Programas de Rastreamento/métodos , Adulto , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Doenças Endêmicas , Feminino , França/epidemiologia , Hepatite B/epidemiologia , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ambulatório Hospitalar , Fatores de Risco , Assunção de Riscos , Desemprego , Adulto Jovem
19.
Ann Dermatol Venereol ; 135(6-7): 479-83, 2008.
Artigo em Francês | MEDLINE | ID: mdl-18598797

RESUMO

BACKGROUND: BCG therapy is an effective adjuvant treatment for superficial bladder tumors. Therapy involves intravesical instillation of live attenuated Calmette-Guérin bacilli. BCG infection of the glans is a rare local complication associated with this treatment, two cases of which are reported below. PATIENTS AND METHODS: Case 1: A 77-year-old man presented relapsing urothelial bladder carcinoma treated by endoscopic resection and BCG therapy. One week after the seventh instillation, severe balanitis developed. Three months later, examination revealed massive painful perimeatal ulceration with yellowish papules in the peripheral regions. Histology revealed epithelioid giant-cell granulomas. Ziehl-Neelsen staining was positive. Slow cure of the lesions was achieved within 12months using double antitubercular antibiotic therapy. Case 2: In a 61-year-old man receiving BCG therapy for relapsing bladder carcinoma in situ, the sixth instillation was considered traumatic since it was highly painful. One week later, papular nodules appeared on the glans with a sclerosing lesion of the balanopreputial sac, dark purple perimeatal papules and a mass beneath the mucosa of the glans. Antibiotic treatment comprising ofloxacin followed by rifampicin for two months proved ineffective. Histology revealed granulomatous dermal lesions with eosinophilic necrosis. Triple antitubercular antibiotic therapy was initiated. DISCUSSION: The first reported case of BCG infection of the glans in patients undergoing intravesical BCG therapy was published in 1992. Since then, there have been nine other reports. There is no stereotypical clinical presentation. In most cases, an infiltrated erythematosus plaque is seen together with yellowish papules in certain patients. Diagnosis is based upon history and histological examination.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/administração & dosagem , Vacina BCG/efeitos adversos , Balanite (Inflamação)/etiologia , Carcinoma in Situ/terapia , Carcinoma de Células de Transição/terapia , Tuberculose/etiologia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Idoso , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Balanite (Inflamação)/patologia , Biópsia , Carcinoma de Células de Transição/cirurgia , Quimioterapia Combinada , Granuloma de Células Gigantes/etiologia , Granuloma de Células Gigantes/patologia , Humanos , Masculino , Pênis/patologia , Tuberculose/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia
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