Steroid -Modified Genital Herpes

PDF

HISTORY

  • 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

EXAMINATION

 

FURTHER HISTORY

  • He had been using a “cream!”

 

FOLLOW-UP:

  • 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

 

DIAGNOSIS 

Steroid-modified genital herpes

 

THE LESSON

  • 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
      and
    •  delayed healing of herpetic lesions, as represented by this case.

Dated November, 2007