Other Sexually Transmitted Diseases
STDs that are less common in the United States include granuloma inguinale and lymphogranuloma venereum (LGV), both of which can present with genital ulcers.C. trachomatis serovars L1, L2, and L3 cause LGV, a dis-ease that has increased in prevalence in the Netherlands and other European countries. When transmitted via vagi-nal intercourse, LGV presents with inguinal or femoral lymphadenopathy in women. When transmitted anally, symptoms of anal bleeding, purulent anal discharge, con-stipation, and anal spasms may occur. A self-limiting gen-ital or rectal vesicle or papule sometimes forms at the site of entry of the bacterium. LGV is a systemic infection that, ifuntreated, can cause secondary infection of rectal or anal lesions, which may lead to abscesses or fistulas.
Granuloma inguinale is caused by sexual transmis-sion of the bacterium Klebsiella granulomatis. Rare in the United States, it is endemic in Papua New Guinea, cen-tral Australia, India, and western Africa. The lesions are vascular and bleed easily on contact. The disease is diag-nosed clinically and can be confirmed by special stains of specimens taken from the lesions or from biopsy.
Chancroid, another STD characterized by genital ulcers,usually occurs in discrete outbreaks. Ten percent of individu-als diagnosed with chancroid are also infected with HSV or T. pallidum. It is also a cofactor for HIV transmission. Thecausative bacterium, Haemophilus ducreyi, is difficult to cul-ture. PCR is often used to confirm the diagnosis, which is made by clinical criteria and ruling out syphilis and HSV through testing of the ulcer secretion.
Molluscum contagiosum is a highly contagious viral skininfection that can be transmitted through sexual contact. It ischaracterized by small, painless papules that appear on the
genital region, inner thighs, and buttocks. The papules usually resolve spontaneously within six months to one year. Antiviral drugs or topical preparations are used to treat the disease and prevent transmission.
Parasitic infections include pediculosis pubis (pubiclice) and scabies. Pubic lice are usually transmitted bysexual contact; some cases in which the lice have been transmitted through contact with infested clothing or bedding have been reported. Scabies can also be transmit-ted via these routes. The predominant symptom of both conditions is itching of the pubic area. Pubic lice or nits can sometimes be detected on pubic hair. Itching due to scabies infection may be delayed several weeks, as the indi-vidual becomes sensitized to the antigens released by the parasites; however, itching may occur within 24 hours fol-lowing reinfection. Pubic lice and scabies are treated with topical medications. Lindane is not recommended as a first-line treatment due to its toxicity.