[Sexually Transmitted Infections in the Tropics]. / Sexuell übertragbare Infektionen in den Tropen.

Sexually transmitted infections (STI) are common all over the world and the incidence of chlamydia, gonorrhea, syphilis and trichomoniasis alone is estimated at 500 million/year. Of these infections 75% occur in tropical countries in Latin America, sub-Saharan Africa and South as well as Southeast Asia. The bacterial infections chancroid, lymphogranuloma venereum (LGV) and granuloma inguinale (GI, Donovanosis) are termed tropical STI. They occur mainly in tropical countries, i. e. regions situated between the equator and the northern and southern 23.5° latitudes, regions which are characterized by hot humid climates as well as poverty and underdevelopment. These three diseases are primarily associated with ulcerations of the skin, thus their presence represents an increased risk for transmission of HIV and other STI. As with all STI, to minimize the risk of tropical infections it is essential to avoid hazardous sexual practices and to use condoms.

Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum contagiosum.

Chancroid, lymphogranuloma venereum, and granuloma inguinale may be considered as tropical venereal diseases. These diseases were a major diagnostic and therapeutic challenge in past centuries. Currently, patients with these bacterial infections that are endemic to the tropics occasionally consult with dermatologists in temperate climates. Due to the increasing frequency of travel to the tropics for tourism and work, as well as the increasing number of immigrants from these areas, it is important for dermatologists practicing in temperate climates to be familiar with the dermatologic manifestations of such infections, to be prepared to diagnose these diseases, and to treat these patients. All three "tropical" infections respond well to prompt and appropriate antimicrobial treatment, although herpes progenitalis still cannot be cured, and the number of people infected keeps growing; moreover, genital herpes can be transmitted by viral shedding before and after the visual signs or symptoms. Acyclovir, valacyclovir, and famciclovir can shorten outbreaks and make them less severe or even stop them from happening. There is currently no etiologic treatment for molluscum contagiosum, and the majority of treatment options are mechanical, causing a certain degree of discomfort. The molluscum contagiosum virus, unlike the other infectious agents mentioned, does not invade the skin.

Donovanosis / Donovanosis

La catedra de Dermatología de la Universidad Nacional Mayor de San Marcos, con sede en el Hospital Nacional "Dos de Mayo" reporta 120 casos de donovanosis entre enero de 1991 y octubre del 2000, cifra que es la más alta de nuestro medio. La donovanosis se ha constituido en la enfermedad transmitida sexualmente como la número uno del síndrome de úlcera genital crónica en los pacientes inmunocompetentes. Ante el conocido rol facilitador de las úlceras genitales en general para la infección por VIH, la donovanosis adquiere vigencia e importancia. Se presenta una revisión detallada con aportes de la experiencia de la consulta médica diaria, tomando en cuenta los aspectos históricos, etiológico, clínico y terapéutico de esta enfermedad.

Sexually transmitted diseases in children in developing countries.

PIP: The populations of developing countries have younger age structures than the populations of more developed, Western countries. That is, children, adolescents, and youth constitute a far greater proportion of the populations of developing countries than in developed countries. These young people experiment with sex and sexual intercourse or have coitus on a regular basis depending upon their individual personalities and circumstances. The prevalence of sexually transmitted diseases (STD) among younger age groups in developing countries is not well documented. It may, however, be inferred on the basis of reported experience of STD in surveys of adolescents and young adults that many children are infected with STDs. Some young people have sex consensually, some are coaxed into it, and others are coerced. On the one hand, young children have been thought to contract STD by sitting on the laps of infected, scantily-clad adults where such limited attire is the norm. Close contact between youngsters such as communal sleeping, for example, could then facilitate the spread of the STD among children. Sex, consensual or otherwise, is not involved in such infection and transmission beyond the index adult. On the other hand, however, many children and adolescents are forced to have sexual relations and/or intercourse either directly against their will or as a result of the primal need to ensure their individual survival. For example, there are an estimated 100-200 million street children worldwide; many have little alternative but to sell sex to survive. When having sex, they may not use condoms because they are unaware of the STD risk they face, they have no access to free condoms, clients/employers/peers prevent them from using condoms, or due to a myriad of other reasons. Struggling to survive, many such kids place condom use very low on their list of priorities. Children and adolescents can also become infected and transmit STDs to others by engaging in sexual intercourse under more narrowly-defined cultural norms. For example, the belief exists that a male with urethritis can be cured by sexual intercourse with a virgin or prepubertal girl. Elsewhere, it is normal practice for an adult male, typically a boy's uncle, to have anal insertive sexual intercourse with the boy on a regular basis over the period of a couple years to facilitate his transition into manhood. People in young age groups around the world have sex for a range of reasons under a variety of conditions. Measures are needed to ensure that they have the means to prevent infection with STDs and control that infection, if possible, once acquired. Sections discuss vulvovaginitis, donovanosis, chancroid, and venereal and nonvenereal treponematosis, as well as prevention and future research.^ieng

[Sexually transmissible diseases following travel in tropical countries]. / Sexuell übertragbare Krankheiten nach Reisen in tropische Länder.

Travel to tropical countries is an important factor in the spread of sexually transmitted diseases. In spite of intensive anti-AIDS campaigns, some 30% of Swiss tourists have casual sexual contacts abroad. The prevalence of sexually transmitted diseases is higher in tropical countries than in western industrialized countries. More than 25% of cases of gonorrhea treated in Switzerland from 1989-1991 were imported from abroad. The penicillin producing Neisseria gonorrhoeae strains (PPNG) isolated in Switzerland from 1989-1991 are mainly imported from abroad (60%). The typical "imported sexually transmitted diseases" in Switzerland are chancroid, lymphogranuloma venereum and donovanosis. The clinical manifestations, laboratory and special examinations, and treatment of these diseases are described. The most frequent sexually transmitted disease from the so-called "imported tropical STD's" is chancroid. Chancroid is also a major risk factor for HIV infection.

Donovanosis in Dutch South New Guinea: history, evolution of the epidemic and control.

PIP: The focus on donovanosis (venereal granuloma) in Dutch South New Guinea is relevant because the epidemic number of sexually transmitted disease cases (10,000) occurring between 1922-52 affected a small population (15,000) of the Marind-anim people. The history, evolution, and control are discussed as well as the relationship between medical and social factors and depopulation. Sections are devoted to identification of sources, the ethnographic background of the Marind-amin, evolution of the epidemic, the systematic campaign to eradicate the disease, and a final report on the relationship between the illness, depopulation, the original culture, and the effects of contact. The principle data sources were the Kooyman's SPC report of 1954, the medical report of 1913, the medical literature of Thierfelder and others, memoranda of government officers from the Resident Office at Merauke, and the logbook of the Roman Catholic mission begun in 1905. The 1954 report concluded that the coastal Marind-amin population dropped from 10,000 to 5,000 between 1900-20 due to a lowered birth rate and influenza mortality, and occurred before the spread of donovanosis. Sexual practices account for the low birthrate before 1923. When sexual practices were intensified upon the arrival of foreigners, donovanosis was spread more rapidly. The ritual was to avert sickness by having 1 woman have intercourse with many men. Government intervention in 1923 stabilized the birth rate. The population remained static due to the lack of young people, a high infant mortality rate, and a 1938/9 influenza epidemic. Nutrition was found not to be a factor. In the ethnographic literature, the belief in otiv--bombari is described. This emphasis on sexual activity (promiscuous sex with a religious base and semen as a curative power) was responsible for the spread of the disease. It is surmised that the disease appeared at a festival in 1905 and the spread was apparent by 1908. Model villages were established which were free of donovanosis and compulsory treatment enforced. The present culture may reflect the government and religious intervention of the 1920's.^ieng

Mutilating granuloma inguinale after rape. A case report.

A woman with extensive mutilating lesions of genital granuloma inguinale following rape is described. As far as is known granuloma inguinale has not previously been reported in a rape victim.

[Epidemiology and pathogenesis of donovanosis]. / Reflexões sobre a epidemiologia e patogenia da donovanose.

Thirty three cases of donovanosis have been observed at the Dermatology Department of Cayenne's Hospital between 1970 and 1982, only in black people. The high frequency of rectal lesions of passive homosexual patients and the vagina contamination in women without sexual intercourse postulate for the intestinal reservoir of the bacteria, and the possibility of auto-inoculation. There is probably a cellular immune deficit. Donovanosis is often associated with other diseases, and in our practice in French Guyana, with leprosy. The skin of the genitalia is the most frequently infected, the mucosa generally resistant. The intracellular life of the "Donovan bodies" "Calymmatobacterium granulomatosis"--in the cytoplasm of large mononuclear cells seems an argument for an anergic disease.

Granuloma inguinale.

An unusual American epidemic consisting of twenty cases of granuloma inguinale is chronicled. Evidence from this series supports the venereal transmission of the disorder. Trimethoprim/sulfamethoxazole proved to be a safe and effective therapy.

[24 cases of donovanosis in French Guiana]. / Etude de 24 cas de donovanose en Guyane française.

24 cases of Donovanosis (Granuloma inguinale) have been observed at the Dermatology Clinic of the Centre Hospitalier of Cayenne (French Guyana) between 1970 and 1980, representing a high rate for a 60,000 population. All the patients were coloured people. The disease is more important in the cutaneous parts of the ano-genital areas, than on the mucous parts. The "carcinoid" aspects of some histopathological exams must be considered with the bacteriological research and the very soft clinical aspects. It is often caused by intrarectal sexual contacts whether homo- or heterosexual. The high rate of Donovanosis within the homosexual population is a good argument for an intestinal localisation of the germ Calymnatobacterium granulomatis. All the cases diagnosed show an individual susceptibility to this disease. A deficit of cellular immunity as found in lepromatous leprosy seems a very attractive hypothesis. The treatment with 4 g of streptomycin by day during 5 days or more is considered as the best actually.