acyclovir and Syphilis

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Balanitis; Diagnosis, Differential; Herpes Genitalis; Humans; Immunocompromised Host; Inflammation; Lichen Sclerosus et Atrophicus; Male; Penis; Phimosis; Recurrence; Skin; Syphilis

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Chorioretinitis; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Keratitis, Dendritic; Light Coagulation; Mycoses; Necrosis; Opportunistic Infections; Retina; Retinitis; Syphilis; Toxoplasmosis

This study aimed to determine the prevalence of genital ulcer and urethral pathogens, as well as their association with clinical features, in men with genital ulcer disease (GUD) enrolled in a clinical trial.. Clinical data were collected by questionnaire. Ulcer swabs were tested for herpes simplex viruses (HSV-1/2), Treponema pallidum, Haemophilus ducreyi, and Chlamydia trachomatis L1-L3. First-pass urine was tested for urethral pathogens, namely Neisseria gonorrhoeae, C. trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. Pathogens were detected by real-time molecular assays. Blood was tested for HIV, HSV-2, and syphilis-associated antibodies. Pathogens and clinical associations were investigated using the χ test.. A total of 615 men with GUD were recruited. Herpes simplex virus (HSV-1, 4.2%; HSV-2, 98.2%) and bacterial pathogens were detected in 451 (73.6%) and 48 (7.8%) of genital ulcers, respectively. Human immunodeficiency virus, HSV-2, and treponemal antibodies were detected in 387 (62.9%), 434 (70.6%), and 141 (23.0%) men, respectively, whereas 54 men (8.8%) were rapid plasmin reagin (RPR) seropositive. A total of 223 urethral infections were diagnosed in 188 men (30.6%), including 69 (11.2%) M. genitalium, 64 (10.4%) T. vaginalis, 60 (9.8%) C. trachomatis, and 30 (4.9%) N. gonorrhoeae infections. Dysuria was reported by 170 men (27.6%), and 69 men (11.5%) had urethral discharge on examination. Urethral pathogens were detected in 102/409 (24.9%) men without these clinical features.. Herpes accounted for most GUD cases and urethral pathogen coinfections were common. Erythromycin, dispensed to treat infrequent chancroid and lymphogranuloma venereum cases, provided additional treatment of some asymptomatic urethral pathogens. Additional antibiotics would be required to treat asymptomatic trichomoniasis and gonorrhea.

Topics: Acyclovir; Adult; Chancre; Chlamydia Infections; Chlamydia trachomatis; Gonorrhea; Haemophilus ducreyi; Herpes Genitalis; Herpesvirus 1, Human; Herpesvirus 2, Human; HIV Seropositivity; HIV-1; Humans; Male; Neisseria gonorrhoeae; Prevalence; Primary Health Care; Real-Time Polymerase Chain Reaction; Sentinel Surveillance; South Africa; Surveys and Questionnaires; Syphilis; Treponema pallidum; Ulcer; Urethral Diseases; Urine

Herpes simplex virus (HSV) has been the leading cause of genital ulcer syndrome (GUS) in South Africa for more than a decade, and acyclovir therapy is incorporated into syndromic management guidelines. We conducted surveillance at 3 sentinel sites to define the common sexually transmitted etiologies of GUS and to determine whether current syndromic management is appropriate. Secondary objectives of surveillance were to determine the seroprevalence of coinfections (HIV, syphilis, HSV-2) in persons presenting with GUS.. Consecutive, consenting adult men and women presenting with visible genital ulceration were enrolled between January 1, 2019, and December 31, 2020. Genital ulcer swab and blood specimens were collected and transported to a central sexually transmitted infection reference laboratory in Johannesburg.. Among 190 participants with GUS, HSV-2 was the most frequently detected ulcer pathogen (49.0%; 95% confidence interval [CI], 41.9%-56.1%). The relative prevalence of the second most common ulcer-derived pathogen, Treponema pallidum, was 26.3% (95% CI, 20.5%-33.1%), with 90% of primary syphilis cases having a positive rapid plasma reagin (RPR) titer. Male sex was independently associated with primary syphilis compared with herpetic ulcers, after adjusting for the effect of casual sex partners and other exposures (adjusted odds ratio, 3.53; 95% CI, 1.35-9.21; P = 0.010). The overall HIV prevalence among participants was 41.3% (78 of 189; 95% CI, 34.2%-48.6%).. Herpes simplex virus 2 remains the predominant cause of GUS, justifying the continued use of acyclovir in syndromic guidelines. Adequate supplies of benzathine penicillin G for syphilis treatment are essential at primary health care level, in addition to the provision of syphilis and HIV risk reduction services.

Topics: Acyclovir; Adult; Female; Genitalia; Herpes Genitalis; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Male; Seroepidemiologic Studies; Sexually Transmitted Diseases; South Africa; Syphilis; Ulcer

Topics: Acyclovir; Adult; Cardiolipins; Cholesterol; Drug Therapy, Combination; Fluorescein Angiography; Fluorescent Treponemal Antibody-Absorption Test; HIV Seropositivity; Humans; Male; Panuveitis; Penicillins; Phosphatidylcholines; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Syphilis

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Chancroid; Chlamydia Infections; Epididymitis; Escherichia coli Infections; Female; Genital Diseases, Male; Herpes Simplex; Humans; Infertility, Male; Male; Mumps; Orchitis; Prostatitis; Syphilis; Urethritis

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Anti-Bacterial Agents; Antitrichomonal Agents; Female; Genital Neoplasms, Female; Gonorrhea; Humans; Lice Infestations; Lymphogranuloma Venereum; Lymphoma; Pregnancy; Pregnancy Complications, Infectious; Sarcoma, Kaposi; Sexually Transmitted Diseases; Syphilis

Topics: Acute Disease; Acyclovir; Adult; Chlamydia Infections; Diagnosis, Differential; Female; Gonorrhea; Herpes Genitalis; Humans; Male; Meningitis; Sexually Transmitted Diseases; Simplexvirus; Syphilis