[Syphilis and HIV infection. Characteristic features of diagnosis, clinical assessment, and treatment]. / Syphilis und HIV-Infektion. Besonderheiten der Diagnose, Klinik und Therapie.

The incidence of syphilis has increased dramatically in Germany since 2001. Homosexual men have been particularly afflicted. Several characteristic features should be taken into account in the diagnosis and treatment of HIV patients with concomitant syphilis. Since laboratory analyses are frequently unreliable, the experienced physician must pay special attention to the clinical picture. The stages in the clinical course of syphilis do not differ essentially between HIV-positive and HIV-negative patients. However, atypical and serious courses with rapid progression and CNS involvement are observed more frequently. Moreover, incorrect diagnoses are often reached. Treatment requires particular diligence. Penicillin is the agent of choice for all stages of syphilis in patients infected with HIV. Because the stages are often difficult to differentiate, the choice of which penicillin derivative should be administered is the subject of controversy. There is no safe alternative for patients allergic to penicillin.

Erosions and ulcers of the vulva: diagnosis, incidence, and management.

In a study of 877 patients with disorders of the vulva seen at a vulva clinic, 375 (43%) presented with an erosion or ulceration or a condition in which an erosion or ulceration developed as a complicating feature. One hundred sixty-one of these patients had a sexually transmitted disease. This report identifies the conditions associated with erosions and ulcerations of the vulva by incidence and provides a simple clinical classification of them as an aid in diagnosis. Methods of study of this group of diseases and their management are discussed.