- 34 yr old bisexual male
- Partners in Australia and China
- Penile ulcer for 5 weeks
- Tests all negative:
- HSV PCR
- Syphilis serology
- Treponema pallidum PCR
- Microscopy and culture for Haemophilus ducreyi
- Biopsied: Histology showed non-specific inflammation only
- Referred by dermatologist
- He had been using a “cream!”
- Returned with new lesions and the tube of cream
- The cream was Kenacomb ointment
- New lesions HSV-2 positive by PCR
- Treated with valaciclovir 500 mg bd
After 1 week of valaciclovir treatment
Steroid-modified genital herpes
- Topical steroids are well known to delay healing of Herpes simplex lesions, and are contraindicated unless the patient is also being treated with an effective systemic antiviral medication.
- Kenacomb is a combination of a potent steroid (triamcinolone), an antifungal (nystatin) and two antibacterial agents (neomycin and gramicidin.)
- Kenacomb is commonly prescribed as “shotgun” therapy for a wide variety of dermatological conditions.
- Topical Kenacomb causes two main problems, both seen fairly commonly in sexual health practice:
- contact dermatitis, often severe, due to the neomycin component
- delayed healing of herpetic lesions, as represented by this case.
Dated November, 2007