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Virology Research Journal | Volume 2
May 18-19, 2018 | Montreal, Canada
2
nd
World Conference on
STDs, STIs & HIV/AIDS
S
exually Transmitted Infections (STIs) are associated with
profound physical as well as psychosexual morbidity.
Presence of an ulcer or genital discharge results inmuch distress
and a myriad of questions in the mind of the patient. Recurrent
ulcerations on the genitals place are significant stress on sexual
relationships. Untreated STIs constitutes a major burden on
public health systems; secondary to transmission to sexual
partners. STIs with genital ulcers are associated with increased
risk for HIV transmission. HIV shedding in genital ulcers has been
demonstrated in patients with co-infections. Early diagnosis and
treatment of STIs with genital ulcers has been demonstrated
to reduce HIV transmission. Diagnosis and treatment of STIs
is hence one of the important pillars in strategies to prevent
transmission of HIV. When patients present with classic clinical
featuresandreliablediagnostic laboratory facilitiesareavailable,
targeted therapy for the STI is possible. However, in many
circumstances, a syndromic approach is undertaken to treat STIs
with theaimof rapid resolutionof symptoms andhence reduced
transmission of HIV. Commonly encountered STIs presenting as
genital ulcers include herpes, syphilis and chancroid. Genital
herpes is characterized by recurrences and a chronic course.
Syphilis is making a comeback in certain populations secondary
to increased risk-taking- behaviors. STIs like lymphogranuloma
venereum (LGV) and granuloma inguinale (GI) are seen less
frequently. Genital herpes - caused by Herpes simplex virus
- occurs as grouped vesicles that rupture easily resulting in
grouped ulcerations, often with severe symptomatology. A
syphilitic chancre - caused by
Treponema pallidum
- is painless,
with a “button-like” consistency and associated with painless
local lymphadenopathy. Chancroid with
Haemophilus ducreyi
as etiologic agent presents as painful soft ulcer with tender
localized lymphadenopathy. LGV may not manifest a genital
ulcer and often presents as bilateral inguinal lymphadenopathy.
GI presents as genital erosions with beefy red granulation tissue
that easily bleeds on minimal trauma. These are the classic
presentations. However, all these STIs can present with clinical
variations and some patients may have concomitant infections.
Co-infection with HIV results in modification of the classic
clinical characteristics and often results in delayed diagnosis
and patients need prolonged therapy. In this presentation, we
will review classic clinical features of individual STIs presenting
with genital ulcers, along with clinical variations and differential
diagnoses. Modifications in patients with HIV co-infection and
implications for management will also be discussed.
Speaker Biography
Alwyn Rapose obtained his Doctorate in Dermatology, Venereology and Leprology
from King Edward VII Memorial Hospital, Bombay, India. Thereafter, he obtained his
MD in Internal medicine from St. Vincent Hospital, Worcester, Massachusetts, USA,
followed by a fellowship in infectious diseases at the University of Texas Medical
Branch, Galveston, Texas, USA. During this time, he was a recipient of the NIH / NIAID
supported UTMB postdoctoral research grant in emerging and reemerging infectious
diseases. He is board certified in both infectious diseases and internal medicine. He is
presently Assistant Professor of clinical medicine at the University of Massachusetts,
USA and practices as consultant in infectious diseases at the Reliant Medical Group and
St. Vincent Hospital in Worcester, Massachusetts, USA.
e:
Alwyn.Rapose@reliantmedicalgroup.orgAlwyn Rapose
Reliant Medical Group, USA
Unusual presentations of common STIs in the HIV era