Acquisition and clearance of perianal human papillomavirus infection in relation to HIV-positivity in men who have sex with men in the Netherlands

This study was performed to establish the prevalence of perianal human papillomavirus (HPV) infection in relation to HIV-positivity in a group of men who have sex with men (MSM), and to correlate follow-up data with regard to acquisition and clearance of HPV infection. Data with regard to HPV prevalence and HIV serostatus during two visits were compared. At both visits participants underwent a routine venereological examination and swabs were taken from the perianal region for HPV DNA testing. During both visits HPV types 16, 18, 31, 33 and 52 were significantly more often detected in HIV-positive individuals. Persistence of HPV type 31 at the perianal region was significantly more often seen in HIV-positive MSM (p=0.036) while the incidence of type 16 may be associated with HIV positivity (p=0.059). In HIV-positive MSM significantly more high-risk HPV types were detected at the perianal region

The use of serological titres of IgA and IgG in (early) discrimination between rectal infection with non‐lymphogranuloma venereum and lymphogranuloma venereum serovars of Chlamydia trachomatis

Objectives: To investigate whether serological titres of species-specific IgA and IgG antibodies in patients with rectal chlamydial infection could discriminate between infection with serovar L2 lymphogranuloma venereum (LGV) and infection with non-LGV serovars. Methods: A total of 39 male patients with chlamydial infection of the rectum were tested for titres of IgA and IgG antibodies within 14 days after detection of the infection and 6 and 12 months after adequate treatment. Data were collected regarding demographics, sexual orientation, HIV serostatus, history of chlamydial infection, concomitant sexually transmitted infection (STI) or HIV infection, hepatitis C virus antibodies and new STIs during follow-up. Results: Between May 2003 and November 2005, 24 men with confirmed L2 proctitis and 15 men with non-LGV rectal chlamydial infection were recruited. In multivariable analyses, both high titre of IgA within 14 days after detection of the infection and older age of the individual were found significantly associated with L2 proctitis (p<0.001 and p = 0.001, respectively). A total sum score of seven times IgA titre and individual's age ≥50 years resulted in an overall sensitivity of 92% and specificity of 100%. This total sum score was highly accurate for detection of LGV proctitis, with an area under the curve in a receiver operating characteristic curve of 0.989. Conclusions: An increased IgA antibody response and the age of the infected individual are of possible diagnostic value for (early) detection of LGV proctitis

Two cases of cutaneous leishmaniasis in Dutch military personnel treated with oral miltefosine

In the Netherlands, cutaneous leishmaniasis is most commonly seen in military personnel deployed on a mission or training abroad. The treatment of two Dutch soldiers who acquired cutaneous leishmaniasis with oral miltefosine was evaluated. Adverse effects were monitored and the improvement of skin lesions was assessed. A military nurse with a painless Chiclero's ulcer due to Leishmania (Viannia) braziliensis acquired in Belize and a military physical training instructor with itchy swelling and small ulcer of the back of his left elbow due to L. donovani/infantum complex acquired in Ibiza were treated with oral miltefosine 50 mg three times a day for 28 days. Both patients responded well to oral miltefosine. Adverse effects were mild. Increase of creatinine levels was seen while liver transaminase levels were unremarkable. Miltefosine proved to be a convenient, effective and well-tolerated treatment option in the treatment of cutaneous leishmaniasis in Dutch military personne

Granulomateuze secundaire syfilis: een zeldzame uiting van een polymorf ziektebeeld

BACKGROUND: Due to a great diversity of clinical presentations secondary syphilis can mimic various skin diseases, which means that the diagnosis of this sexually transmitted condition can be missed. Occurrence of a granulomatous inflammatory reaction in secondary syphilis is rare and may be confused with other granulomatous dermatoses. CASE DESCRIPTION: We present a 37-year-old homosexual male with a granulomatous dermatitis due to secondary syphilis. The differential diagnosis based on clinical and histopathological findings was lengthy and the initial syphilitic serology results were negative, resulting in delayed diagnosis. After revision of the histopathology and repeated serological testing secondary syphilis could be diagnosed. CONCLUSION: Not only the clinical, but also the histopathological presentation of secondary syphilis is variable. To prevent transmission, treatment delay and complications, we recommend repeating syphilitic serology following negative results if there is clinical or histopathological suspicion of this disease, especially in patients displaying high-risk behaviour. Syphilis should be also excluded in granulomatous dermatoses with plasma cells

HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 1984-2005

BACKGROUND: In The Netherlands, the western part, including Rotterdam and Amsterdam harbors the majority of the known HIV-infected population, of whom men who have sex with men (MSM) comprise the largest transmission category. Given a general rise in sexually transmitted infections (STI) and risky sexual behavior, we examine the HIV incidence among MSM in the Netherlands with data from three different sources. METHODS: To describe the HIV epidemic among MSM we use: a prospective cohort study in Rotterdam (ROHOCO: 1998-2003, n = 265) and another in Amsterdam (ACS: 1984-2005, n = 1498]) plus an anonymous HIV surveillance study (Amsterdam STI clinic: 1991-2004, n = 3733) in which HIV-positive MSM were tested with a less-sensitive HIV assay. We evaluated calendar trends in HIV incidence, also focusing on age effects. RESULTS: Since the start of the HIV epidemic in the early 1980s, incidence has declined strongly in the ACS. In recent years, an increase was noted among older MSM attending the Amsterdam STI clinic (P = 0.0334). In both cohort studies, HIV incidence was lower and recent time-trends were not statistically significant. Among recently infected men at the STI clinic, only 40% accepted named HIV testing at their STI consultation. CONCLUSIONS: Data suggest that among MSM in the Netherlands, the HIV incidence is between one and four infections per 100 person-years. The epidemic expands among older STI clinic attendees. Prevention should be developed specifically for older men, along with a more efficient HIV testing approach such as routine HIV testing of MSM when they are screened for ST