[Modern diagnosis of sexually transmitted diseases]

Status quo and future perspectives of molecular diagnostics in dermatology

Molecular diagnostics (MDx) has become an indispensable pillar of diagnostics in dermatology. Modern sequencing technologies allow for identification of rare genodermatoses, analysis of somatic mutations in melanoma are prerequisite for targeted therapies, and cutaneous infectious pathogens are quickly detected by PCR and other amplification methods. However, to push innovation in molecular diagnostics and tackle so far unmet clinical needs, research activities need to be bundled and the pipeline from idea to MDx product clearly rolled out. Only then, the requirements for technical validity and clinical utility of novel biomarkers can be fulfilled and the long-term vision of personalized medicine will be realized.

Sexuell übertragbare Infektionen (STDs) und Prävention

Auch im Lichte aktueller, infektionsimmunologischer Erkenntnisse über Entstehung und Behandlung spielen im Zeitalter der modernen Therapien einschließlich Antisepsis und Antibiotika sexuell übertragbare Erkrankungen nach wie vor, und speziell für bestimmte Risikogruppen, eine bedeutende Rolle. Die grundsätzliche Behandelbarkeit lange Zeit tödlich verlaufender Infektionen wie AIDS hat andererseits sogar vielfach zu vermehrter Sorglosigkeit geführt, wodurch nicht nur die HIV-Infektion und häufig ko-akquirierte Infektionen wie Syphilis nach wie vor wichtige Infektionskrankheiten auch in entwickelten Ländern darstellen, sondern grundsätzlich viele eindämmbare Erkrankungen z.T. auch wieder vermehrt auftreten und entsprechende Probleme bereiten. Daher ist und bleibt es unumgänglich, dass sich Ärzte und sexualmedizinisches Personal ständig auch über die Möglichkeiten der Übertragung wie der Prävention sexuell übertragbarer Krankheiten auf dem Laufenden halten.

[Nonviral sexually transmitted infections-epidemiology, clinical manifestations, diagnostic workup, therapy : Part 3: Treponemes, Gardnerella and trichomonads]

In Germany, the reported syphilis prevalence has increased continuously since 2010, with a total of 6834 syphilis cases being reported in 2015. The largest increase of reported syphilis occurred in men who have sex with men (MSM). The antibiotic agent of choice for treatment of syphilis is still penicillin. There are no penicillin-resistant Treponema pallidum strains. Alternatives are ceftriaxone and doxycycline. In Germany, azithromycin is not approved for treatment of syphilis; however, therapy failures are increasingly reported. Bacterial vaginosis is accompanied by vaginal discharge. The vaginal secretion exhibits an increased pH value higher than 4.5. Clinical symptoms are pruritus, burning, and the characteristic amine odor. The probability for bacterial vaginosis is highest in women with higher numbers of sexual partners, unmarried women, early first sexual intercourse, in commercial female sex workers, and those women who regularly apply vaginal douches. The main pathogen of bacterial vaginosis is Gardnerella vaginalis. For oral therapy metronidazole is given, alternatively clindamycin; the latter should be applied additionally as topical agent. Trichomoniasis is considered as the nonviral sexually transmitted infection with the highest prevalence worldwide. Other than direct microscopic detection of the protozoa (trophozoites) in vaginal secretion or urine, PCR has been approved as the diagnostic method with the highest sensitivity. Oral metronidazole represents the therapy of choice in trichomoniasis.