Genital Ulcers in Women with HIV Proposed Revision on Management Algoritm

Moerbono Mochtar

doi:10.11648/j.ajls.20170503.13

Abstract

More than 100,000 people has been infected by HIV (Human Immunodeficiency Virus) in Indonesia. Mucocutaneous disorders occur in most patients with HIV during the course of the disease, it is caused by acquired immunodeficiency or the effects of the HIV therapy. One of the most important clinical manifestations is genital ulcers. A specific attention is needed to identify the clinical manifestations of genital ulcers in HIV patients to find the etiology so that the treatment of the case can be more appropriate. There are 4 cases of genital ulcers in women with AIDS (Acquired Immune Deficiency Syndrome). Both VDRL test (Venereal Disease Reseach Laboratory) and TPHA (Trepenoma pallidum Haemagglutination) test gave negative results. Two cases has successful therapy with acyclovir 400 mg three times for 2 weeks. Test results for herpes simplex antibodies is 2 positive. The incidence of genital ulcers, especially in the chronic form, increases along with the incidence of the growing AIDS epidemic. A prospective study in Paris shows that the most common cause of genital ulcers in patients with AIDS is syphilis. All of these four cases have negative results of VDRL and TPHA, so it is necessary to consider another diagnosis as the cause of genital ulcers in immunocompromised patients that often give atypical clinical symptoms. The accuracy of the diagnosis is necessary to provide adequate treatment, especially in immunocompromised patient.

Highlights

The prevalence of HIV (Human Immunodeficiency Virus) infection is reported to be increasing worldwide
Statistical data in Indonesia through 2014 shows that there are more than 100,000 HIV patients. [1], [2] Mucocutaneous disorders occur in most cases of HIV during the course of diseases including genital ulcers
Research with larger scale may help clinicians and health authorities in determining the need for "preventive" therapy policy, or HSV-2 test in the case of genital ulcers in HIV patients. Suppressive antiviral therapy such as acyclovir can be offered to patients who had recovered from genital ulcers, in patients with CD4 cell counts less than 200 x106/L, because recurrence is more common in this group of patients. [12]

Summary

Introduction

The prevalence of HIV (Human Immunodeficiency Virus) infection is reported to be increasing worldwide. [5] Management guidelines of sexually transmitted disease issued by the Ministry of Health of the Republic of Indonesia in 2011 provide similar algorithms, it can give an 'open space' for a delay of genital ulcer therapy in HIV patients with HSV-2 infection which is atypical due to lack of clear guideline for the determining diagnosis and treatment. Author reported four cases of genital ulcer without a history and physical examination that shows vesicles in patient with HIV. 46 year old woman came to Dermatovenereology outpatient clinic of Dr Moewardi General Hospital with chief complain of ulceration in the pubic area since two days before admission. 30 years old woman came to dermatovenerology clinic with a chief complain of wound around her vagina, since 4 months ago she felt some itch, and small wound without other symptoms She went to primary health care but the lesions still exists.

Findings

Discussion

Conclusion