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3 Big Takeaways from Fall Clinical Dermatology: STDS, LGV, and Scabies

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You can always rely on Dr. Ted Rosen to give a talk that is fun, informative, occasionally off-color, and timely, and this talk did not disappoint. Dr. Rosen concentrated on three topics:

1. Are STDs relevant in the COVID-19 era?

2. Lymphogranuloma Venereum (LGV) can present similarly to syphilis.

3. Scabies may be resistant to ivermectin and permethrin – especially in Germany?

First, STDs in COVID-19

Dr. Rosen shared that recent data reports that STDs have declined by ~33% in 2020. This may make some sense given social distancing rules. Of course, people continue to interact with each other distantly by “sexting,” mutual self-pleasuring online, and apparently there are relatively new devices called “teledildonics” that are controlled by a partner over the internet; obviously these methods do not involve transmission of STDs. However, the reported decline is probably not correct, mainly because the agencies that usually keep track of this data have been diverted to collect COVID-19 data. Apparently, there is a 70% decline in personnel at the agencies whose usual job is to keep track of STDs and HIV. A more recent study from Italy concluded the same number and types of STDs are occurring in the usual populations even during the COVID-19 lockdown. 

Good news is that COVID-19 infection does not seem to be associated with an increase in the incidence of other STDs. Nor does it change the presentation of the usual STD infections such as can happen with HIV and other co-infections. 

Is COVID-19 transmitted in semen? A study in Italy failed to find COVID in the semen of men who were positive for COVID-19 via nasal swab. However, studies in China showed that 25% of men with an acute infection did have COVID-19 detected in semen. They also found remnants of the COVID-19 virus in 9% of men who had recovered from the virus. Whether COVID-19 in semen can transmit the virus to a sexual partner remains to be reported. 

Second, Lymphogranuloma Venereum (LGV)

Traditionally, we think of LGV as having a transient ulcer and mainly presenting with tender and impressive adenopathy. However, LGV has been recently reported to present with the same signs and symptoms we usually associate with primary syphilis — a painless genital or perianal ulcer and painless or minimally painful inguinal lymphadenopathy. The ulcers may last for months, especially in the HIV+ population and men who have sex with men. This LGV strain has the serotype L2b. 

Third, Scabies

Reports are emerging in Europe of scabies infestations resistant to ivermectin and permethrin. In this situation it is appropriate to use topical Spinosad. This is formulated in alcohol and is already approved for head lice; it kills scabies with one application. Mechanism of action is causing hyperexcitability of neurons, causing paralysis and death in lice and scabies, but it does not affect mammals. 

Also, what is the best way to treat the environment once a scabies infection has been made? A recent study showed that scabies mites die when exposed to heat to more than 1,220 F; the average household hot water is 1,300 degrees so washing in hot water kills them. Mites also cannot live without a blood meal for 3–5 days so putting bedding and clothing in a bag, sealing it up, and putting it aside for five days is also effective. 

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