Extragenital Sites Research Articles

Treatment Modalities for Genital Lichen Sclerosus: A Systematic Review

Background: Lichen sclerosus (LS) is a chronic, inflammatory dermatosis that affects both genital and extragenital sites. It is often difficult to treat and may lead to a variety of complications if not adequately treated. The mainstay of therapy involves topical corticosteroids, topical calcineurin inhibitors, and systemic immunomodulators. Although a variety of topical, oral, and procedural therapies are available, a review comparing relative efficacy is lacking. To this end, this systematic review aimed to summarize the literature regarding treatment modalities and their respective response rates in patients with genital LS. Methods: A literature search was conducted in accordance with PRISMA guidelines. Results: This review qualitatively summarizes information from 31 randomized controlled trials, encapsulating a total of 1507 patients with LS, the majority of which were female (n = 1374, 91%). Topical corticosteroids, the mainstay of therapy for LS, were discussed throughout the literature, and proved to be more efficient than topical calcineurin inhibitors, topical hormonal therapy, topical vitamin E oil and cold cream. However, other treatment modalities proved to be more efficient than topical corticosteroids, including CO2 and Nd:YAG laser therapies, and the addition of polydeoxyribonucleotide intradermal injections, to steroid therapy. Finally, other modalities that proved to be efficient in the treatment of LS included silk undergarments, human fibroblast lysate cream, platelet-rich plasma, acitretin, and surgical intervention. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Limitations included the inclusion of only randomized controlled trials, moderate or high risk of bias, and heterogeneity in treatment regimens, among others. Conclusion: Although high-potency topical corticosteroids have validated efficacy in the management of LS, other treatment modalities, including steroid-sparing agents and/or procedural adjuncts, have been demonstrated to have a beneficial role in the treatment of LS.

Infection of Mycoplasma hominis in the left lower leg amputation wound of a patient with diabetes: a case report

BackgroundMycoplasma hominis is typically found on the mucosal epithelium of the human genital tract, with infections being rare. However, when the mucosal barrier is compromised or in individuals with weakened immune systems, this microorganism can trigger infections in both intragenital and extragenital sites. This study offers a comprehensive overview of infections caused by the rare pathogen M. hominis. This overview helps laboratories identify M. hominis infections in a timely manner, thereby enabling earlier clinical intervention for patients.Case presentationA 75-year-old Taiwanese man with type 2 diabetes mellitus initially underwent a left lower extremity amputation following a severe infection caused by necrotizing fasciitis. Subsequently, a poorly healing wound developed at the site of amputation. Upon culturing the wound abscess, M. hominis was isolated and identified as the causative agent.ConclusionsThrough this case, we present clinical and microbiological observations along with a review of the literature to deepen our understanding of M. hominis. Our findings can be used to develop laboratory diagnostic protocols and innovative therapeutic approaches.

Epidemiology of Chlamydia trachomatis and Repeat Positivity Following Detection in New York State.

In New York State, excluding New York City, chlamydia remains a persistent health concern. Our aim was to characterize chlamydia epidemiology and identify groups at higher risk of repeat positivity to inform targeted public health interventions. We analyzed demographic and clinical data of laboratory-confirmed chlamydia cases in New York State from 2015 to 2019. Repeat positivity was defined as a second positive chlamydia test within 31 to 365days of the initial positive test. We compared characteristics of individuals with single and repeat positivity and evaluated associations with repeat positivity using multivariable logistic regression models. During the study period, 176273 individuals were diagnosed with chlamydia, with 17253 experiencing repeat positivity. Repeat positivity was more common among individuals assigned female at birth. Key predictors of repeat positivity among females included non-Hispanic Black (adjusted odds ratio [aOR]: 1.33; 95% confidence interval [CI], 1.27-1.40) race/ethnicity, ages 13 to 19 (aOR: 1.62; 95% CI, 1.55-1.69), prior sexually transmitted infection (STI) diagnosis (aOR: 1.24; 95% CI, 1.18-1.31), symptomatic examination (aOR: 1.07; 95% CI, 1.02-1.13), and county/community (aOR: 1.10; 95% CI, 1.05-1.15) or private/public (aOR: 1.18; 95% CI, 1.11-1.25) provider. Among males, predictors included non-Hispanic Black (aOR: 1.57; 95% CI, 1.45-1.70) race/ethnicity, ages 13 to 19 (aOR: 1.27; 95% CI, 1.17-1.38), HIV coinfection (aOR: 1.30; 95% CI, 1.10-1.54), prior STI diagnosis (aOR: 1.31; 95% CI, 1.20-1.43), extragenital infection site (aOR: 2.59; 95% CI, 2.27-2.95), symptomatic examination (aOR: 1.21; 95% CI, 1.12-1.31), and county/community health (aOR: 1.09; 95% CI, 1.02-1.17) provider. Our findings provide valuable insights for sexual health interventions to prevent chlamydia transmission and recurrence. Prioritizing resources for prevention interventions and tailored sexual health promotion among non-Hispanic Black individuals is crucial. Additionally, targeted STI prevention efforts are needed for males who have sex with men and those initially diagnosed with extragenital infection. Research is warranted on STI prevention among people living with HIV or at high risk of HIV infection. Strengthening prevention strategies through Expedited Partner Therapy and sexual health education for individuals at risk of repeat positivity could enhance prevention efforts.

Standardised protocol for a prospective international multicentre clinical-based evaluation of point-of-care tests for the screening of genital and extragenital chlamydial and gonococcal infections in men who have sex with men and for the screening of genital chlamydial, gonococcal and Trichomonas vaginalis infections in at risk women

IntroductionIn 2016, WHO estimated there were roughly 374 million new infections among adults of the following four curable sexually transmitted infections (STIs): chlamydia (caused by Chlamydia trachomatis (CT)), gonorrhoea (Neisseria...

Impact of education and clinic site champion on extragenital testing for sexually transmitted infections.

Sexually transmitted infections (STIs) are on the rise in the United States. Infections at extragenital (EG) sites (throat or rectum) may serve as an overlooked reservoir for STIs. The aims of this project were to determine the proportion of patients receiving EG testing and to observe the impact of an educational intervention. Phase I included four urgent care clinics and baseline data for adults receiving STI testing (Chlamydia trachomatis and Neisseria gonorrhoeae). Clinics received access to an educational presentation regarding the importance of EG testing. Two of these clinics served as pilot sites for the implementation of self-collection kits. Phase II involved further expansion and utilization of clinic site champions. Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were from EG sites. There was an increase in EG testing after the educational intervention and implementation of self-collection kits. A larger increase in EG testing was seen after utilization of a site champion in Phase II. EG infections serve as a potential source for STI transmission which makes multi-site testing necessary. Our interventions to improve EG testing were most effective in Phase II after implementing a clinic site champion.

Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium at pharyngeal and anorectal sites in patients presenting to an STI outpatient ward.

The incidence of sexually transmitted infections (STIs) is unbridled and on the rise. Extragenital STIs (anal and pharyngeal infections) are commonly asymptomatic, resulting in delayed diagnosis and treatment and consequently higher chances of onward transmission. The aim of this observational single-centre study was to determine the prevalence of STIs at extragenital sites in symptomatic and asymptomatic patients presenting at an STI outpatient clinic. We conducted a retrospective analysis of patients who presented between October 2019 and February 2021 at the STI outpatient clinic of a tertiary centre in Central Europe. Patients were included in the study if they received at least one pharyngeal and/or anorectal swab in addition to a genital swab for multiplex-PCR STI diagnostics. Demographic data, symptoms and serological results were collected and analysed. Data collected from 440 patients were analysed (mean age: 33.9 years, male: n = 345, 78.4%, female: n = 95, 21.6%). Ninety-seven males reported having sex with men (MSM); 174 patients identified as heterosexual (132 males, 42 females), and 10 females as bisexual. The sexual orientation was not reported in 159 cases. An STI was confirmed in 195 patients (44.3%) and, among those, 109 patients (55.9%) tested positive for an STI at extragenital sites. Seventy-one patients had a pharyngeal STI whereas 61 were infected in the anorectal region. Of those suffering from an extragenital STI, 64.2% (70 out of 109) tested negative for relevant pathogens at genital sites. The most frequently detected extragenital pathogen was Neisseria gonorrhoeae (71.8% of all pharyngeal STIs [51 out of 71], 55.7% of anorectal STIs [34 out of 61]), followed by Chlamydia trachomatis (41.0% of all anal infections [25 out of 61], 5.6% of pharyngeal infections [4 out of 71]). Pharyngeal and anorectal infections were asymptomatic in 88.7% [63 out of 71] and 65.6% [40 out of 61] of the cases, respectively. These results underline the need to perform multisite testing, regardless of the presence of symptoms.

Clinicopathological Analysis of Postmenopausal Bleeding and Endometrium

Highlights: 1. Malignancies in postmenopausal bleeding are not very common, yet it is necessary to evaluate the etiology and implement appropriate treatment strategies.2. The findings of this study highlight the need for early detection of benign, premalignant, or malignant cases to provide more effective management, prevent the development of cancer, and improve the prognosis of the condition. Abstract Bleeding from the genital organ after a year of menopause is called postmenopausal bleeding. The causes may be either benign or malignant, originating from genital (uterine or extrauterine) and extragenital sites. About 3% of postmenopausal women suffer from uterine cancer. This present study aimed to analyze the clinical significance of postmenopausal bleeding concerning the source, associated risk factors, and various endometrial pathologies, including malignant and premalignant conditions. This retrospective study was conducted over four years and featured postmenopausal bleeding patients who met the inclusion criteria. Different causes of bleeding were noted and managed. Data collection on the history, clinical examination, blood test, and endometrial biopsy was performed on women with endometrial bleeding. The collected data were analyzed using standard descriptive statistics and presented using frequency tables. A total of 88 women were admitted, of whom 73 (82.95%) had endometrial bleeding and 15 (17.05%) experienced bleeding from other sites. The endometrial bleeding group mostly consisted of women aged >50–60 years (45.20%). Hypertension (26.03%), diabetes (21.91%), obesity (43.83%), and nulliparous (5.48%) were the risk factors present among the patients. The majority of the patients (41.10%) were within five years of menopause. The transvaginal ultrasound findings indicated that 56.16% of the women had an endometrial thickness of >10 mm, while 9.59% had an endometrial thickness of ≤4 mm. Upon histological investigation, endometrial hyperplasia (34.24%), atrophy (38.36%), and cancer (4.11%) were detected. Furthermore, a prevalence of 16.44% was identified as proliferative endometrium, whereas polyps were found in 6.84% of cases. In conclusion, postmenopausal bleeding is mostly benign, but it may raise concerns about the possibility of malignancy, which can be distressing for women. Disregarding the amount and frequency, postmenopausal bleeding requires a thorough evaluation, primarily because adequate management can prevent the progression of many premalignant cases to be endometrial cancer.

British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024).

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.

Clinic-based evaluation of the dual Xpert CT/NG assay on the GeneXpert System for screening for extragenital chlamydial and gonococcal infections amongst men who have sex with men

BackgroundChlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term complications. Men who have sex with men (MSM) are disproportionally affected, underscoring the need to offer screening programmes to this population. CT/NG Point of Care Testing (POCT) constitutes a strategic tool to improve the continuum of STI care, however extensive real-life evaluations amongst at risk populations are lacking. The aim of this study is to estimate the GeneXpert CT/NG assay performance and usability for CT and NG at genital and extragenital sites for screening amongst MSM.MethodsThis study was a multi-site sexual health clinic-based evaluation (Italy, Malta and Peru) with consecutive enrolment. A first void urine sample (divided in two aliquots), two oropharyngeal and two anorectal swabs were collected for each study participant. One specimen set (one for each anatomical site) was tested with the dual index test (Cepheid) at the clinics by the healthcare staff, the other set with FDA/CE approved Nucleic Acid Amplification Tests (NAATs) at the laboratory. Clinical sites and reference laboratories participated in an internal and external quality control programme. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values for each anatomical site were estimated using a meta-analytic approach.ResultsOne thousand seven hundred two MSM were recruited across all clinical sites for a total of 5049 biological specimens. NG and CT were respectively detected in 274 and 287 of samples. Overall, the NG POCT sensitivity and specificity was 91.43% and 99.75% in urine (LR + 372.80, LR- 0.09), 89.68% and 99.55% in rectal specimens (LR + 197.30, LR- 0.10) and 75.87% and 98.77% at the pharynx respectively (LR + 61.94, LR- 0.24). The CT component of the POCT sensitivity was 84.82% and specificity 99.63% in urine (LR + 228.68, LR- 0.15), 78.07% and 99.19% respectively on rectal site (LR + 96.23, LR-0.22), 67.79% and 99.88% respectively at pharyngeal site (LR + 554.89, LR- 0.32). 95.95% of MSM reported to be willing to wait for POCT results and no provider reported difficulties in terms of performance or interpretation of the results of the Xpert CT/NG.ConclusionRapid turnaround time, ease of use and high acceptability make the Xpert CT/NG testing system a strategic tool for increasing testing frequency, reaching those not yet tested and offering the possibility of immediate treatment if needed. The assay showed good negative likelihood ratios and confirms its use to rule out CT/NG infections. Sensitivity varied across sites and pathogens. Periodic staff training at the testing sites should be mandatory.

In vitro susceptibility of Neisseria gonorrhoeae to netilmicin and etimicin in comparison to gentamicin and other aminoglycosides

PurposeSingle doses of gentamicin have demonstrated clinical efficacy in the treatment of urogenital gonorrhea, but lower cure rates for oropharyngeal and anorectal gonorrhea. Formulations selectively enriched in specific gentamicin C congeners have been proposed as a less toxic alternative to gentamicin, potentially permitting higher dosing to result in increased plasma exposures at the extragenital sites of infection. The purpose of the present study was to compare the antibacterial activity of individual gentamicin C congeners against Neisseria gonorrhoeae to that of other aminoglycoside antibiotics.MethodsAntimicrobial susceptibility of three N. gonorrhoeae reference strains and 152 clinical isolates was assessed using standard disk diffusion, agar dilution, and epsilometer tests.ResultsGentamicin C1, C2, C1a, and C2a demonstrated similar activity against N. gonorrhoeae. Interestingly, susceptibility to the 1-N-ethylated aminoglycosides etimicin and netilmicin was significantly higher than the susceptibility to their parent compounds gentamicin C1a and sisomicin, and to any other of the 25 aminoglycosides assessed in this study. Propylamycin, a 4’-propylated paromomycin analogue, was significantly more active against N. gonorrhoeae than its parent compound, too.ConclusionSelectively enriched gentamicin formulations hold promise for a less toxic but equally efficacious alternative to gentamicin. Our study warrants additional consideration of the clinically established netilmicin and etimicin for treatment of genital and perhaps extragenital gonorrhea. Additional studies are required to elucidate the mechanism behind the advantage of alkylated aminoglycosides.

Maximizing the Neisseria gonorrhoeae confirmatory rate and the genotypic detection of ciprofloxacin resistance for samples screened with cobas CT/NG.

Supplementary nucleic acid amplification testing for Neisseria gonorrhoeae (NG) is widely used to circumvent specificity problems associated with extragenital sites. Here, we compared different supplementary approaches for confirming NG-positive samples from the cobas 4800 CT/NG (c4800) and cobas 6800 CT/NG (c6800) assays using the ResistancePlusGC (RP-GC) assay, which in addition to detecting NG, also predicts ciprofloxacin susceptibility via NG gyrA characterization. Two different nucleic acid extraction techniques were investigated for RP-GC detection; extracts from c4800 (c4800-RP-GC) and MagNA Pure 96 (MP96-RP-GC). NG-positive (n = 300) and -negative (n = 150) samples in cobas PCR media from routine c4800 testing were retrospectively retested with c4800, c6800, c4800-RP-GC, and MP96-RP-GC. Selected samples were also tested with Xpert CT/NG (Xpert) for discrepant analysis. The gyrA status was compared to ETEST ciprofloxacin susceptibility or non-susceptibility for recovered isolates (n = 63). Extragenital confirmatory rates were higher for MP96-RP-GC (131/140; 93.6%) compared to c4800-RP-GC (126/146; 86.3%), albeit not significantly (P = 0.6677). Of 9 samples testing positive by c6800 and negative by MP96-RP-GC, 7/9 (77.8%) were also negative by Xpert. By contrast, the number of samples returning a valid gyrA status was significantly (P = 0.0003) higher for MP96-RP-GC (270/293; 92.2%) compared to c4800-RP-GC (245/298; 82.2%). The overall MP96-RP-GC gyrA status correlated 98.4% (61/62) with the reported ciprofloxacin sensitive (35/36; 97.2%) or non-susceptible (26/26; 100%) phenotype. Improved RP-GC confirmatory rates and reported gyrA status were observed using MP96 nucleic acids compared to c4800 extracts. The data further highlight the ongoing need for NG supplemental testing for oropharyngeal samples.

2685. Impact of Education and Clinic Site Champion on Extragenital Testing for Sexually Transmitted Infection

Abstract Background Over the last several years sexually transmitted infections (STIs) have been on the rise in the United States. A potential area for improving the diagnosis of STIs is appropriate testing of extragenital (EG) sites (i.e., throat or rectum). These sites may serve as a reservoir for infection and lead to increased transmission if not identified and treated. Prior studies have shown that in men who have sex with men, genital testing alone misses >70% of STIs. In other patient groups, this may range from 10-40%. The aims of this project were twofold: to determine the proportion of patients receiving EG STI testing, and to observe the effect of a two-phase educational intervention on EG site testing. Methods Phase I (Jul-Dec 2021) included four urgent care clinics within a Midwest health system. Retrospective baseline data was ascertained for all adults receiving STI testing for Chlamydia trachomatis (CT) and Neisseria gonorrhea (GC) at these clinics. Next, all four clinics received access to an educational presentation regarding the importance of EG testing for STI detection. Two of these clinics served as pilot sites for the implementation of patient self-collection kits. Data was compiled for all adults undergoing STI testing at these clinics for a 6-month period. Phase II (Jul 2022-Mar 2023) involved further expansion and utilization of a site champion at several family medicine clinics including on-site promotion of multi-site testing and patient self-collection. Educational materials as in Phase I were provided to site champions Results Phase I baseline data indicated that less than 1% of samples from patients receiving STI testing were obtained from EG sites. There was a small increase in EG site testing after the educational intervention and implementation of self-collected swab kits (Table 1). Phase II data showed an increase in EG testing after the utilization of a clinic site champion and the sharing of testing data in family medicine clinics (Table 2). Conclusion Rates of STIs have reached an all-time high in the United States. EG infections serve as potential sources for STI transmission. Adequate multi-site testing is necessary. Implementation was most effective when a clinic site champion was identified, and clinic testing data was provided to them. Disclosures All Authors: No reported disclosures

Challenges and Solutions to STI Control in the Era of HIV and STI Prophylaxis.

This article reviews current efforts to control bacterial sexually transmitted infections (STIs) among HIV pre-exposure prophylaxis (PrEP) users and outlines the opportunities and challenges to controlling STIs within HIV PrEP programs. The incidence of STIs continues to rise globally especially among HIV PrEP users, with an estimated 1 in 4 PrEP users having a curable bacterial STI. STIs and HIV comprise a syndemic needing dual interventions. The majority of STIs are asymptomatic, and when testing is available, many STIs occur in extragenital sites that are missed when relying on urine testing or genital swabs. Optimal testing and treatment, including testing for antimicrobial resistance, pose difficulties in high income countries and is essentially non-existent in most low- and middle-income countries. Novel STI primary prevention strategies, like doxycycline post-exposure prophylaxis (PEP) for STI prevention, have proven to be highly efficacious in some populations. A few jurisdictions have issued normative guidelines and position statements for doxycycline PEP; however, clinical standards for implementation and data on public health impact are limited. STI incidence rates are high and rising in sexually active populations. Sexual health programs should leverage the expansion of HIV PrEP delivery services to integrate STI testing, surveillance, and novel STI prevention services.

A Web-Based, Mail-Order Sexually Transmitted Infection Testing Program: Qualitative Analysis of User Feedback.

The incidence of sexually transmitted infections (STIs) is increasing in the United States. The COVID-19 pandemic resulted in significant reductions in access to health care services, including STI testing and treatment, leading to underreporting of STI cases and a need for alternatives to clinic-based testing. Moreover, concerns around confidentiality, accessibility, and stigma continue to limit access to clinic-based STI testing, particularly for high-priority populations. IWantTheKit (IWTK) is a web-based platform that mails free, confidential, self-administered sample collection kits for testing for gonorrhea, chlamydia (both genital and extragenital sites), and vaginal trichomonas. Individuals visiting the IWTK website may select genital, pharyngeal, and rectal samples for chlamydia and gonorrhea testing. Vaginal samples are tested for trichomoniasis. Self-collected samples are processed in a College of American Pathologists-accredited laboratory, and results are posted to an individual's secure digital account. This study aimed to (1) describe users' experience with the IWTK service through analysis of routine data and (2) optimize retention among current users and expand reach among high-priority populations by responding to user needs through programmatic and functional changes to the IWTK service. Free-text entries were submitted by IWTK users via a confidential "Contact Us" page on the IWTK website from May 17, 2021, to January 31, 2022. All entries were deidentified prior to analysis. Two independent analysts coded these entries using a predefined codebook developed inductively for thematic analysis. A total of 254 free-text entries were analyzed after removing duplicates and nonsensical entries. Themes emerged regarding the functionality of the website and personal experiences using IWTK's services. Users' submissions included requests related to order status, address changes, replacement of old kits, clinical information (eg, treatment options and symptom reports), and reported risk behaviors. This analysis demonstrates how routine data can be used to propose potential programmatic improvements. IWTK implemented innovations on the website based on the study results to improve users' experience, including a tracking system for orders, address verification for each order, a physical drop box, additional textual information, direct linkage to care navigation, and printable results. Web-based, mail-order STI testing programs can leverage user feedback to optimize implementation and retention among current users and potentially expand reach among high-priority populations. This analysis is supported by other data that demonstrate how comprehensive support and follow-up care for individuals testing positive are critical components of any self-testing service. Additional formal assessments of the IWTK user experience and efforts to optimize posttesting linkage to care may be needed.

Extragenital canine transmissible venereal tumours: A case series

Transmissible venereal tumour is a contagious tumour frequently found in dogs in Sri Lanka. Generally, canine TVT (cTVT) is transmitted via sexual intercourse and therefore the lesions are typically found in external genitals of dogs. Due to the characteristic cauliflower like gross appearance of gross lesions of TVT, diagnosis of genital TVT is mostly easy and straight forward when confirmed by cytology. However, TVT cells may transplant on mucous membranes other than external genitals due to social behaviours of dogs and produce atypical lesions at extra genital sites. Extra genital TVT is difficult to diagnose, especially when the affected dogs lacking concurrent genital lesions. Only a limited number of extragenital cTVT case reports are published in Sri Lanka and this report provide a comprehensive description of extragenital cTVT in nine dogs presented with a variety of lesions, diagnosis and response to treatment with vincristine sulphate.

An Unusual Presentation of Extra Genital Giant Condyloma in the Gluteal Region: A Rare Case Report

Giant condyloma is a rare and sexually transmitted disease which is characterized by solitary pink or red raised lesions affecting mucosal surface of anogenital regions. Condylomas may also develop in extragenital sites. Diagnosis of genital condyloma is simple whereas extragenital condyloma is challenging. Here we present a case in a 64year old man with history of psoriasis, presenting with extragenital giant condyloma in the gluteal region.

Aggressive Angiomyxoma (AAM) at an Uncommon Site: Case Report

Aggressive angiomyxoma are rare myxoid soft tissue neoplasms, affecting the pelvis and the perineum, rarely encountered in extragenital sites, with a marked preponderance for females in the reproductive age group. AAMs are thought to be benign, locally infiltrative and non-metastasizing. Here is case report of AAM located in the posterior chest wall.

Coexistence of Genital and Extragenital LSA with Dermoscopic Features

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory dermatosis, primarily involving the anogenital region, and sometimes extragenital sites (15–20%). Rarely, patients can present with only extragenital lesions (2.5%). A 50-year-old female presented with depigmented lesions on vulva, bilateral knees and legs for 1½ years. Dermoscopy showed patchy white structureless areas with follicular plugs and histopathological examination revealed focal vacuolar degeneration of the basal layer and hyalinisation in the papillary dermis, with mild perivascular lymphohistiocytic inflammation, helping confirm the diagnosis of genital and extragenital LSA. Thus, the authors elaborate the rarity of coexistence of genital and extragenital LSA in a single patient and the use of dermoscopy as a tool in its diagnosis.

Genital and Extragenital Lichen Sclerosus et Atrophicus: A Case Series Written Using ChatGPT.

Background Lichen sclerosus et atrophicus (LSEA) is a chronic inflammatory dermatosis of genital and extragenital sites with a prevalence ranging from 9% in prepubertal patients to 50% in postmenopausal patients. Chat generative pre-trained transformer (ChatGPT) is an artificial intelligence tool designed to assist humans based on supervised and reinforcement techniques. In this study, we aimed to evaluate the characteristics of patients with LSEA using ChatGPT. Methods In this retrospective study, we included all patients who presented to the outpatient dermatology department during 2017-2022 at a tertiary care teaching hospital in South India. Information regarding demographic data, characteristics of LSEA, comorbidities, and associated autoimmune disorders was gathered using a medical chart review. Following data analysis and drafting of the manuscript, the utility of ChatGPT-3 and ChatGPT-4 in finalizing the draft was assessed. Results Of 20 patients diagnosed with LSEA, 16 (80%) and four (20%) patients were females and males, respectively. Of them, 50% of female patients had attained menopause. While 65% of patients had genital LSEA, 30% of patients had extragenital LSEA only, and 5% of patients had both genital and extragenital LSEA. Furthermore, four (20%) patients were prepubertal children. Of four male patients, two (50%) were younger than 18 years of age, and one patient was diagnosed with balanitis xerotica obliterans. The commonest associated features in LSEA included joint involvement (30%), hypertension (25%), and anemia (15%). Rare concomitant disorders includedpsoriasis, asthma, and basal cell carcinoma over the nose. Conclusions LSEA may be confused with other various dermatoses, such as morphea, vitiligo, and lichen planus. A high index of suspicion is required, especially in children, to diagnose it early and intervene to prevent further complications. Its relationship with autoimmune disorders and comorbidities warrants further large-scale studies. ChatGPT was unreliable in the literature search due to the provision of non-existent citations. ChatGPT-4 was better than ChatGPT-3 since it provided few true publications. ChatGPT was used in this study to summarize the articles identified by the authors during the literature search and to correct grammatical errors in the final draft of the manuscript.

Canine Cutaneous Extragenital Venereal Granuloma (CCEVG): Clinical and Pathological Features, Diagnostic Approach, and Treatment Strategies

Transmissible venereal tumor (TVT) is a contagious neoplasm affecting canines that is primarily transmitted through the transfer of malignant cells during coitus. TVT is a rare example of a naturally occurring allograft cancer, and studies have suggested that it may have originated from an individual dog or wolf that lived approximately 11,000 years ago (Murchison et al., 2014). The tumor is characterized by its predominantly extra-genital manifestations, which may develop from the implantation of neoplastic cells on exposed mucosae, as well as its unique genetic features. For instance, TVT has an unusual karyotype that is believed to have arisen from a rearrangement of the normal canine chromosomes, resulting in the maintenance of a stable tumor genome across the population of TVT cells (Bongiovanni et al., 2016). Young dogs, stray dogs and sexually active dogs are most regularly affected by this tumour (Nak et al., 2005). It is classified into two groups, genital TVT and extragenital TVT, depending upon the sites of the tumour mass is present (Das and Das, 2000). The most common site of TVT is the caudal penile region in male dogs and the posterior vagina region in female dogs, with the tumor frequently surrounding the urethral orifice and protruding from the vulva if located within the vagina. In rare cases, TVT may develop at extra-genital sites. Macroscopically, TVT lesions are often friable, with a low cohesion between the neoplastic cells, resulting in their propensity to hemorrhage. This tendency towards bleeding, in conjunction with the formation of nodular, granulomatous, or necrotic masses, typically forms the first clinical sign observed in affected animals. Diagnosis of TVT often involves a combination of clinical presentation, cytology, histopathology, and immunohistochemistry to differentiate it from other neoplasms. While TVT can cause significant morbidity, several chemotherapeutic agents have shown to be highly effective in treating it. Hence, this report describes canine cutaneous extragenital venereal granuloma (CCEVG) in three dogs: its clinical and pathological features, diagnostic approach, and treatment strategies.