A "sexually transmitted" fixed drug reaction

2022 European guideline for the management of balanoposthitis

BACKGROUND

This guideline is an update to the 2014 edition of the European guideline for the management of balanoposthitis. Balanoposthitis describes inflammation of the glans penis and prepuce and is caused by a range of disparate conditions including infection, dermatoses and premalignancy.

OBJECTIVE

The main objectives of this guideline are to aid recognition of the symptoms and signs and complications of penile skin conditions and to offer recommendations on the diagnostic tests and treatment for a selected group of these conditions.

METHODS

The previous guideline was updated following a literature review and priority was given to randomized controlled trial and systematic review evidence.

RESULTS

The updated guideline includes amended management for infective balanitis to provide clear guidance for Group A streptococcal infections, management of on going Lichen sclerosus (to include circumcision and supportive management to reduce the recurrence of genital herpes and warts), additional regimens for Zoonoid change, use of calcineurin inhibitors in management and risk of premalignancy and change of nomenclaturefrom Premalignant conditions to Penile Intraepithelial neoplasia (PeIN).

CONCLUSION

Balanoposthitis has a widerange of causes high quality evidence specific to the management of penile disease is not available for all the conditions described.

[Cutaneous and mucosal manifestations of sexual practices]

Sexual activity may on occasion be associated with local trauma, infections or allergies. During visits, patients may be reluctant to report on the circumstances leading to such lesions. The dermatologist may be unfamiliar with these manifestations, especially where they occur outside the genital area. Our aim is to present the spectrum of genital and extra-genital signs associated with sexuality. The dermatologist must feel sufficiently confident to broach the patient's sexual history in order to avoid any diagnostic errors and unnecessary explorations.

Anaphylaxis probably induced by transfer of amoxicillin via oral sex

We present a case of a possible amoxicillin-induced anaphylaxis in a sensitive woman triggered by an instance of oral sexual contact with a man who was taking amoxicillin-clavulanic acid treatment.To our knowledge, this is the first case reported of a suspicion of amoxicillin-induced anaphylaxis in a woman after a sexual contact with a man who was taking the drug, we hypothesised an oral drug transfer through semen.Studies about amoxicillin concentrations achieved in semen after a drug intake are scarce. There are few cases reported of hypersensitivity reactions induced by drugs transported in semen but we have found some concern in sensitive patients about the possibility of transference of allergens via sexual intercourse. As clinicians, we consider that it is important to be aware of the existence of this possibility both in the diagnosis and in the prevention of anaphylactic reactions.