Number Of Infectious Agents Research Articles

The main etiopathogenetic factors, features of the clinical course, diagnosis and treatment of ischemic stroke in young people

This article deals with the topical issue of today — ischemic strokes in young people. Currently, there are more than 150 identified causes of ischemic stroke, the most common of them are antiphospholipid syndrome, Fabry disease, genetic mutations, acquired and congenital thrombophilia, heart defects, a number of infectious agents, comorbid nosologies (migraine), and the use of narcotic agents. Special attention was paid to the monogenic disorders, which begin from an ischemic stroke or in which this type of stroke is one of the leading characteristics. The article shows in detail the characteristic features of each pathology, methods of diagnosis and ways of treatment, which is necessary in the work of a neuropathologist and doctors of other specialties.

The Galton–Watson branching process for TB dynamics: The potential for disease persistence or extinction

Tuberculosis is a critical problem particularly in developing countries of Africa that has resulted in a high mortality rate. The disease is transmitted through air when a susceptible individual inhales Mycobacterium tuberculosis bacteria that have been released by an infected person during coughing, sneezing, singing or speaking. In this work, we formulate and analyze a deterministic model and its corresponding continuous time Markov chain (CTMC) stochastic model to study the dynamics of tuberculosis in humans. The Galton–Watson multitype branching process is adopted to compute the stochastic threshold ρ(M) and determine the possibility of tuberculosis persistence or extinction. The next generation method is employed to find the basic reproduction number R0 and the partial rank correlation coefficient method is used to determine the most sensitive parameters in the spread of tuberculosis. Sensitivity analysis shows that the probability of TB infection, the fraction of individuals who progress to pulmonary TB, pulmonary TB induced death and human recruitment rate influence the transmission of TB disease. If the basic reproduction number R0<1 and the stochastic threshold ρ(M)<1 then tuberculosis clears in human population. If R0>1 then tuberculosis persists in the population. However, there is a possibility of tuberculosis to persist or clear if ρ(M)>1 depending on the number of infectious agents at the beginning of the tuberculosis outbreak. Results reveal that the probability of tuberculosis extinction is small if TB emerges from individuals with pulmonary TB and it is large if TB emerges from individuals with latent TB. If TB emerges from individuals with extra-pulmonary TB, then the disease clears in the population. These results suggest that it is essential to treat humans with pulmonary tuberculosis particularly at the beginning of the disease outbreak so as to control human TB.

Modern Approach to Assessing Quality of Laboratory Animals Used for Experimental Purposes

Introduction: The main task of conducting a biomedical research is to obtain statistically significant experimental results. The studies with laboratory animals used as test systems are conducted in research organizations. Owing to the introduction of good laboratory practice (GLP) principles into the world practice, stricter requirements have been imposed on the quality of test systems. The purpose of our study was to analyze the regulatory, methodological, and legislative framework governing laboratory research using biomodels in order to update a number of regulatory documents that are mandatory for implementation. Methods: We searched electronic databases of references and abstracts (Web of Science, PubMed, eLibrary) for appropriate keywords and, having reviewed search results, selected 22 literary sources on the topic. Results: We established that, based on existing regulations, specialized institutions develop internal instructions to fulfil their goals and objectives. The presence of a program of standard operating procedures allows experiments to be performed with appropriate quality. The quality of laboratory animals can be affected by unfavorable conditions of keeping, lack of balanced feeding, and violation of sanitary and hygienic standards of care. For different categories of laboratory animals, different requirements are imposed on their housing in accordance with the microbiological status. Institutions are implementing a specially developed program for health monitoring in laboratory animals. Healthy-looking animals are carriers of a number of infectious agents that can distort results of an experiment. Veterinarians specializing in laboratory animals should have knowledge of biomodeling and effects of drugs on physiological and pathological processes in animals and should perform adequate anesthesia during painful manipulations. Only employees with high qualifications and skills in working with animals are authorized to handle biomodels. Conclusions: Our findings demonstrate that the use of high-quality laboratory animals and standardization of all stages of an experiment ensures a quality research compliant with international standards.

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

Immunostimulation by chronic infection has been linked to an increased risk for different non-communicable diseases, which in turn are leading causes of death in high- and middle-income countries. Thus, we investigated if a positive serostatus for pathogens responsible for common chronic infections is individually or synergistically related to reduced overall survival in community dwelling elderly. We used data of 365 individuals from the German MEMO (Memory and Morbidity in Augsburg Elderly) cohort study with a median age of 73 years at baseline and a median follow-up of 14 years. We examined the effect of a positive serostatus at baseline for selected pathogens associated with chronic infections (Helicobacter pylori, Borrelia burgdorferi sensu lato, Toxoplasma gondii, cytomegalovirus, Epstein-Barr virus, herpes simplex virus 1/2, and human herpesvirus 6) on all-cause mortality with multivariable parametric survival models. We found a reduced survival time in individuals with a positive serostatus for Helicobacter pylori (accelerated failure time (AFT) − 15.92, 95% CI − 29.96; − 1.88), cytomegalovirus (AFT − 22.81, 95% CI − 36.41; − 9.22) and Borrelia burgdorferi sensu lato (AFT − 25.25, 95% CI − 43.40; − 7.10), after adjusting for potential confounders. The number of infectious agents an individual was seropositive for had a linear effect on all-cause mortality (AFT per additional infection − 12.42 95% CI − 18.55; − 6.30). Our results suggest an effect of seropositivity for Helicobacter pylori, cytomegalovirus, and Borrelia burgdorferi sensu lato on all-cause mortality in older community dwelling individuals. Further research with larger cohorts and additional biomarkers is required, to assess mediators and molecular pathways of this effect.

Characteristic of infectious status in patients with acutely decompencated chronic heart failure and its impact on annual prognosis

The assessment of infectious status in patients with acutely decompensated chronic heart faiure (ADCHF) without evident signs of acute inflammatory stress and its impact on the 1 year prognosis. Totally, 65 patients with ADCHF of ischemic origin investigated, age 67,3±2,3 y.o. All patients were taken markers of phagocytosis and inflammatory stress as well as antibodies to Streptococcus, Cytomegalovirus (CMV), Epstein-Barr virus (VEB), Candida albicans, Toxoplasma gondii, Aspergillus, Mycoplasma hominis and pneumonia and also level of lipopolysaccharids (LPS) of gram-negative bacteriae. More often LPS of gram-negative bacteriae were revealed in patients with ADCHF and further in decreasing order - antibodies to CMV, VEB, Streptococcus, Candida, Aspergillus and LPS. All patients have been infected by at least 2 pathogens, more than 90 % of them had 3 ones or more. Mortality in first 12 months observation correlated with quantity of patient`s pathogenic patterns (r=0,52, p=0,004). Dependency of one-year mortality from degree of viral-bacterial mixt contamination was almost linear. CMV was a monopathogen with strongest correlation with mortality (r=0,39, p=0,001). In patients with more significant infection bigger rate of re-hospitalizations about new ADCHF correlated with number of pathogens was observed (r=0,61, p=0,001). Chronic latent infection with a significant number of pathogens is characteristic of patients with low-ejection ADCHF of ischemic genesis with a significant number of pathogens: more than 90 % of patients had three or more. The most common exogenous pathogens in the study sample of patients with chronic obstructive heart failure were CMV, EBV, and hemolytic streptococcus, of the potentially endogenous ones, gram-negative intestinal bacteria. The number of infectious agents in patients with chronic obstructive heart failure has a direct correlation with deaths and re-admission to hospital with total heart failure within 1 year after discharge from the hospital.

Characterisation of the Pacific Oyster Microbiome During a Summer Mortality Event.

The Pacific oyster, Crassostrea gigas, is a key commercial species that is cultivated globally. In recent years, disease outbreaks have heavily impacted C. gigas stocks worldwide, with many losses incurred during summer. A number of infectious agents have been associated with these summer mortality events, including viruses (particularly Ostreid herpesvirus 1, OsHV-1) and bacteria; however, cases where no known aetiological agent can be identified are common. In this study, we examined the microbiome of disease-affected and disease-unaffected C. gigas during a 2013-2014 summer mortality event in Port Stephens (Australia) where known oyster pathogens including OsHV-1 were not detected. The adductor muscle microbiomes of 70 C. gigas samples across 12 study sites in the Port Stephens estuary were characterised using 16S rRNA (V1-V3 region) amplicon sequencing, with the aim of comparing the influence of spatial location and disease state on the oyster microbiome. Spatial location was found to be a significant determinant of the disease-affected oyster microbiome. Furthermore, microbiome comparisons between disease states identified a significant increase in rare operational taxonomic units (OTUs) belonging to Vibrio harveyi and an unidentified member of the Vibrio genus in the disease-affected microbiome. This is indicative of a potential role of Vibrio species in oyster disease and supportive of previous culture-based examination of this mortality event.

Ocean -The Biomedical Frontier

In 1928, with the discovery of penicillin in bread mould by Sir Alexander Fleming, a revolution sparked in drug development. Researchers started diligently shifting through soil and plants in search of new weapons to fight disease. In fact, many of today’s pharmaceuticals came from terrestrial sources. Morphine came from opium poppy. Aspirin was found in the bark of a willow tree. Digitalis, a heart medication came from the foxglove plant. Bacteria, fungi and other soil microbes also gave to an army of antibiotics and antifungals used to treat everything from strep throat to pneumonia. With the rise in the number of infectious agents that are resistant to known antibiotics, the scientists have begun to look to the tiniest organisms in the sea as new source of drugs.

The Assessment of the Association Between Herpesviruses and Subgingival Bacterial Plaque by Real-time PCR Analysis

This study used a real-time PCR analysis to determine possible correlations between periodontal presence of human cytomegalovirus, Epstein-Barr virus and various putative parodontopathogenic bacteria. The study included 18 patients (aged 18-38 years) with aggressive periodontitis, 12 patients (ages 37 to 62) with chronic periodontitis and 30 periodontally healthy subjects (aged 21-54 years). Clinical periodontal evaluation included plaque index, gingival index, percentage of bleeding on probing sites, and probing depth. In each patient, a subgingival bacterial plaque sample was obtained from the deepest periodontal pocket. The real-time fluorogenic PCR detection system was used to determine the number of infectious agents. Human cytomegalovirus was detected in 17 sites with periodontal lesions and in two healthy periodontal sites, and the Epstein-Barr virus was detected in 19 sites with periodontal lesions and in 3 normal periodontal sites. Positive correlations were found between human cytomegalovirus and P. gingivalis, T. forsythia and C. rectus. The Epstein-Barr virus positively correlated with P. gingivalis and T. forsythia. Unfavorable changes in environmental exposure or alteration of the immune system genes can periodically suppress the host�s defence against periodontal aggression, which can then result in reactivation of resident herpesviruses and increased pro-inflammatory mediators followed by an increase in pathogenic bacteria.

Evidence of non-influenza respiratory viruses among children under five years hospitalized with pneumonia, Greater Accra, 2013-2017

Introduction : acute respiratory illness contributes significantly to hospitalizations. It causes morbidity and mortality in younger children throughout the world, especially in developing countries. Pneumonia is a lower respiratory infection which causes inflammation of the lung parenchyma and leads to reduced oxygenation, shortness of breath and death. It is caused by a number of infectious agents which includes; viruses, bacteria and fungi. In 2015, pneumonia accounted for about 15% of deaths among children below five years, killing 920,136 children globally. Greater Accra records an estimated 16300 cases of pneumonia annually of which 40% are children under five years. Viral etiological agents responsible for pneumonia are not investigated, with treatment mostly focused on antibiotics. Against this introduction, this study sought to determine the contribution of non-influenza respiratory viruses (Respiratory syncytial virus, human para-influenza and adenovirus) in children under five years hospitalized with pneumonia in the Greater Accra region. Methods : a laboratory-based cross sectional study was conducted where nasopharyngeal (NP) and oropharyngeal (OP) specimen were obtained from children under five years hospitalized with pneumonia in two three health facilities. Specimen were tested via reverse transcription polymerase chain reaction (RT PCR). Data were entered into a Microsoft visual basic interface linked to SQL database. Analysis was performed using STATA v13 and data presented in proportions and charts. Results : a total of 238 nasopharyngeal and oropharyngeal swabs were obtained children under five years hospitalized with pneumonia from February 2013 through to April 2017. The mean age of the participants was 14 months (+/-13months), ranging from 2 to 58months, with 51.3% (122) males being the majority. A total of 60 (25.2%) tested positive for at least one of respiratory syncytial virus, adenovirus, human para-influenza virus 1 and 3. Relatively 39 (16.4%) were positive for RSV, 11 (4.6%) for adenovirus, 8 (3.4%) HPIV-3 and 5 (2.1%) HPIV-1. Conclusion : the study demonstrated the presence of non-influenza respiratory virus namely; RSV, HPIV-1, HPIV-3 and Adenoviruses among children under five years hospitalized with pneumonia in Greater Accra. Hence, non-investigation of these viruses before treatment with antibiotics could lead to a gap in proper patient management.

Resistance to apoptosis in Leishmania infantum-infected human macrophages: a critical role for anti-apoptotic Bcl-2 protein and cellular IAP1/2.

Apoptosis is essential for maintaining tissue homoeostasis in multi-cellular organisms, also occurring as a defence mechanism against a number of infectious agents, such as parasites. Among intracellular protozoan parasites reported to interfere with the apoptotic machinery of the host cell, Leishmania (L.) sp. have been described, although the various species might activate different pathways in their host cells. Since until now it is not yet well clarified the signalling pathway involved in the apoptosis modulation by L. infantum, the aim of this work was to investigate the role of the anti-apoptotic protein, Bcl-2, and the inhibitors of apoptosis IAP1/2 (cIAP1/2) in cell death resistance showed in L. infantum-infected human macrophages. We observed that actinomycin D-induced apoptosis in U-937 cells, evaluated by Annexin V-CY3, DNA fragmentation and caspase-3, caspase-8, caspase-9 activation assays, was inhibited in the presence of L. infantum promastigotes and that, in these conditions, Bcl-2 protein expression resulted significantly upregulated. Interestingly, L. infantum infection in combination with the Bcl-2 inhibitor, ABT-737, significantly increased the apoptotic process in actinomycin D-treated cells, suggesting a role for Bcl-2 in the anti-apoptotic regulation of human macrophages induced by L. infantum infection. Moreover, Western blotting analysis demonstrated not only a significantly upregulation of cIAP1/2 in infected U-937 cells, but also that the inhibition of cIAPs, employing specific siRNAs, restored the apoptotic effect of actinomycin in infected macrophages. These results clearly support the hypothesis that Bcl-2 and cIAPs are strongly involved in the anti-apoptotic action played by L. infantum in human macrophages.

Detection and characterisation of Clostridium difficile in Australian Thoroughbred foals

Diarrhoea is a common disease in young foals that is labour intensive and costly to manage. A large number of infectious agents have been detected in foals with diarrhoea, but the pathogenic importance of many of these agents is poorly understood. Clostridium difficile has been associated with severe necrotising enteritis in foals, but has also been isolated from healthy foals. Hypervirulent strains of C. difficile, such as ribotypes 027 and 078, commonly associated with human hospital outbreaks of diarrhoea, have also been detected in some animal populations. There are limited data on C. difficile disease in Australian horses. In a prospective case control investigation of diarrhoea in foals, faecal samples were collected on five Thoroughbred breeding farms in New South Wales, Australia, from foals with diarrhoea and age-matched control foals (agematched pair). In addition, faeces were collected from foals with diarrhoea at an equine referral hospital. Foal faeces were tested for the presence of C. difficile using a quantitative polymerase chain reaction assay (qPCR) targeting the gene encoding triose phosphate isomerase. Anaerobic culture for C. difficile was performed on samples that tested positive by qPCR and isolates were further characterised by ribotyping. In total, 117 age

Selection of Substrate Material for Protein Arrays

Problems of multiplex test development for the detection of antibodies to a number of infectious agents in clinical blood samples using protein arrays are discussed. Experimental data on the evaluation of microstructure and adsorption properties of synthetic materials for protein chip substrate are presented. The synthetic paper Pentaprint PR-M480/09-07/8101-482D8 was recognized as the best of the studied materials for the production of protein arrays.

Nouveaux risques viraux en transfusion sanguine à l’horizon 2016

Viral safety remains a major concern in transfusion of blood products. Over years, the control measures applied to blood products were made more and more sophisticated; however, the number of infectious agents, and notably of viruses, that can be transmitted by transfusion is increasing continuously. The aim of this review paper is to actualize that published in the same journal by the same authors in 2011 with more details on some of actual vs virtual viral threats that were identified recently in the field of blood transfusion. The main subjects that are covered successively concern the transmission via transfusion of hepatitis E virus, the frequency of transfusion transmitted arboviruses, transfusion at the time of the Ebola epidemics in West Africa, the debated role of Marseillevirus (giant viruses infecting amoebae and suspected to infect human blood latently), and, finally, the recent report of the identification in blood donors of a new member of the Flaviviridae family. The addition of these new viral risks to those already identified—partially controlled or not—pleads for the urgent need to move forward to considering inactivation of infectious agents in blood products.

Prevention of infection-related cancers in the WHO Western Pacific Region.

A considerable number of infectious agents have been classified as human carcinogens Group 1 by the International Agency for Research on Cancer. Major infection-related cancers such as cancers of nasopharynx (53%), stomach (60%) and liver (63%) occur in the World Health Organization Western Pacific Region. Many infection-related cancers are preventable, particularly those associated with human papilloma virus, Helicobacter pylori, human immunodeficiency virus-I, hepatitis B virus and hepatitis C virus and liver flukes. Mongolia shows the highest prevalence of hepatitis B virus and hepatitis C virus, and China shows the highest prevalence of Helicobacter pylori. Chronic infection is attributable for 17-28% of overall cancer incidence or mortality in China, Japan and Korea. Through infant immunization for hepatitis B, 30 of 37 countries and areas in the Western Pacific Region have reached the 2012 milestone of chronic hepatitis B virus infection prevalence of <2% in 5-year-old children and countries and areas of the region are now striving toward reaching the regional goal of <1% by 2017. Human papilloma virus immunization program is implemented either by government funding or, in some low-income countries, by public and private sector organizations. Cervical cancer screening via visual inspection with acetic acid or Pap smear is available in many Western Pacific Region Member States. More efforts are needed to implement new World Health Organization guide to vaccinate 9- to 13-year-old girls with two doses of human papilloma virus vaccine, and use human papilloma virus tests to screen women to prevent and control cervical cancer including guaranteed monitoring and appropriate follow-up for abnormal results.

Sudden infant death syndrome: Postulated role of impaired vasoactive neuropeptide-related inflammatory modulation

Sudden infant death syndrome (SIDS) has been extensively investigated in the context of infection as a contributing factor in the death of otherwise apparently healthy infants. A number of infectious agents have been implicated suggesting the causal pathomechanism is related to infection, but not necessarily solely attributable to any one type of infection. An alternative provocative hypothesis is that of post-infection autoimmunity affecting critical novel neurotransmitters of the vasoactive neuropeptide family. Their role in respiratory and cardiac functioning together with novel hypotheses postulating their autoimmune compromise may suggest a role in SIDS etiology following infection. Animal models demonstrate their vital role in neonatal survival and the neuronal control of breathing. Autoimmune compromise of vasoactive neuropeptide receptors through molecular mimicry following infection or idiopathic autoimmunity is postulated as a cause of SIDS.

Frequency of seropositivity against infectious agents amongst pemphigus vulgaris patients: a case-control study on Strongyloides stercoralis, Helicobacter pylori, Toxoplasma gondii, Leishmania major, and Epstein-Barr virus.

Environmental and genetic factors may contribute to the pathogenesis of pemphigus vulgaris (PV) as an autoimmune disease. We aimed to determine rates of seropositivity for immunoglobulin G (IgG) antibodies against a number of infectious agents in untreated and treated PV patients and in healthy individuals. Eighty-two newly diagnosed untreated PV patients (34 men and 48 women; mean ± standard deviation [SD] age: 44.18 ± 14.43 years) and 36 previously diagnosed patients under immunosuppressive therapy (16 men and 20 women; mean ± SD age: 38.53 ± 9.96 years) were enrolled in the study. The clinical diagnosis of PV was confirmed by histopathology and direct immunofluorescence findings. As a control group, 131 healthy individuals (68 men and 63 women; mean ± SD age: 42.56 ± 19.69 years) were recruited. In all patients and controls, serum IgG antibodies against Strongyloides stercoralis, Helicobacter pylori, Epstein-Barr virus (EBV) capsid antigen, and Leishmania major were measured using enzyme-linked immunosorbent assays. The indirect immunofluorescence test was used to detect IgG antibodies against Toxoplasma gondii. Newly-diagnosed untreated PV patients had significantly higher rates of seropositivity of IgG antibodies against S. stercoralis and H. pylori compared with the control group (69.5% vs. 16.0% [P < 0.001] and 79.3% vs. 59.5% [P = 0.004], respectively). For the other agents, namely T. gondii, L. major, and EBV capsid antigen, the differences between groups in seropositivity for IgG antibodies were not statistically significant. Significant associations between S. stercoralis and H. pylori seropositivity rates and untreated disease led to the hypothesis that these pathogenic agents may contribute to the pathogenesis of PV.

The role of wild canids and felids in spreading parasites to dogs and cats in Europe: Part I: Protozoa and tick-borne agents

Over the last few decades, the world has witnessed radical changes in climate, landscape, and ecosystems. These events, together with other factors such as increasing illegal wildlife trade and changing human behaviour towards wildlife, are resulting into thinning boundaries between wild canids and felids and their domestic counterparts. As a consequence, the epidemiology of diseases caused by a number of infectious agents is undergoing profound readjustements, as pathogens adapt to new hosts and environments. Therefore, there is a risk for diseases of wildlife to spread to domestic carnivores and vice versa, and for zoonotic agents to emerge or re-emerge in human populations. Hence, the identification of the hazards arising from the co-habitation of these species is critical in order to plan and develop adequate control strategies against these pathogens. In the first of this two-part article, we review the role that wild canids and felids may play in the transmission of protozoa and arthropod-borne agents to dogs and cats in Europe, and provide an account of how current and future progress in our understanding of the ecology and epidemiology of parasites, as well as of host-parasite interactions, can assist efforts aimed at controlling parasite transmission.

Infection and Colorectal Neoplasm

Colorectal cancer is a major cause of cancer-related morbidity and mortality. Colorectal cancer is the third most common malignancy and the 4th most common cause of cancer mortality worldwide. A number of infectious agents are considered to be cancer risk factors due to the hypothesis-generating and supportive evidence accumulated to date. It has been estimated that one fifth of all cancer is caused by some infectious agent(s). Infections from certain bacteria, such as Helicobacter pylori (H. pylori), Streptococcus bovis (S. Bovis), viruses, such as human papillomavirus (HPV), human cytomegalovirus (HCMV), and parasites may increase the risk of colorectal cancer. More studies are needed to learn the association of infectious agents with the incidence of colorectal cancer.Keywords: colorectal cancer, infectious agents, malignancy, neoplasms

Molecular analysis of β-lactamase genes to understand their differential expression in strains of Yersinia enterocolitica biotype 1A.

Beta-lactams are used as major therapeutic agents against a number of infectious agents. Due to widespread use of β-lactams, β-lactamases have evolved at a rapid pace leading to treatment failures. Yersinia enterocolitica causes many gastrointestinal problems. It is an extremely heterogeneous species comprising more than fifty serotypes and six biotypes which differ in their ecological niches, geographical distribution and pathogenic potential. Though biotype 1A strains have been associated with outbreaks of Yersiniosis, there has been a controversy regarding their pathogenicity. The strains of Y. enterocolitica isolated from India belonged to biotype 1A and possessed genes for two β-lactamases namely, blaA and blaB. An earlier study by us reported differential expression of blaA by strains of Y. enterocolitica biotype 1A. The present study has been carried out to understand the molecular bases which regulate the expression of blaA in Y. enterocolitica biotype 1A. We concluded that six types of blaA variants were present in strains of biotype 1A. Neither amino acid substitutions in blaA nor mutations in promoter regions of blaA contributed to differential expression of blaA in Y. enterocolitica biotype 1A. Rather, the secondary structures attained by mRNA of blaA might underlie the differential expression of blaA in Y. enterocolitica.

Protocolo diagnóstico y terapéutico de las úlceras genitales

A small number of infectious agents cause most genital ulcers, but they can also be produced by non-infectious diseases. They constitute one of the most frequent reasons for consultation in sexually transmitted infections centers. In Spain, the most common causes of genital ulcers are herpes (HSV 1 and 2) and syphilis (Treponema pallidum). Chancroid (Haemophilus ducreyi), lymphogranuloma venereum (Chlamydia trachomatis) and inguinal granuloma (Klebsiella granulomatis) are other infectious diseases, much less frequent, that produce genital ulcers. The history and physical examination are essential to guide the diagnosis, but often can be misleading. Therefore confirmatory microbiological tests must be performed at least for syphilis and herpes. Performing these tests should not delay the start of treatment for the most likely causes. Waiting for diagnostic confirmation, empirical treatment for more than one etiology (e.g. herpes and syphilis) can be initiated.