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This review focuses on typical and atypical manifestations of neurosyphilis. The manifestations of neurosyphilis are manyfold and may involve many specialties. Today, clinicians have limited experience with the well-described manifestations of neurosyphilis. Many screening opportunities for men who have sex with men might catch the majority of cases of syphilis in this group. However, a concern could be if disclosure about heterosexuality or, in general, monosymptomatic neurosyphilis constitute a risk for delayed diagnosis.

Mycoplasma genitalium (MG) is a common cause of nongonococcal cervicitis and urethritis. We investigated the demographic and clinical characteristics of patients tested in Denmark with the Conformité Européenne (CE)/in vitro diagnostics (IVD) Aptima Mycoplasma genitalium assay (CE/IVD AMG; Hologic) and examined the clinical significance of the higher sensitivity of the TMA-based MG assays. From March to June 2016, urogenital and extragenital specimens from consecutive attendees at a sexually transmitted infection clinic in Copenhagen, Denmark were tested with the CE/IVD AMG assay (TMA-based), the research-use-only MG Alt TMA-1 assay (Hologic), a laboratory-developed TaqMan mgpB quantitative real-time PCR (qPCR), and the Aptima Combo 2 (CT/NG; Hologic). Demographic characteristics and clinical symptoms were collected from the patient records. There were 1,245 patients included in the study. The MG prevalence among female subjects was 9.4%, and the MG prevalence among male subjects was 8.7%. Compared to the TMA-based assays, the sensitivity of the PCR-based MG assay was 64.52%, and 55 specimens from 48 individuals were missed in the mgpB qPCR. Of these, 26 individuals (54.2%) were symptomatic, whereas, among 64 individuals with concordant results, 30 individuals (46.9%) were symptomatic; no statistically significant difference was found between the groups (P = 0.567). The improved sensitivity of the TMA-based assays resulted in diagnoses of more patients with clinically relevant symptoms for which antibiotic treatment is indicated. However, approximately half of the MG-infected patients reported no symptoms, and future research is needed to investigate the pros and cons of diagnosing and treating MG in asymptomatic subjects.

Background Kidney transplant recipients (KTRs) have increased risk of human papillomavirus (HPV)–related anogenital (pre)cancers, including anal high-grade intraepithelial lesions and cancer. Previous studies on anal high-risk HPV (hrHPV) among KTRs are sparse. Methods In a cross-sectional study, we included 247 KTRs and 248 controls from a dermatology department and 5 nephrology departments in Denmark during 2016–2017. All participants provided an anal cytobrush sample that was tested for HPV DNA. Participants completed a questionnaire on lifestyle and sexual habits. We used logistic regression to estimate odds ratios (ORs) of anal hrHPV in KTRs compared with controls and risk factors for anal hrHPV in KTRs. Results The anal hrHPV prevalence was higher in female KTRs (45.5%) than in controls (27.2%). Female KTRs had almost 3-fold higher adjusted odds of anal hrHPV than controls (adjusted OR, 2.87 [95% confidence interval, 1.57–5.22]). In contrast, among men we did not observe increased prevalence or odds of anal hrHPV in KTRs compared with controls (prevalence, 19.4% vs 23.6%; adjusted OR, 0.85 [95% 95% confidence interval, .44–1.64]). Among hrHPV-positive KTRs, 63% and 52% of men and women, respectively, were infected with hrHPV types covered by the nonavalent HPV vaccine (type 16, 18, 31, 33, 45, 52, or 58). Current smoking, >10 lifetime sexual partners, history of genital warts, and among men having had receptive anal sex were risk factors for anal hrHPV in KTRs. Conclusions Female KTRs had an increased risk of anal hrHPV compared with immunocompetent controls. Our findings indicate that pretransplant HPV vaccination should be considered to prevent anal high-grade intraepithelial lesions and cancer caused by anal hrHPV infection in KTRs. Clinical Trials Registration NCT03018327.

The aim of this study was to investigate the characteristics of patients co-infected with Chlamydia trachomatis and Neisseria gonorrhoea. A retrospective case-control study was performed, which included 399 co-infected patients seen at a sexually transmitted infection clinic in Copenhagen, Denmark. Case-control groups included 300 patients who tested positive only for N. gonorrhoea, 300 who tested positive only for C. trachomatis, and 300 who tested negative for both N. gonorrhoea and C. trachomatis in the same study period. For men, non-Danish origin (odds ratio (OR) 2.3, 95% confidence interval (Cl) 1.34–4.12), previous sexually transmitted infections with C. trachomatis (OR 3.3, 95% CI 1.94–5.92) and N. gonorrhoea (OR 10.6, 95% CI 6.36-17.76), and higher number of sex partners (OR 1.7, 95% Cl 1.40-2.28) were significantly associated with diagnosis of co-infection. For women, previous sexually transmitted infections with C. trachomatis (OR 6.7, 95% CI 3.89-11.78) and N. gonorrhoea (OR 10.4, 95% CI 4.99-21.71), and higher number of sex partners (OR 1.8, 95% CI 1.28-2.56) were significantly associated with a diagnosis of co-infection, whereas being of non-Danish origin was, in some cases, a protective factor (OR 0.3, 95% CI 0.17-0.69). Furthermore, this study demonstrated sex-associated characteristics that should raise concern about coinfection, including: for men, being of non-Danish origin, men who have sex with men status, and higher age, and, for women, young age, in particular, and previous sexually transmitted infections.

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BACKGROUND Anogenital warts (AGW) can cause physical discomfort and decreased quality of life. Recent case reports suggest that ingenol mebutate gel might be an effective treatment of AGW. OBJECTIVE To explore primarily the safety, and secondarily the efficacy of ingenol mebutate gel 0.05% in patients with AGW. METHODS This was an exploratory, open-label, 1-arm trial of ingenol mebutate gel 0.05% administered up to three times to patients with AGW. Safety was assessed by occurrence and severity of local skin reactions (LSRs) and treatment-related adverse events (AEs). Efficacy was assessed by complete clearance and reduction in AGW count 14 days after last treatment, and recurrence 12 weeks after clearance. RESULTS Of 41 patients enrolled, 40 received treatment and 26 completed the trial. Patients had a median AGW count of 11.0 and AGW duration of 3.0 years at baseline. All patients experienced transient LSRs following treatment with a maximum composite LSR score of 7.5 (on a scale from 0 to 18). A total of 93% of patients reported treatment-related AEs, most frequently pain (85%) and procedural complications (35%) due to smearing of the gel. 78% of patients took mild analgesics for the pain, typically for 1-2 days following treatment. The majority of AEs were of moderate-to-severe intensity. Seventeen of 39 patients (43.6%) had complete clearance 14 days after last treatment, and AGW count was reduced by 90.9%. There was a tendency towards lower clearance rate in patients with longer duration of AGW. Eight of 14 patients (57.1%) had AGW recurrence 12 weeks after clearance. CONCLUSION Ingenol mebutate gel was associated with a high number of AEs and withdrawals due to painful local and adjacent skin reactions. Furthermore, it showed promising efficacy in reducing AGW despite a difficult-to-treat population. Optimization of the formulation is warranted to improve the safety profile of the treatment.

Ano-genital warts are in general considered as benign lesions, as they are mostly caused by the non-oncogenic HPV types 6 and 11. In this review, there is a focus on the problematic issues, that these lesions and their treatments can cause. Both topical and ablative treatments are associated with side effects, and the varying effect of the treatments combined with an uncertain timeline to clearance are known to cause psychological distress. Vaccination against HPV-6 and -11 has been shown to reduce the incidence of this troublesome infection substantially in both women and men in countries with high vaccine coverage.

We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.

We describe a multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and azithromycin intermediate resistance in a heterosexual man in Denmark, 2017. Whole genome sequencing of the strain GK124 identified MSLT ST1903, NG-MAST ST1614 and all relevant resistance determinants including similar penA resistance mutations previously described in ceftriaxone-resistant gonococcal strains. Although treatment with ceftriaxone 0.5 g plus azithromycin 2 g was successful, increased awareness of spread of gonococcal strains threatening the recommended dual therapy is crucial.

Background and Objectives Treatment of recalcitrant viral warts remains a therapeutic challenge. Intense pulsed light (IPL) has been suggested effective to clear wart tissue. The objective was in a randomized controlled trial to assess the efficacy of paring followed by IPL versus paring alone for recalcitrant hand and foot warts. Materials and Methods Eighty-nine patients with recalcitrant hand and foot warts were included and randomized (1:1) to three treatments at 3-week intervals with either paring of warts followed by IPL or paring of warts alone. IPL was given with the Ellipse Flex IPL system (Danish Dermatologic Development A/S, Horsholm, Denmark, 400–950 nm, 5.5 millisecond pulse duration in double pulses with a 2 millisecond interval, 26.0–32.5 J/cm2 repetitive passes). The primary outcome was complete and partial clearance of warts evaluated by blinded photo assessment at 6 weeks after final treatment. Secondary outcomes were treatment related pain and adverse reactions. Results We found no significant difference in clearance of warts between the two intervention groups (OR 1.64, 95% confidence interval 0.62–4.38). Paring followed by IPL resulted in complete or partial clearance of wart tissue in nine (22%) and five patients (12.2%) versus five (13.5%) and four patients (10.8%) from paring alone. Mostly plantar warts were treated (92.1%). The pain intensity after paring and IPL was moderate and significantly higher than the pain intensity after paring alone (P

The aim of this nationwide study is to determine the strain type diversity among patients diagnosed with syphilis by PCR during a 4-year period in Denmark. Epidemiological data, including HIV status, for all patients were obtained from the Danish national syphilis registration system. Molecular strain typing was based on characterization of 3 variable treponemal genes, arp, tpr and tp0548. A total of 278 specimens from 269 patients were included. Among the fully typeable specimens (n = 197), 22 strain types were identified, with 1 type, 14d/g, accounting for 54%. The majority (93%) of the patients reported acquiring syphilis in Denmark. Among patients with concurrent HIV, 9 full strain types were identified and no difference in strain type was found by HIV status (p = 0.197). In conclusion, the majority of patients were infected in Denmark and the HIV-infected syphilis patients were diagnosed with a wide spectrum of different strain types of Treponema pallidum.

Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection. High-risk HPV causes penile cancer and a substantial proportion of oropharyngeal and anal malignancy in men. Low-risk types of HPV cause anogenital warts. The incidence of oropharyngeal and anal cancers is increasing in Denmark. Prevention of penile, anal and oropharyngeal cancers and anogenital warts represents potential benefits of the HPV vaccine; and vaccination of men is now recommended by the Australian and the North American health authorities. Thus, we recommend that the Danish HPV vaccination program should include men.

Anal intra-epithelial neoplasia is of high incidence in the post-highly active antiretroviral treatment era especially among men, who have sex with men (MSM). This article focuses on the relation between infection with oncogenic HPV types and anal intra-epithelial neoplasia, and the potential progression to anal cancer. Vaccine studies with the quadrivalent HPV vaccine in HIV-negative MSM shows promising results regarding preventing development of HGAIN.

In this case report we present an otherwise healthy 63 year-old male patient with herpes zoster corresponding to the 2nd left branch of the trigeminal nerve. Real time-polymerase chain reaction analyses were positive for both herpes simplex virus (HSV) type 1 and varicella zoster virus (VZV). The most probable explanation is that this reflects asymptomatic, latent expression of HSV-1 in a herpes zoster patient with no clinical relevance. Another hypothesis is that reactivation of a neurotropic herpes virus can reactivate another neurotropic virus if both types are present in the same ganglion. If co-infection with HSV/VZV is suspected the treatment regimen for herpes zoster will sufficiently treat a possible HSV infection also.

Diagnosing gonorrhoea from extra-genital as well as genital sites is important in managing this sexually transmitted disease. In this study we evaluated a screening procedure for Neisseria gonorrhoeae (GC) from all sample sites in a low-prevalence setting. A total of 69,252 specimens submitted for Chlamydia trachomatis testing were also examined for GC on the BD Viper™ platform using the BD Probetec ET system. In order to avoid false-positive results all GC BD reactive samples were re-tested using a PCR method with the porA pseudogene as target. Using this method we screened 170% more samples for GC than in the previous year, in the same population, and diagnosed more than twice as many GC-positive episodes. The BD system can be used successfully to screen extra-genital as well as genital specimen types for GC in a low-prevalence area if it is combined with a validated confirmatory PCR test.

Background A recent qualitative study in Denmark showed that genital warts (GWs) can considerably lower the quality of life of heterosexual patients. In this follow-up study, we interviewed men having sex with men (MSM) suffering from GWs to obtain an in-depth understanding of their perception of GWs and determine the extent to which minority (homosexual) cultural issues affect these patients' experiences. Qualitative interviews with six MSM were performed using a semi-structured interview guide. Questions were formulated on the basis of the earlier qualitative study in heterosexual patients with GWs along with a literature review. Data were analysed using a medical anthropological approach. Findings Many MSM worried about being stigmatised and excluded from the small homosexual 'scene', their key social group, thereby lowering their chances of finding sex and love. Most participants had suffered from GWs for several years which added to the negative psycho-sexual and social effects of the disease. Participants' fears of developing anal cancer were similar to those expressed about cervical cancer by females with GWs. Conclusions Ano-genital human papillomavirus (HPV) infection is common and has a serious psychological and sexual impact among MSM. However, they do not benefit to the same extent as heterosexual men from the herd immunity effect of HPV vaccination of girls. The pathological profile and concerns specific to MSM should be addressed when communicating with these patients, and should be taken into account when considering HPV vaccination of boys.

Background Genital warts, which are caused by infection with human papillomavirus (HPV), are one of the most common sexually transmitted diseases in Europe. Although genital warts are commonly perceived as a non-serious condition, treatment is often long, of varying effectiveness and the recurrence rate is high. Very few studies have been performed on the personal consequences of genital warts. The aim of this qualitative study, set in Denmark, was to examine the ways in which genital warts may affect patients' quality of life. Methods To obtain an in-depth understanding of patients' perceptions of genital warts, we used qualitative focus-group interviews with five men and five women aged between 18 and 30 years who had genital warts. The interview guide was based on a literature review that identified important issues and questions. The data were analysed using a medical anthropological approach. Results Patients' experiences were related to cultural conceptions of venereal diseases and the respective identities and sexuality of the sexes. The disease had negative psychological and social effects both for men and for women and it affected their sex and love lives, in particular. The psychological burden of the disease was increased by the uncertain timeline and the varying effectiveness of treatment. We identified a need for more patient information about the disease and its psycho-sexual aspects. Conclusions The men and women participating in this study considered their quality of life to be significantly lowered because of genital warts. The experiences described by the participants give insights that may be valuable in treatment and counselling. The quadrivalent HPV vaccine that has now been added to the childhood vaccination programme for girls in Denmark for the prevention of cervical cancer can also prevent 90% of cases of genital warts. Our results suggest that HPV vaccination could considerably reduce the largely unacknowledged psychological and social burden associated with genital warts, in men as well as women.

Pruritus ani is defined as an intense itching sensation affecting the perianal skin. The condition affects up to 5% of the population, and occurs four times more commonly in men than in women. Pruritus ani occurs in a primary form caused by overt but insufficient cleansing of the perianal skin, and in a secondary form caused by underlying pathology, often of proctological or dermatological/infectious origin. Causes and treatment are reviewed, and it is concluded that the condition, even in its chronic refractory form, has a favourable prognosis.

A recent qualitative study shows that genital warts can reduce the quality of life of heterosexual patients considerably. This follow-up study seeks to elucidate the illness perception among men who have sex with men (MSM). The aim is to examine the extent to which minority cultural conditions and factors affect the experiences of these patients.This study was based on qualitative interviews with six Danish MSM. Along with the study among heterosexual patients, a literature review identified the important questions to be presented to the participants.Many MSM worry about being stigmatized in the homosexual "scene" and thereby losing their affiliation to a significant social group as well as their chances of finding sex and love. Most participants had suffered from genital warts for several years - which added to the negative psycho-sexual and social effects of the disease. These participants' fears of developing anal cancer corresponded to the concerns of female genital warts patients about cervical cancer.Ano-genital HPV infection is common among MSM. However, these men will not benefit to the same extent as heterosexual men from the herd immunity effect of HPV vaccination of girls. MSM may have particular pathological pictures as well as concerns that should be addressed when communicating with these patients and taken into account when considering HPV vaccination of boys.

The new quadrivalent vaccine against human papillomavirus (HPV) can prevent a large number of cervical cancer cases and most cases of genital warts. Genital warts are among the most common sexually transmitted diseases in Denmark and constitute a considerable burden to the health care system as well as to the individual patient. The aim of this study is to examine the ways in which genital warts may affect the patient's quality of life. The results are important in relation to treatment as well as counselling of patients suffering from genital warts. The results are particularly relevant to decisions concerning the introduction of HPV vaccination of men as well as women.A qualitative research design was applied using focus group interviews with male and female genital wart patients aged 18-30 years. The study was based on a literature review which identified the important issues and questions presented to the participants.The participants in the study have a significantly lowered quality of life due to their genital warts. The disease negatively affects them psychologically, socially and in their sex and love life in particular. The course of treatment is a burden because of the uncertain time-line and the varying effectiveness. There is much need for more information and communication about the disease and its psycho-sexual aspects.The development of a quadrivalent HPV vaccine is a milestone in the prevention of both cervical cancer and genital warts. The knowledge of genital warts is limited despite the prevalence of the disease and its severe effects on the patient's quality of life. This study indicates that HPV vaccination of both sexes would have a marked positive effect on the mental burden associated with the disease.

The referral pattern of acute dermatologic conditions is not well described in either outpatients or hospitalized patients. The aim of this study is to describe in more detail the skin diseases that were referred for evaluation in an acute outpatient clinic at Bispebjerg Hospital, Copenhagen. In a 3-month period in 2003 a total of 428 consecutive new patients were referred for various skin diseases that needed subacute and acute dermatological evaluation in a university hospital setting. Referral pattern, age ratio and sex ratio were examined retrospectively. Two hundred and twenty-five (53%) of the 428 patients were referred from other hospital clinics in the local area. Sixty-six (15%) were referred from private practising dermatologists and 64 (15%) from general practitioners in the City of Copenhagen. Referral information was not noted in 35 (8%) of the 428 patients. The most prevalent diagnoses were: unspecified eczema (10.7%), drug eruptions (6.3 %), psoriasis (6.3%), atopic dermatitis (5.6%), bacterial skin infections (4.0%), inflammatory skin disorders (3.7%), seborrhoeic dermatitis (3.5%), urticaria (3.0%), seborrhoeic keratosis (3.0%), toxic contact dermatitis (2.8%), ulcus cruris (2.8%), autoimmune diseases (2.8%), malignant skin tumours (2.5%), candidiasis (2.5%), pruritus/prurigo (2.5%) and viral skin infections (2.5%). The fact that drug eruptions are one of the leading causes of acute referral conditions probably reflects the proximity to other hospital settings, where a large number of patients receive several systemic medicaments for various conditions.

Neutrophil dermatosis of the dorsal hands (NDDH) is a recently described skin manifestation regarded as a subset of acute febrile neutrophilic dermatotis (Sweet syndrome). We describe 5 cases with pustular and ulcerative plaques and/or bullae and vesicles of the dorsal hands. Three of the patients also had skin changes at sides other than the hands. Associated conditions were found in two patients, one patient treated with hemo-dialysis for chronic glomerulonephritis, and one patient had suffered from a streptococcal tonsillitis prior to the eruption. Two of the patients had fever, two had neutrophil leucocytosis in peripheral blood and two had elevated sedimentation rates. Histological findings showed signs of vasculitis in biopsies from two of the patients. NDDH is discussed on the basis of prior case reports concerning the subject, and it is concluded that Neutrophil dermatosis of the dorsal hands should be regarded as a localized variety of Sweet syndrome.