UK national guidelines on the management of syphilis 2015.

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline.

Acute generalised exanthematous pustulosis induced by Pneumocystis jirovecii pneumonia prophylaxis with dapsone.

We describe the case of HIV-1 infected patient presenting to hospital with a severe cutaneous adverse drug reaction shortly after commencing dapsone therapy as Pneumocystis jirovecii pneumonia prophylaxis. To the best of our knowledge, acute generalised exanthematous pustulosis has not been reported as a reaction to dapsone in the setting of HIV.

Management of pyrexia of unknown origin in HIV-positive patients.

Recently, we managed the case of a young HIV-positive man with a pyrexial illness and severe constitutional symptoms, the cause of which was elusive for several weeks. Here we review the causes of pyrexia of unknown origin in HIV-positive individuals, review appropriate investigations and discuss possible empirical treatment when this is required.

Adherence to antiretroviral therapy in pregnancy.

Successful interventions to prevent congenital HIV require adherence to highly active antiretroviral therapy (HAART) in pregnancy from mothers and agreement with other interventions including mode of delivery and infant testing. We sought to audit adherence support offered antenatally, adherence with HAART, recommendations for delivery and infant testing in women receiving HIV care at our unit and delivering a child in 2004 and 2005. Of the 32 women identified, an adherence discussion was conducted when commencing therapy in 87% and subsequent visits in 77%. Five women were non-adherent with HAART, one disagreed with recommendations for delivery, and attendance at initial post-natal tests was documented in 61%. In general, the British HIV Association guidelines with regard to adherence are followed. Although numbers in this cohort are small, age, ethnicity and pre-pregnancy HIV diagnosis did not seem to affect adherence, but being therapy naïve and poor adherence may predict non-attendance at infant follow-up.

Treatment of vulvar intraepithelial neoplasia using topical imiquimod 5% cream in a genitourinary medicine clinic setting.

In the last five years, options for the treatment of vulvar intraepithelial neoplasia (VIN) have come to include the use of the immune response modifier imiquimod, following case reports of its efficacy in the USA and Europe. Despite topical imiquimod 5% cream being frequently prescribed for the treatment of ano-genital warts, there are no reports of it being used for the treatment of VIN in a genitourinary medicine setting. In this case report self-administered topical imiquimod 5% cream proved an effective treatment for undifferentiated VIN2/3 and should be considered as an alternative therapy in a genitourinary medicine setting.

Chancre redux or reinfection? A case report in an HIV-positive man.

An HIV-positive heterosexual man presented with a recurrent penile chancre, 20 months after treatment with intramuscular procaine benzyl penicillin. Was this a rare case of chancre redux (monorecidive) or re-infection?