DÄ internationalArchive26/2016Morphological Variants Forgotten
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I would like to add some comments that I think are important to the successful and important review paper on sexually transmitted infections (1).

Chancroid caused by Haemophilus ducreyi should at least be mentioned together with diseases caused by genital, anal, perianal, or oral ulcers. In addition to the differential diagnosis between soft chancre and syphilis, morphological variants of the disease are difficult to distinguish from a herpes infection (“dwarf chancroid”) (2). A recent prospective study from Paris showed a Haemophilus ducreyi infection in 3% of cases of genital ulcer (3). The disease is not usually diagnosed. Neither the complex media that is necessary to grow the microaerophile pathogen in culture, nor the necessary nucleic acid amplification methods, are routinely available (4).

Therapy for human papillomavirus diseases is prone to errors. Cyclosporin and 5-fluorouracil are not indicated for the treatment of anogenital warts. Permitted substances for patient self-medication, which are recommended by the large STD specialtist societies CDC and IUSTI, are imiquimod, podophyllotoxin, and the purified dry extract of green tea leaves with the active substance epigallocatechin gallate. Only these three substances are mentioned in the current CDC treatment guidelines (5).

Cryotherapy, similar to curettage or treatment with electrocautery, is a surgical procedure and is therefore a destructive method.

DOI: 10.3238/arztebl.2016.0460a

Prof. Dr. med. Dietrich Abeck

München

professorabeck@mytum.de

Conflict of interest statement

Prof. Abeck has received consultant fees, registration fee reimbursement, travel and accommodation expenses, and speaking honoraria from Taurus Pharma.

1.
Wagenlehner FME, Brockmeyer NH, Discher T, Friese K, Wichelhaus TA: The presentation, diagnosis and treatment of sexually transmitted infections. Dtsch Arztebl Int 2016; 113: 11–22 VOLLTEXT
2.
Ballard RC, Abeck D, Korting HC, Dangor Y, Braun-Falco O: Morphologic variants of genital ulcer caused by Haemophilus ducreyi. Hautarzt 1989; 40: 443–7 MEDLINE
3.
Hope-Rapp E, Anyfantakis V, Fouéré S, et al.: Etiology of genital ulcer disease. A prospective study of 278 cases seen in an STD clinic in Paris. Sex Transm Dis 2010; 37: 153–8 CrossRef MEDLINE
4.
O’Farrel N, Lazaro N: UK National Guideline for the management of chancroid in 2014. Int J STD AIDS 2014; 25: 975–83 CrossRef MEDLINE
5.
Workowski KA, Bolan GA: Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1–137. MEDLINE
1.Wagenlehner FME, Brockmeyer NH, Discher T, Friese K, Wichelhaus TA: The presentation, diagnosis and treatment of sexually transmitted infections. Dtsch Arztebl Int 2016; 113: 11–22 VOLLTEXT
2.Ballard RC, Abeck D, Korting HC, Dangor Y, Braun-Falco O: Morphologic variants of genital ulcer caused by Haemophilus ducreyi. Hautarzt 1989; 40: 443–7 MEDLINE
3.Hope-Rapp E, Anyfantakis V, Fouéré S, et al.: Etiology of genital ulcer disease. A prospective study of 278 cases seen in an STD clinic in Paris. Sex Transm Dis 2010; 37: 153–8 CrossRef MEDLINE
4.O’Farrel N, Lazaro N: UK National Guideline for the management of chancroid in 2014. Int J STD AIDS 2014; 25: 975–83 CrossRef MEDLINE
5.Workowski KA, Bolan GA: Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1–137. MEDLINE

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