CDC Sexually Transmitted Infections Treatment Guidelines, 2021

Hazra, Aniruddha; Collison, Maggie; Davis, Andrew M.

doi:10.1001/jama.2022.1246

Cited by 39 publications

(40 citation statements)

References 7 publications

(13 reference statements)

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“…We retrospectively reviewed the medical records of patients diagnosed with secondary syphilis between December 2010 and December 2021. The diagnosis was established in accordance with the Center of Disease Control criteria ( 12 , 13 ). Of all secondary syphilis cases, the diagnosis of SA was based on the following: (i) hair loss within 6 months after disease onset and significant (cosmetically acceptable) hair regrowth within 6 months after antibiotic therapy; and/or (ii) histopathological features compatible with SA.…”

Section: Methodsmentioning

confidence: 99%

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

et al. 2022

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BackgroundSyphilitic alopecia (SA), which mimics other types of alopecia, is an uncommon manifestation of secondary syphilis. Trichoscopic features may facilitate its diagnosis. However, studies on SA and its trichoscopic characteristics remain limited.ObjectiveTo investigate the epidemiological, clinical, and trichoscopic findings and laboratory results, treatment, and outcomes of SA in Thai patients as well as to comprehensively summarize all trichoscopic features of SA through a systematic review.MethodsData on patients diagnosed with SA between December 2010 and December 2021 were obtained from their medical records and analyzed retrospectively. A systematic review of trichoscopic data, both from our institution and from studies registered in the PubMed, MEDLINE, and Embase databases, was conducted. A descriptive summarization was performed to comprehensively study the trichoscopic features of SA.ResultsOf the 205 patients with secondary syphilis, 23 patients with SA (symptomatic SA: 20, essential SA: 3) were included. The mean age was 27.6 ± 8.8 years, and male predominance was noted. The moth-eaten pattern was the most common SA presentation, and the parieto-occipital scalp was the most commonly affected area. All patients with SA achieved significant hair regrowth within 3 months of antibiotic therapy. Trichoscopic images were available for 20 patients with SA from our institute and were included in the systematic review. Fourteen articles provided information on 21 patients. Overall (N = 41), 26 (63.4%), 8 (19.5%), and 7 (17.1%) patients had moth-eaten alopecia, diffuse alopecia, and mixed alopecia, respectively. The most frequent trichoscopic finding was short regrowing hairs (78%), followed by decreased hair per follicular unit (75.6%), and empty follicles (51.2%). Unique features included flame hairs, bent tapering hairs, reddish-brown background, and brown rings around the perifollicular areas, each described in one case. However, the results were based only on case reports and small case series.ConclusionsGiven the progressively increasing frequency of SA, trichoscopic examination may be valuable when SA is suspected in patients with idiopathic alopecia; however, our findings are quite non-specific. The absence of exclamation mark hairs may help in the diagnosis of SA. Further comparative studies on other types of alopecia are required to determine the most useful diagnostic features.

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Section: Methodsmentioning

confidence: 99%

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

et al. 2022

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“…[ 2 , 11 , 15 ] The Centers for Disease Control and Prevention guidelines for anogenital warts recommend that biopsy be performed when a lesion is atypical (e.g., pigmented, indurated, affixed to underlying tissue, bleeding, or ulcerated). [ 6 ] When skin cancer is missed, diagnosis is inevitably made in a more advanced state. Furthermore, visual diagnosis of a skin malignancy coexisting with CA without a biopsy is difficult, and thus, we recommend a biopsy be conducted before treating condyloma non-surgically.…”

Section: Discussionmentioning

confidence: 99%

“…[8] CA is treated using topical agents (podophyllotoxin, imiquimod cream, or sinecatechins), by destructive or surgical treatments (trichloroacetic acid, cryotherapy, CO 2 laser ablation, or surgery), or by systemic interferon treatment. [6][7][8][9] Only 3 cases of coexistent CA and EMPD have been reported. [10][11][12] Here, we report a rare case of coexistent EMPD and CA.…”

Section: Introductionmentioning

confidence: 99%

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Coexistence of condyloma acuminatum and extramammary Paget’s disease on penis and scrotum: A rare case report

Kang

Lee

et al. 2022

Medicine

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Rationale: Extramammary Paget’s disease (EMPD) is a rare skin cancer that commonly occurs in sites rich in apocrine glands, such as perineum, vulva, axilla, scrotum, and penis. On the other hand, condyloma acuminatum (CA; also referred to as anogenital warts) is a common benign neoplasm caused by human papillomavirus. Few cases of coexistent EMPD and CA have been reported because of the rarity of the condition. Patient concerns and diagnosis: A 72-year-old man with a genital mass, which appeared to be composed of multiple papillomatous masses, was referred for surgical resection. The lesion was first noticed 6 months previously and grew rapidly. CO2 ablative laser therapy was performed twice at a primary clinic, but the mass recurred. Intervention and outcomes: Excisional biopsy revealed the presence of coexistent EMPD and CA. Additional wide excision was performed, and postoperative biopsy confirmed no residual tumor. Two years after surgery, no recurrence had occurred. Lessons: CA can co-occur with several types of skin malignancies, and a skin malignancy coexisting with CA is difficult to diagnose visually. Therefore, even if a skin lesion in the genital region is considered to be CA, we recommend punch biopsy before treatment because it can benefit prognosiss.

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“…Even so, the isolation and cultivation of anaerobes is still difficult and requires a long time, and this process may not be able to guide clinical treatment within a reasonable amount of time, so anti-anaerobic drugs and anti-pathogenic drugs are commonly used in combination. The CDC currently recommends considering the addition of metronidazole in all outpatient treatments of PID patients and in patients who have BV, trichomoniasis or who were exposed to recent uterine instrumentation ( 26 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of morinidazole in the treatment of pelvic inflammatory disease: A multicenter, prospective, open-label phase IV trial

et al. 2022

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BackgroundAntimicrobial resistance to metronidazole has emerged after several decades of worldwide use of the drug. The purpose of this study was to evaluate the effectiveness, safety and population pharmacokinetics of morinidazole plus levofloxacin in adult women with pelvic inflammatory disease (PID).MethodsPatients in 30 hospitals received a 14-day course of 500 mg intravenous morinidazole twice daily plus 500 mg of levofloxacin daily. A total of 474 patients were included in the safety analysis set (SS); 398 patients were included in the full analysis set (FAS); 377 patients were included in the per protocol set (PPS); 16 patients were included in the microbiologically valid (MBV) population.ResultsThe clinical resolution rates in the FAS and PPS populations at the test of cure (TOC, primary effectiveness end point, 7–30 days post-therapy) visit were 81.91 and 82.49% (311/377), respectively. There were 332 patients who did not receive antibiotics before treatment, and the clinical cure rate was 82.83%. Among 66 patients who received antibiotics before treatment, 51 patients were clinically cured 7–30 days after treatment, with a clinical cure rate of 77.27%. The bacteriological success rate in the MBV population at the TOC visit was 87.5%. The minimum inhibitory concentration (MIC) values of morinidazole for use against these anaerobes ranged from 1 to 8 μg/mL. The rate of drug-related adverse events (AEs) was 27.43%, and no serious AEs or deaths occurred during the study.ConclusionsThe study showed that treatment with a 14-day course of intravenous morinidazole, 500 mg twice daily, plus levofloxacin 500 mg daily, was effective and safe. The results of this study were consistent with the results of a phase III clinical trial, which verified the effectiveness and safety of morinidazole.

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CDC Sexually Transmitted Infections Treatment Guidelines, 2021

Abstract: This Clinical Guideline Synopsis discusses updated guidelines from the Centers for Disease Control and Prevention on the prevention, diagnosis, and management of sexually transmitted infections, specifically gonorrhea, chlamydia, Mycoplasma genitalium, and syphilis.

Cited by 39 publications

References 7 publications

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

Epidemiological, Clinical, and Trichoscopic Features of Syphilitic Alopecia: A Retrospective Analysis and Systematic Review

Coexistence of condyloma acuminatum and extramammary Paget’s disease on penis and scrotum: A rare case report

Effectiveness and safety of morinidazole in the treatment of pelvic inflammatory disease: A multicenter, prospective, open-label phase IV trial

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