Pubic Lice

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Pubic lice, Phthirus pubis, are small, macroscopic parasites that are generally sexually transmitted, annoying, and medically trivial. Fomites also are known to transmit lice. Also called ''crabs,'' these organisms localize to the pubic hair and eyelashes, and these are distinct from head lice.

The primary symptom of lice is itching. Physical findings are often very, very subtle. The 1 to 2 mm mites are nearly skin colored and attached to hair. Very close examination with magnification generally also reveals nits, light-colored oval eggs glued to the hairs. The skin is usually normal in appearance (Fig. 24). Modified mucous membranes and the vaginal epithelium are not affected.

Tear Drop Shape Mites Skin
Figure 24 (See color insert) Pubic lice are small parasites that cling to pubic hair, with nits appearing as teardrop-shaped eggs attached to hair shafts.
Table 20 Pubic Lice

Diagnosis

Symptoms

Clinical appearance

Differential diagnosis

Therapy

Pubic lice

None, or itching

Small tan para-

Lichen simplex

Lindane,

sites and nits

chronicus,

pyrethrin,

attached to

scabies

permethrin

hair shafts

The differential diagnosis includes any pruritic disease. The diagnosis is made by the visualization of the mite or nits.

The management of pubic lice includes a screen for other sexually transmitted diseases, as these have been reported to occur more often in patients with pubic lice (66). Treatment consists of the elimination of the lice, destruction of nits, and the treatment of fomites. Lindane applied topically overnight generally kills the lice and the nits, although the nits remain glued to the hair shaft. Alternatively, over-the-counter pyrethrin or permethrin are also effective, but resistance to pyrethrin has been reported (67). The nits can be left in place, removed by shaving the affected hair, or removed with a nit comb, a very fine comb often included with the medication. Resistance of pubic lice, like head lice, is becoming recognized (Table 20).

REFERENCES

1. Centers for Disease Control: Epidemiology and prevention of vaccine-preventable diseases. Varicella Zoster. Chapter 12, Pinkbook, www.cic.gov/nip/publications/pink/ varicella.rtf, accessed July 2005.

2. Alper BS, Lewis PR. Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia? J Fam Pract 2000; 49(3):255-264.

3. Lilie HM, Wassilew S. The role of antivirals in the management of neuropathic pain in the older patient with herpes zoster. Drugs Aging 2003; 20(8):561-570.

4. Miron D, Lavi I, Kitov R, Hendler A. Vaccine effectiveness and severity of varicella among previously vaccinated children during outbreaks in day-care centers with low vaccination coverage. Pediatr Infect Dis J 2005; 24(3):233-236.

5. Wagenpfeil S, Neiss A, Wutzler P. Effects of varicella vaccination on herpes zoster incidence. Clin Microbiol Infect 2004; 10(11):954-960.

6. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271-2284.

7. Lafferty WE, Downey L, Celum C, Wald A. Herpes simplex virus type 1 as a cause of genital herpes: impact on surveillance and prevention. J Infect Dis 2000; 181:1454-1457.

8. Centers for Disease Control. 2002 Guidelines for treatment of sexually transmitted diseases. mmWR Morb Mortal Wkly Rep 2002; 51 (No. RR-6).

9. Gupta R, Wald A, Krantz E, et al. Valacyclovir and acyclovir for suppression of shedding of herpes simplex virus in the genital tract. J Infect Dis 2004; 190(8):1374—1381.

10. Kimberlin DW. Neonatal herpes simplex infection. Clin Microbiol Rev 2004; 17(1):1-13.

11. Centers for Disease Control and Prevention. Genital HPV infection, http://www. cdc.gov/sdt/HPV/STDFact-HPV.htm, accessed July, 2005.

12. Nebesio CL, Mirowski GW, Chuang TY. Human papillomavirus: clinical significance and malignant potential. Int J Dermatol 2001; 40:373-379.

13. Rosenblatt C, Lucon AM, Pereyra EA, Pinotti JA, Arap S, Ruiz CA. HPV prevalence among partners of women with cervical intraepithelial neoplasia. Int J Gynaecol Obstet 2004; 84(2):156-161.

14. Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther 2004; 17:68-101.

15. Cox JT, Petry KU, Rylander E, Roy M. Using imiquimod for genital warts in female patients. J Womens Health (Larchmt) 2004; 13:265-271.

16. Massad LS, Silverberg MJ, Springer G, et al. Effect of antiretroviral therapy on the incidence of genital warts and vulvar neoplasia among women with the human immunodeficiency virus. Am J Obstet Gynecol 2004; 190(5):1241-1248. (Erratum in: Am J Obstet Gynecol 2004; 191:1842-1844).

17. Berry JM, Palefsky JM. A review of human papillomavirus vaccines: from basic science to clinical trials. Front Biosci 2003; 8:s333-s345.

18. Stanley MA. Progress in prophylactic and therapeutic vaccines for human papillomavirus infection. Expert Rev Vaccines 2003; 2:381-389.

19. Theos AU, Cummins R, Silverberg NB, Paller AS. Effectiveness of imiquimod cream 55 for treating childhood molluscum contagiosum in a double-blind, randomized pilot trial. Cutis 2004; 74:134-8, 141-142.

20. Tran H, Moreno G, Shumack S. Imiquimod as a dermatological therapy. Expert Opin Pharmacother 2004; 5:427-438.

21. Maurer T, Rodrigues LK, Ameli N, et al. The effect of highly active antiretroviral therapy on dermatologic disease in a longitudinal study of HIV type 1-infected women. Clin Infect Dis 2004; 15(38):579-584.

22. Kiddugavumg, Kiwanuka N, Wawer MJ, et al., the Rakai Study Group. Effectiveness of syphilis treatment using azithromycin and/or benzathine penicillin in Rakai, Uganda. Sex Transm Dis 2005; 32:1-6.

23. Berman SM. Maternal syphilis: pathophysiology and treatment. Bull World Health Organ 2004; 82(6):433-438.

24. Watson-Jones D, Gumodoka B, Weiss H, et al. Syphilis in pregnancy in Tanzania. II. The effectiveness of antenatal syphilis screening and single-dose benzathine penicillin treatment for the prevention of adverse pregnancy outcomes. J Infect Dis 2002; 186: 948-957.

25. Kaufman R, Faro S, Brown D. Benign Diseases of the Vulva and Vagina. Elsevier and Mosby, 2005.

26. Hollier LM, Workowski K. Treatment of sexually transmitted diseases in women. Obstet Gynecol Clin North Am 2003; 30:751-775, vii-viii.

27. Aliyu MH, Aliyu SH, Salihu H. ''Female genital tuberculosis: a global view.'' Int J Fertil Womens Med 2004; 49:123-136.

28. Yasmeen N, Kanjee A. Cutaneous tuberculosis: a three-year prospective study. J Pak Med Assoc 2005; 55(1):10-12.

29. Zariffard MR, Novak RM, Lurain N, Sha BE, Graham P, Spear GT. Induction of tumor necrosis factor-alpha secretion and toll-like receptor 2 and 4 mRNA expression by genital mucosal fluids from women with bacterial vaginosis. J Infect Dis 2005; 191:1913-1921.

30. Sha BE, Zariffard MR, Wang QJ, et al. Female genital-tract HIV load correlates inversely with Lactobacillus species but positively with bacterial vaginosis and Mycoplasma hominis. J Infect Dis 2005; 191:25-32.

31. Moran GJ, Amii RN, Abrahamian FM, Talan DA. Methicillin-resistant Staphylococcus aureus in community-acquired skin infections. Emerg Infect Dis 2005; 11:928-930.

32. Schulz P, Allen M, Murray Q, et al. Infections due to community-acquired methicillin-resistant Staphylococcus aureus: an emergent epidemic in Kentucky. J Ky Med Assoc 2005; 103:194-203.

33. Weigelt J, Itani K, Stevens D, Lau W, Dryden M, Knirsch C. Linezolid CSSTI Study Group. Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antimicrob Agents Chemother 2005; 49:2260-2266.

34. Brauers J, Kresken M, Hafner D, Shah PM, German Linezolid Resistance Study Group. Surveillance of linezolid resistance in Germany, 2001-2002. Clin Microbiol Infect 2005; 11:39-46.

35. Taviloglu K, Cabioglu N, Cagatay A, et al. Idiopathic necrotizing fasciitis: risk factors and strategies for management. Am Surg 2005; 71:315-320.

36. Muqim R. Necrotizing fasciitis: management and outcome. J Coll Physicians Surg Pak 2003; 13:711-714.

37. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005; 352(14):1445-1453.

38. Mindrup SR, Kealey GP, Fallon B. Hyperbaric oxygen for the treatment of Fournier's gangrene. J Urol 2005; 173:1975-1453.

39. Norrby-Teglund A, Muller MP, Mcgeer A, et al. Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach. Scand J Infect Dis 2005; 37:166-172.

40. Holdiness MR. Management of cutaneous erythrasma. Drugs 2002; 62:1131-1141.

41. Donder GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002; 109:34-43.

42. Honig E, Mouton JW, van der Meijden WI. Can group B streptococci cause symptomatic vaginitis? Infect Dis Obstet Gynecol 1999; 7:206-209.

43. Shaw C, Mason M, Scoular A. Group B streptococcus carriage and vulvovaginal symptoms: causal or casual? A case-control study in a GUM clinic population. Sex Transm Infect 2003; 79:246-248.

44. Martens MG, Hoffman P, El-Zaatari M. Fungal species changes in the female genital tract. J Low Genit Tract Dis 2004; 8(1):21-24.

45. De Punzio C, Garutti P, Mollica G, Nappi C, Piccoli R, Genazzani AR. Fluconazole 150 mg single dose versus itraconazole 200 mg per day for 3 days in the treatment of acute vaginal candidiasis: a double-blind randomized study. Eur J Obstet Gynecol Reprod Biol 2003; 106:193-197.

46. Richter SS, Galask RP, Messer SA, Hollis RJ, Diekema DJ, Pfaller MA. Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases. J Clin Microbiol 2005; 43:2155-2162.

47. Sobel JD, Chaim W, Nagappan V, Leaman D. Treatment of vaginitis caused by Candida glabrata: use of topical boric acid and flucytosine. Am J Obstet Gynecol 2003; 189:1297-1300.

48. Phillips AJ. Treatment of non-albicans Candida vaginitis with amphotericin B vaginal suppositories. Am J Obstet Gynecol 2005; 192:2009-2012.

49. Sobel JD, Wiesenfeld HC, Martens M, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med 2004; 351:876-883.

50. Bern VH. New study shows probiotics ineffective in prevention of post-antibiotic vaginal candidiasis. Schweiz Rundsch Med Prax 2004; 93:1 p following 1843.

51. Jeavons HS. Prevention and treatment of vulvovaginal candidiasis using exogenous Lactobacillus. Obstet Gynecol Neonatal Nurs 2003; 32:287-296.

52. Scheinfeld NS. Obesity and dermatology. Clin Dermatol 2004; 22:303-309.

53. Budimulja U, Bramono K, Urip KS, et al. Once daily treatment with terbinafine 1% cream (Lamisil) for one week is effective in the treatment of tinea corporis and cruris. A placebo-controlled study. Mycoses 2001; 44:300-306.

54. Sanmano B, Hiruma M, Mizoguchi M, Ogawa H. Abbreviated oral itraconazole therapy for tinea corporis and tinea cruris. Mycoses 2003; 46:316-321.

55. Tarazooie B, Kordbacheh P, Zaini F, et al. Study of the distribution of Malassezia species in patients with pityriasis versicolor and healthy individuals in Tehran, Iran. BMC Derma-tol 2004; 4:5.

56. Farschian M, Yaghoobi R, Samadi K. Fluconazole versus ketoconazole in the treatment of tinea versicolor. J Dermatolog Treat 2002; 13:73-76.

57. Karakas M, Durdu M, Memisoglu HR. Oral fluconazole in the treatment of tinea versicolor. J Dermatol 2005; 32:19-21.

58. Kose O, Bulent Tastan H, Riza Gur A, Kurumlu Z. Comparison of a single 400 mg dose versus a 7-day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. J Der-matolog Treat 2002; 13:77-79.

59. Faergemann J, Gupta AK, Al Mofadi A, Abanami A, Shareaah AA, Marynissen G. Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor. Arch Dermatol 2002; 138:69-73.

60. Cohen CE, Desmond NM. Clinically resistant trichomoniasis. Sex Transm Infect 2005; 81:181.

61. Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE. Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis. Clin Microbiol Rev 2004; 17:783-793.

62. Bhalla M, Thami GP. Reversible neurotoxicity after an overdose of topical lindane in an infant. Pediatr Dermatol 2004; 21:597-599.

63. Yu KJ, Chen HH, Chang YC, Hong HS, Ho HC. Ulcerative irritant contact dermatitis from lindane. Contact Dermatitis 2005; 52:118-119.

64. Del Giudice P. The treatment of scabies: topical or systemic? Ann Dermatol Venereol 2004; 131:1045-1047.

65. Currie BJ, Harumal P, McKinnon M, Walton SF. First documentation of in vivo and in vitro ivermectin resistance in Sarcoptes scabiei. Clin Infect Dis 2004; 39:e8-e12.

66. Varela JA, Otero L, Espinosa E, Sanchez C, Junquera ML, Vazquez F. Phthirus pubis in a sexually transmitted diseases unit: a study of 14 years. Sex Transm Dis 2003; 30:292-296.

67. Speare R, Koehler JM. A case of pubic lice resistant to pyrethrins. Aust Fam Physician 2001; 30:572-574.

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Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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