Umeå University's logo

SwedAD, a Swedish nationwide registry for patients with atopic dermatitis receiving systemic pharmacotherapy, was launched on 1 September 2019. We describe here the establishment of a user-friendly registry to the benefit of patients with atopic dermatitis. By 5 November 2022, 38 clinics had recorded 931 treatment episodes in 850 patients with an approximate national coverage rate of 40%. Characteristics at enrolment included median Eczema Area and Severity Index (EASI) 10.2 (interquartile range 4.0, 19.4), Patient-Oriented Eczema Measure (POEM) 18.0 (10.0, 24.0), Dermatology Life Quality Index (DLQI) 11.0 (5.0, 19.0) and Peak Itch Numerical Rating Scale-11 (NRS-11) 6.0 (3.0, 8.0). At 3 months, median EASI was 3.2 (1.0, 7.3) and POEM, DLQI, and NRS-11 were improved. Regional coverage varied, reflecting the distribution of dermatologists, the ratio of public to private healthcare, and difficulties in recruiting certain clinics. This study highlights the importance of a nationwide registry when managing systemic pharmacotherapy of atopic dermatitis.

Chlamydia trachomatis is the most common bacterial sexually transmitted infection in Europe and has large impacts on patients' physical and emotional health. Unidentified asymptomatic rectal Chlamydia trachomatis could be a partial explanation for the high Chlamydia trachomatis prevalence. In this study, we evaluated rectal Chlamydia trachomatis testing in relation to symptoms and sexual habits in women and men who have sex with men. Rectal Chlamydia trachomatis prevalence was 9.1% in women and 0.9% in men who have sex with men. None of the patients reported any rectal symptoms; 59.0% of the women with a rectal Chlamydia trachomatis infection denied anal intercourse and 18.8% did not have a urogenital infection; 9.4% did neither have a urogenital infection nor reported anal sex. We suggest that rectal sampling should be considered in women visiting sexually transmitted infection clinics regardless of rectal symptoms and irrespective of anal intercourse, since our data suggest that several cases of rectal Chlamydia trachomatis otherwise would be missed, thus enabling further disease transmission.

Objectives: We aimed to investigate how an infection with Chlamydia trachomatis (CT) influenced patients' well-being and whether there were differences due to gender, age or relationship status, in an effort to strengthen preventive measures and provide better healthcare for patients with CT.

Methods: Patients diagnosed with CT in the county of Västerbotten, Sweden, were asked to fill out a questionnaire about their feelings, thoughts and actions after CT diagnosis. The patients were also asked to fill in the validated questionnaires Hospital Anxiety and Depression Scale and Alcohol Use Disorder Identification Test. Between February 2015 and January 2017, 128 patients (74 women and 54 men) were included in the study.

Results: After being diagnosed with CT, men were generally less worried than women (P<0.001). Women worried more about not being able to have children (P<0.001) and about having other STIs (P=0.001) than men did. Men felt less angry (P=0.001), less bad (P<0.001), less dirty (P<0.001) and less embarrassed (P=0.011) than women did. Nineteen per cent of men and 48% of women reported symptoms of anxiety. The majority of both men (60%) and women (72%) had a risk consumption of alcohol.

Conclusion: Women and men reacted differently when diagnosed with CT. Women worried more about complications and more often blamed themselves for being infected. Being aware of these gender differences may be important when planning preventive measures and during counselling of CT-infected patients. Persons working with patients with CT must also be aware of the high frequency of harmful alcohol consumption among their patients.

Objectives: The aim of the study was to investigate whether the use of dating apps is a risk factor for acquiring Chlamydia trachomatis (CT) infections.

Methods: Patients attending the drop-in facility at the STI clinic at Umea University Hospital between April 2016 and November 2017 were asked to fill in a survey about their sexual preferences and behaviors, including dating app use.

Results: Of 943 participants, 80 (8.5%) received a CT diagnosis (34 women and 46 men). Dating app users did not seem to have an increased risk of CT infection. Having 3 or more sex partners within the last year was a risk factor for CT only among those not using a dating app. Alcohol use before sex and unprotected sex with a new partner were risk factors for CT infection in the univariate but not in the multivariate analysis.

Conclusions: Dating app users did not seem to have an increased risk of acquiring CT and for dating app users the seemingly well-established risk factor of having many partners was not valid.

The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0-24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.

Klamydia är den vanligaste anmälningspliktiga infektionen i Sverige: 37 791 fall rapporterades till Smittskyddsinstitutet år 2009, och 87 procent av de smittade var i åldern 15–29 år.

Klamydiainfektion är klassad som allmänfarlig sjukdom enligt smittskyddslagen, vilket bl a innebär att en läkare som misstänker att en patient bär på smitta är skyldig att se till att patienten lämnar prov, och vid positivt provresultat se till att förhållningsregler ges samt att smittskyddsanmälan och smittspårning görs.

Provtagning görs vanligen med urinprov hos män och med självtaget vaginalprov hos kvinnor, eventuellt kombinerat med urinprov.

Majoriteten av personer med klamydia har subkliniska infektioner men kan ändå få bestående reproduktiva skador och föra smittan vidare. Ungefär var tionde kvinna med obehandlad klamydiainfektion utvecklar klinisk salpingit inom en tolvmånadersperiod. Klamydiaorsakad salpingit ökar risken för utomkvedshavandeskap och nedsatt fertilitet.

Okomplicerad genital klamydiainfektion behandlas i Sverige med doxycyklin, vanligen i lägre dosering än i många andra länder. Det är därför viktigt att se till att hela kuren tas enligt anvisningarna och att patienten informeras om att samtidigt intag av vissa läkemedel, spårämnen och födoämnen liksom alkohol kan resultera i suboptimal antibiotikaeffekt.

Contact tracing is proved to be a good way to prevent asymptomatic sexually transmitted infections, such as Chlamydia trachomatis, from spreading. According to the Swedish law a physician has to report all cases of genital C. trachomatis to the County Medical Officer of Health and to the National institute for Infectious Disease Control and perform contact tracing. An evaluation of the sexual history 6 months back in time is recommended and standard in most of the country. The county of Västerbotten has one of the lowest incidenses of C. trachomatis in Sweden though the population is younger than the Swedish average. During year 2002 the contact tracing in Västerbotten was evaluated by sending a questionnaire to everyone who reported a case of genital C. trachomatis. We recived 534 (98%) out of 544 questionnaires. The patients reported 1360 partners, 2.5 on average, 1129 were identified. 761 had a known test result and 497 of them were positive, 0.9 on average. 72% of the contact tracers evaluated the sexual history > or = 12 months back in time. 78% of the contact tracings were performed by four social workers. Their patients reported 2.5 partners on average and 80% evaluated > or = 12 months back in time. 14 persons did only one contact tracing, 1.3 partners/index on average, 40% evaluated > or = 12 months back in time. 82% of the partners had sex with the infected patient 0-6 months before the patients was diagnosed with C. trachomatis, 75% out of those with a known test result were infected, 16% had sex 7-12 months before diagnosis, 30% infected. (The C. trachomatis prevalence in Sweden is estimated to be 2.7-4.9% among young women.) Conclusion: A few experienced persons tracing for at least 12 month back in time is probably two important reasons why Västerbotten has such a small C. trachomatis incidence.

OBJECTIVES: To evaluate the Swedish model for contact tracing and especially the "Västerbotten model" with centralised, extended contact interview periods, sometimes by telephone.

METHODS: Using questionnaires, the contact tracing and interview procedure was evaluated during 2002, followed by an evaluation of contact interviewing by phone in 2005-6.

RESULTS: Patients with diagnosed Chlamydia trachomatis infection reported on average 2.5 sexual contacts, 3.0 contacts when contact interviewing was performed at the clinic, and 2.3 contacts when performed by phone. 65% of the sexual contacts with a known test result were infected.

CONCLUSION: Centralised contact tracing, exploring the sexual history for at least 12 months back in time, shows good results. Combined with screening of certain risk groups it is probably one effective way of preventing C trachomatis infections. Preventing C trachomatis by primary prevention such as information and counselling is, however, still of great importance.

Chlamydia trachomatis (CT) infection has been a target for both selective and national screening programmes, and Sweden has an opportunistic approach. A national plan of action states that risk groups should be identified and offered risk reduction counselling. Patients attending a drop-in sexually transmitted infection (STI) clinic reception at the University Hospital, Umeå, Sweden, were invited to complete a questionnaire regarding sociodemographic characteristics, symptoms and sexual risk behaviour; all had a CT test taken. A total of 1305 patients were included, 58% men, mean age 27.8 years. CT prevalence was 11%; 51% of those with CT were ≥ 25 years old. Only 5% used a condom during the entire sexual intercourse with their last new/temporary partner. Sexually active inconsistent condom users comprised 62% of the study population and contributed to 81% of the chlamydia infections. Asking whether a condom was used could quickly triage patients into groups with a 'higher risk' (none or inconsistent use of condoms and at least one new/temporary partners), and 'lower risk' (with more consistent condom use, although not always accurate) allowing for individualized care and counselling when screening for chlamydia. Evaluating whether a condom was used throughout the sexual intercourse did not add any useful information.

Introduction: Depression and hazardous alcohol consumption is associated to high-risk sexual behaviours among adolescents and young adults. Is the same true among grownups? The impact of anxiety on sexual risk behaviour is not thoroughly investigated. Our aim was to evaluate the correlation between hazardous alcohol consumption, depression and anxiety to sexual risk taking including Chlamydia infections, among patients attending an STI reception.

 Method: Patients attending an urban STI reception in Sweden were consecutively included and received questionnaires; screening- and demographic information, Alcohol Use Disorder Identification Test (AUDIT) and Hospital Anxiety and Depression scale (HAD). All patients also had a test for Chlamydia trachomatis taken.

Results: 539 patients were included in the study, mean age 28 years. 152 (30%) had signs of anxiety and 37 (7%) of depression, of which 30 had also anxiety. Neither anxiety nor depression was correlated to sexual risk behaviour. >50% had hazardous alcohol consumption and it was independently linked to sexual risk behaviours and anxiety.

Conclusion: Depression is not associated to sexual risk behaviours among adult STI-patients. Health care staff and must consider the high frequency of anxiety and hazardous alcohol consumption at their treatment of STI-clinic patients and in the preventive work. The society must work with lowering the stigmatization that still seems to be connected to STIs.

Purpose: To describe and analyse experiences of living with lipedema. Methods: Individual, semi-structured interviews with a purposive sample of 12 women diagnosed with lipedema and analysed by qualitative content analysis utilizing an inductive approach.

Results: The overarching theme, “An uncertain uphill battle against a divergent body and societal ignorance”, covers the experiences of living with lipedema and is based on five categories; “Captivated by a disintegrating body”, “Face the impairments of a chronic condi-tion”, “Experience social exclusion”, “Need emotional support to go on” and “Mull over an insecure future”. The women felt entrapped within their bodies and experienced social exclusion due to the chronic symptoms and the progressive body shape alteration caused by their illness. Having experienced deficient information on the illness, varying support from other people, and a deteriorating economic situation, the women face an uncertain future.

Conclusions: Symptoms and restrictions caused by lipedema affect women’s livelihood and future, as there are no indications for disease improvement. Preventive work aimed at reducing health deterioration should be a priority. More research is needed to raise health-care awareness regarding difficulties experienced by patients with lipedema.

Background  The pathogenesis of oral lichen planus (OLP), a chronic inflammatory disease, is not fully understood. It is known that OLP has autoimmune features, and it is suggested to be an autoimmune disease. ELF-3 is involved in differentiation of keratinocytes and deregulated in different tumours and inflammatory diseases. CXCR-3 and its ligands CXCL-10 and CXCL-11 are increased in autoimmune diseases and linked to Th-1 immune response. Objectives  To analyse and compare expression of ELF-3, CXCR-3, CXCL-10 and CXCL-11 in OLP lesions and controls in whole and microdissected epithelium. Methods  Tissue biopsies from 20 patients clinically and histologically diagnosed with OLP and 20 healthy controls were studied using whole tissues or microdissected epithelium. By the use of qRT-PCR, mRNA levels of ELF-3, CXCR-3, CXCL-10 and CXCL-11 were studied. Western blot was used for analysis of ELF-3 protein expression. Sera from 19 OLP patients and 20 controls were analysed with ELISA in search for autoantibodies. Results  The upregulation of CXCR-3, CXCL-10 and CXCL-11 found in OLP is similar to previous findings showing an autoimmune phenotype in lichen planus (LP) and lichen sclerosus. Decreased expression of the differentiation-related transcription factor ELF-3 was also seen in OLP lesions, and we further demonstrate presence of circulating autoantibodies against the ELF-3 protein in sera from 3 of 19 (16%) LP patients tested. Conclusions  On the basis of these findings, we confirm that OLP shows features of an autoimmune disease and suggest deregulated differentiation of keratinocytes to be one of the causes of the disease phenotype.

Lichen planus (LP) is a chronic mucocutaneous disease with unknown cause. Patients with LP often have both oral and genital lesions, but these conditions are often considered as separate diseases and treated accordingly. To find out which genes are differently expressed in mucosal LP compared to normal mucosa and establish whether oral and genital LP are in fact the same disease, whole genome expression analysis was performed on epithelium from 13 patients diagnosed with oral and/or genital LP and normal controls. For confirmation of keratin 4 and corneodesmosin expression, quantitative reverse-transcription PCR and immunohistochemistry were used. Many genes involved in epithelial development and differentiation are differently expressed in epithelium from LP compared to normal epithelium. Several of the differentially expressed genes are common for oral and genital LP and the same biological processes are altered which supports the fact that oral and genital LP are manifestations of the same disease. The change in gene expression indicates that differentiation is altered leading to changes in the epithelial barrier.

Lichen planus is a chronic recurrent inflammatory disease affecting both skin and mucosa, mainly in oral and/or genital regions. Keratinocytes go through a well-regulated process of proliferation and differentiation, alterations in which may result in defects in the protective epithelial barrier. Long-term barrier impairment might lead to chronic inflammation. In order to broaden our understanding of the differentiation process in mucosal lichen planus, we mapped the expression of 4 factors known to be involved in differentiation. Biopsies were collected from oral and genital lichen planus lesions and normal controls. Altered expression of all 4 factors in epithelium from lichen planus lesions was found, clearly indicating disturbed epithelial differentiation in lichen planus lesions.

BACKGROUND: Lichen planus (LP) is a chronic inflammatory, immunological, mucocutaneous disease can affect skin, genital and oral mucosa. Oral lichen planus (OLP) is the most common noninfectious, chronic inflammatory oral disease affecting 1-2% of the general adult population. World Health Organization (WHO) classifies OLP as a potentially malignant disorder. Epstein Barr virus or human herpesvirus-4, is a member of the herpes virus family and one of the most ubiquitous viruses known to human, infecting approximately 90% of the world's adult population. The virus often infects B lymphocytes resulting in a wide spectrum of mucocutaneous and systemic diseases, ranging from mild lesions to aggressive malignancies. The aim of this study was to investigate expression of the EBV encoded RNAs EBER1 and EBER2 in oral and genital lichen planus and compare results with normal tissues in situ hybridization which is considered the golden standard for detection of EBER.

MATERIAL AND METHODS: A total of 68 biopsies, 25 oral LP, 26 genital LP, 10 oral controls and finally 7 genital controls were analysed using situ hybridization.

RESULT: All samples had RNA as shown by the control slide, whereas no case contained neither EBER1 nor EBER2.

CONCLUSIONS: Based on results from our study EBV is not involved in aetiology of lichen planus.

BACKGROUND: Lichen Planus, LP, is an inflammatory disease of possible autoimmune origin affecting mainly oral and genital mucosa and skin. According to the WHO oral LP is considered a potentially malignant disorders. The p16 tumour suppressor protein can act as an inhibitor of cyclin dependent kinases 4 and 6 and thus down regulate cell cycle progression. Since the discovery of p16 several studies have evaluated its expression in various forms of human cancers. The aim of this study was to evaluate and compare the expression of p16 in oral and genital LP and corresponding healthy mucosa.

MATERIAL AND METHODS: A total of 76 cases of oral LP (OLP), 34 cases of genital LP (GLP), 12 cases of healthy oral and 9 cases of healthy genital mucosa were analysed by the use of immunohistochemistry.

RESULTS: Data showed p16 to be highly expressed in both oral and genital LP, higher than in oral (p=0.000), and genital controls (p=0.002).

CONCLUSIONS: Results suggest that the over-expression of p16 seen in LP play a part in the histopathology of the disease.

OBJECTIVE: This study aimed to emphasize the importance of seeing mucosal lichen planus (LP) as a systemic disease and not an isolated oral or genital disease and to analyze the proportion of thyroid antibodies among patients with multimucosal LP.

MATERIALS AND METHODS: All patients examined by the authors and diagnosed with mucosal LP within 1 year were consecutively included. Full medical histories were collected with special emphasis on autoimmune and thyroid diseases. Sera were analyzed for thyroid antibodies and underwent serologic test for herpes virus. The control group comprised 83 healthy volunteers matched regarding sex and age.

RESULTS: Of the patients, 120 were included, 89 (74%) of whom were women and 31 (26%) were men. The vast majority of the patients had multifocal lesions, whereas oral lesions solely were found in 28% of women and 36% of men. Of the patients, 28% had at least 1 additional autoimmune disease. Approximately half of the women were treated with levothyroxine owing to thyroid disease. Antibodies against herpes simplex virus were found in 60% of the patients and 44% of the controls (p < .03).

CONCLUSIONS: Lichen planus with mucosal involvement should be considered and taken care of as a systemic disease and not as an isolated oral and/or genital lichen. Contradictory to many former reports, most of our patients have a multimucosal disease that emphasizes the need for a multidisciplinary clinic to get optimal care and treatment.

Lichen planus is a chronic inflammatory disease of mucosa and skin affecting approximately 1-2% of the adult population. Autoimmunity has been implicated in the etiology of this disease, and recently we detected antibodies directed against all six p63 isoforms in sera from 2 out of 20 patients diagnosed with oral lichen planus (OLP) using Western blot analysis. Here we have developed an ELISA method for screening sera for presence of autoantibodies directed against p63. Using the same sera as previously analysed, we show that the optical density ratios for sera from the two patients with known autoantibodies was considerably higher compared to mean optical density ratios for all samples as well as controls analysed. Applying this novel ELISA technique for screening of sera from an additional group of 46 patients with oral and/or genital or skin lichen and 43 matched controls, we detected another three patients with autoantibodies against the p63 proteins. These data are discussed together with the observation that all five patients with detectable p63 autoantibodies from our two studies had clinically severe disease symptoms.

Epigenetic modifications are essential regulators of biological processes. Decreased DNA methylation of OAS2 (2'-5'-Oligoadenylate Synthetase 2), encoding an antiviral protein, has been seen in psoriasis. To provide further insight into the epigenetic regulation of OAS2, we performed pyrosequencing to detect OAS2 DNA methylation status at 11 promoter and first exon located CpG sites in psoriasis (n = 12) and two common subtypes of squamous cell carcinoma (SCC) of the head and neck: tongue (n = 12) and tonsillar (n = 11). Compared to corresponding controls, a general hypomethylation was seen in psoriasis. In tongue and tonsillar SCC, hypomethylation was found at only two CpG sites, the same two sites that were least demethylated in psoriasis. Despite differences in the specific residues targeted for methylation/demethylation, OAS2 expression was upregulated in all conditions and correlations between methylation and expression were seen in psoriasis and tongue SCC. Distinctive methylation status at four successively located CpG sites within a genomic area of 63 bp reveals a delicately integrated epigenetic program and indicates that detailed analysis of individual CpGs provides additional information into the mechanisms of epigenetic regulation in specific disease states. Methylation analyses as clinical biomarkers need to be tailored according to disease-specific sites.

Epigenetic modifications by DNA methylation are associated with a wide range of diseases. Previous studies. in psoriasis have concentrated on epigenetic changes in immune cells or in total skin biopsies that include stromal-associated changes. In order to improve our understanding of the role of DNA methylation in psoriasis, we sought to obtain a comprehensive DNA methylation signature specific for the epidermal component of psoriasis and to analyze methylation changes during therapy. Genome-wide DNA methylation profiling of epidermal cells from 12 patients undergoing narrow-band UVB phototherapy and 12 corresponding healthy controls revealed a distinct DNA methylation pattern in psoriasis compared with controls. A total of 3,665 methylation variable positions (MVPs) were identified with an overall hypomethylation in psoriasis patient samples. DNA methylation pattern was reversed at the end of phototherapy in patients showing excellent clinical improvement. Only 7% of phototherapy-affected MVPs (150 out of 2,108) correlate with nearby gene expression. Enrichment of MVPs in enhancers indicates tissue-specific modulation of the transcriptional regulatory machinery in psoriasis. Our study identified key epigenetic events associated with psoriasis pathogenesis and helps understand the dynamic DNA methylation landscape in the human genome.

Psoriasis is an inflammatory skin disease in which dysregulation of p63, a member of the p53 family that is crucial for skin development and maintenance, has been demonstrated. Involvement of miR-203, miR-21 and miR-125b, small non-coding RNAs implicated in the regulation of p63 or p53, has been suggested in the patho-genesis of psoriasis. To elucidate the roles of p63 and p63-related microRNAs in psoriasis and to increase our understanding of the mechanisms of narrow-band ultraviolet B (NB-UVB) phototherapy, we studied the effects of NB-UVB treatment on the expression of these molecules. Skin biopsies from 12 psoriasis patients were collected before, during and after NB-UVB therapy. Real-time PCR and immunohistochemistry showed that p63 expression was not significantly affected, whereas NB-UVB phototherapy significantly decreased expression of miR-21 (p = 0.003) and increased miR-125b levels (p = 0.003). The results indicate that the unresolved p63 abnormality in treated epidermis may play a role in maintenance of this disease.

Narrow-band UVB (NB-UVB) phototherapy is commonly used for treatment of psoriasis, though the mechanisms underlying its efficacy have not been completely elucidated. We used gene expression profiling to characterise gene expression in lesional epidermis from psoriasis patients in the middle and late stages of NB-UVB phototherapy. Increased melanogenesis gene expression was the earliest response to phototherapy. At the end of treatment, genes responding to phototherapy and correlated to treatment outcome were involved in oxidation reduction, growth and mitochondria organisation. Particularly, SPATA18, a key regulator of mitochondrial quality, was significantly down-regulated in psoriasis (p < 0.05). Poly(dA:dT) and poly(I:C) stimulation increased SPATA18 level in primary keratinocytes, indicating the importance of mitochondria quality control under innate immune induced oxidative stress. Normalised SPATA18 expression after phototherapy indicates improved mitochondrial quality control and restored cellular redox status. Our data suggest that oxidation reduction is critical for the resolution of psoriatic plaques following NB-UVB phototherapy.

Studies have shown that psychological distress has a role in the symptomology of localized provoked vulvodynia. Therefore, psychosocial support has been presented as a valuable part of the treatment. However, little is known about which psychological variables that coincide with localized provoked vulvodynia. The purpose of this study was to identify qualities of psychological distress in patients with localized provoked vulvodynia. Patients with localized provoked vulvodynia were consecutively recruited to participate in this cross-sectional questionnaire-based study. Participants completed a self-report questionnaire measuring perfectionism, impostor phenomenon, self-compassion, anxiety and perceived stress. A sample of 30 patients were included. Questionnaire results suggestive of perfectionism was seen in 63%, impostor phenomenon in 80%, low self-compassion in 27%, anxiety in 43% and perceived stress in 23% of the participants. The level of self-compassion was higher in patients in a committed relationship. The investigated qualities appear to be more common in patients with localized provoked vulvodynia than in comparable groups. Impostor phenomenon and perfectionism were particularly common, with more than half of the study population scoring above the cutoff for clinical significance. This motivates research to investigate if interventions targeting impostor phenomenon and perfectionism, may aid in the treatment of localized provoked vulvodynia.

Objective: This study aimed to investigate the prevalence of sexually transmitted infections (STIs) and colonizing bacteria in relation to urogenital symptoms.

Materials and Methods: In this cross-sectional study, patients visiting the STI clinic at Umeå University Hospital were asked for symptoms and condom use. Samples from 759 patients (465 male and 294 female) were analyzed for 4 STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium) and 3 colonizing bacteria (Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum).

Results: Chlamydia trachomatis prevalence was 11% among women and 9.5% among men. Neisseria gonorrhoeae prevalence was 0.7% among women and 0.9% among men. Mycoplasma genitalium was found in 11% and 5.6% of women and men, respectively. Asymptomatic men and women had similar distribution patterns of microorganisms as those with urogenital symptoms, with the exceptions of Neisseria gonorrhoeae- and Mycoplasma genitalium-infected men who declared symptoms more frequently. Of 158 men with urogenital symptoms, 55% were test-negative. Of 129 women with urogenital symptoms, 12% were test-negative.

Conclusions: This study reveals a complex picture, where a large number of multi-positive tests made it complicated to correlate urogenital symptoms with microorganisms. A high number of test-negative but symptomatic patients indicate a need of searching for additional pathogens.

The aim of this study was to investigate whether Swedish swingers constitute a risk group for sexually transmitted infections (STIs). Two swinger clubs were invited to participate. At swinger meetings, members were offered an STI sampling kit and a questionnaire. Samples were analyzed for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis using a multiplex real-time polymerase chain reaction assay. In total, 235 swingers participated (118 women and 117 men). Urogenital C. trachomatis prevalence was 1.7%. Urogenital M. genitalium prevalence was 7.6% for women and 4.3% for men. No one tested positive for N. gonorrhoeae or T. vaginalis. For women, the mean number of unprotected temporary sex partners within the last 12 months was four men (range 0–35) and three women (range 0–50). Among men, the mean number of unprotected temporary sex partners within the last 12 months was five women (range 0–50) and 0 men (range 0–10). During vaginal sex, 46.6% women and 38.5% men always used protection with a temporary sex partner. Swedish swingers did not seem to have an increased prevalence of STIs. However, there was high-risk sexual behavior with unprotected sex and multiple sex partners, thereby making them a vulnerable group for acquiring STIs.

Background: Sexually transmitted infections (STIs) may cause substantial individual suffering and a large economic burden for society. This study examined the seroprevalence of Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus (HSV) types 1 and 2, and several human papillomaviruses (HPV) in the Swedish population over time.

Methods: The study population consisted of 30-year-old women attending maternity care, and 50 year-old men and women attending health check-ups, from 1975 to 2018. Antibody status was determined by multiplex serology and quantified using median reporter fluorescence intensity (MFI).

Results: A total of 891 samples were analysed (519 from 30-year-old women, 186 from 50 year-old women and 186 from 50 year-old men). Of these, 41.5% showed seropositivity for Chlamydia trachomatis, 16.7% for Mycoplasma genitalium, 70.5% for HSV-1, 14.9% for HSV-2, 13.2% for high-risk HPV, and 8.3% for low-risk HPV. Seropositivity for Mycoplasma genitalium, HSV-1 and especially Chlamydia trachomatis decreased over time.

Conclusions: There was a decrease over time in Chlamydia trachomatis seroprevalence, probably due to contact tracing, testing and early treatment; this might also have affected Mycoplasma genitalium seroprevalence. Despite the reduction, seroprevalences are still high, so continued and new efforts to reduce STI incidence are essential.

The microbe Mycoplasma genitalium has in several studies been proposed as an individual cause of non-gonococcal urethritis (NGU) in men, and has been associated with pelvic inflammatory disease (PID) and salpingitis. The prevalence of M genitalium has generally been 50-90% of the prevalence of C trachomatis, and this seems to be the case in Sweden as well. This is the first study of the pathogenesis and prevalence of M genitalium in northern Sweden. In total 823 samples, 340 from women and 483 from men, were screened for M genitalium by using a PCR method. Thirtythree (4.0%) patients, 13 (3.8%) women and 20 (4.1%) men, were infected by M genitalium. In the same group 60 (7.3%) patients, 16 (4.7%) women and 44 (9.1%) men, were infected by Chlamydia trachomatis. None of the 22 patients that were tested after treatment with azitromycin was still infected.

Immunobullous diseases are chronic blistering disorders caused by the development of circulating autoantibodies. These diseases may not be suspected because they are rare, but vulval involvement is common. They can affect the quality of life and may even be lethal without treatment. Treatment, which is immunosuppressive, must always be individualised, and the best way of taking care of these patients is through multidisciplinary teams with many specialists.

Background: Mucosal lichen planus is a severe variant of lichen planus, Lichen planus (LP), which in many ways affect patients' lives. The aetiology is not fully understood, and there is no treatment clearing the disease once and for all. Oral LP has by the WHO been classified as a precancerous lesion. Micro-RNAs, miRNAs, are non-coding, small single-stranded RNAs involved in biological processes like apoptosis, proliferation, differentiation, metastasis, angiogenesis and immune response.

Methods and Results: In sera from 30 patients with multifocal mucosal LP, 15 miRNAs were identified as significantly differentially expressed compared with controls. The three most up-regulated miRNAs are all connected to oral squamous cell carcinoma or epithelial carcinoma in general.

Discussion: Even if no specific LP-associated miRNA profile was found, data clearly indicate that miRNAs could play a role in the earlier phases of lichen planus.

Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhoea, which can result in serious complications, e.g. infertility and ectopic pregnancy. The incidence of gonorrhoea is high internationally and has dramatically increased in Sweden during the last 10 years. Gonorrhoea mostly manifests as urethritis, cervicitis, and/or extragenital infections (in pharynx, rectum and eye). Urogenital infections in women and particularly pharyngeal and rectal gonorrhoea are frequently asymptomatic. Nucleic acid amplification tests (NAATs) are recommended for diagnostics, but culture remains imperative for antimicrobial susceptibility testing. Antimicrobial resistance in N. gonorrhoeae is a major concern, which compromises management and control of gonorrhoea globally. Diagnosed gonorrhoea should always be treated and the recommended first-line treatment is an injection with a high dose of ceftriaxone. Test-of-cure is recommended for all cases approximately two weeks after treatment.

BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.

Background: Symptoms from the vulva and vagina affect about one-third of all women and have a negative influence both on sexual health and psychosocial well-being. Research regarding vulvar diseases is sparse and there is a need for a better understanding of women seeking care for vulvar diseases.

Objectives: The objectives of this descriptive study were to investigate symptoms, signs, and background characteristics of women attending our multidisciplinary vulvar clinic at the University Hospital, Umeå, Sweden between 2005 and 2021.

Methods: We conducted a prospective study by using a vulvar-specific questionnaire and reviewed the medical records to collect supplementary data.

Results: A total of 600 women participated. The most common symptom among all participants was dyspareunia (67.6%). Pain diagnoses dominated in the younger population while inflammatory diseases were most common among patients 40 years of age or more. We found a significant association between dyspareunia and negative experiences of gynaecological examination (p < 0.001) as well as between pruritus and not having a regular contact with a psychologist (p < 0.05).

Conclusions: Women seeking care at our vulvar clinic exhibit a complicated and complex set of symptoms intertwined with many aspects of life. Increasing awareness among healthcare professionals, an experienced team at the clinic, and a multidisciplinary approach regarding the symptoms and needs of women with vulvar conditions are important to optimise care and treatment. Clinicians must be aware that vulvar diseases may have different symptomatology due to age. It is also important to highlight that the symptomatology presented by patients attending for vulvar diseases, has changed during the past decade.

Primary hyperhidrosis affects approximately 3% of the population and reduces quality of life in affected persons. Few studies have investigated the symptoms of anxiety, depression and hazardous alcohol consumption among those with hyperhidrosis and the effect of treatment with botulinum toxin. The first aim of this study was to investigate the effect of primary hyperhidrosis on mental and physical health, and alcohol consumption. Our second aim was to study whether and how treatment with botulinum toxin changed these effects. One hundred and fourteen patients answered questionnaires regarding hyperhidrosis and symptoms, including hyperhidrosis disease severity scale (HDSS), visual analog scale (VAS) 10-point scale for hyperhidrosis symptoms, hospital anxiety and depression scale (HADS), alcohol use disorder identification test (AUDIT) and short-form health survey (SF-36) before treatment with botulinum toxin and 2 weeks after. The age of onset of hyperhidrosis was on average 13.4 years and 48% described heredity for hyperhidrosis. Significant improvements were noted in patients with axillary and palmar hyperhidrosis regarding mean HDSS, VAS 10-point scale, HADS, SF-36 and sweat-related health problems 2 weeks after treatment with botulinum toxin. Changes in mean AUDIT for all participants were not significant. Primary hyperhidrosis mainly impairs mental rather than physical aspects of life and also interferes with specific daily activities of the affected individuals. Despite this, our patients did not show signs of anxiety, depression or hazardous alcohol consumption. Treatment with botulinum toxin reduced sweat-related problems and led to significant improvements in HDSS, VAS, HADS and SF-36 in our patients.

Background: Primary hyperhidrosis consists of excessive focal sweating. Affected individuals camouflage the sweating on their body, avoiding stigmatisation. Hence, misrepresentation in social interactions is a common feature in patients with hyperhidrosis. The aim of this study was to investigate impostor phenomenon, perfectionism, self-compassion, stress and anxiety among individuals with primary hyperhidrosis.

Methods: A cross-sectional study was conducted at our clinic among 100 participants with axillary and palmar primary hyperhidrosis. The questionnaire contained a hyperhidrosis part and Perceived Stress Scale-4, Generalised Anxiety Disorder Scale-2, Clinical Perfectionism Questionnaire-6, Self-Compassion Scale Short form and Clance Impostor Phenomenon Scale. Descriptive statistics was used for analyses of categorical variables. As data were normally distributed independent t-test and one-way analysis of variance with post hoc Tukey test were used to compare the mean values for the questionnaires with other variables. Pearson's correlation was used, and a forward multiple linear regression model was performed to predict presence of impostor phenomenon with gender, age and other scales in this study.

Results: Impostor phenomenon occurred in almost half of our patients (48%) with hyperhidrosis. While feelings of impostor phenomenon were more common in women, there was no difference between gender regarding its intensity levels (p = 0.07). In addition, we found a significant (p < 0.001) negative correlation between impostor phenomenon and self-compassion, while feelings of impostor phenomenon increased with stress, anxiety and perfectionism (p < 0.001).

Conclusions: Feelings of impostor phenomenon was found in 48% of individuals with hyperhidrosis which indicates that it is a common feature in this patient group. Future research is warranted regarding the prevalence of impostor phenomenon in hyperhidrosis and other medical conditions, among men and women, seeking medical healthcare. Psychological interventions in hyperhidrosis may be beneficial both for the individual and in public health, by facilitating management of patients' daily lives and saving considerable resources in healthcare regarding pharmacological interventions and medical consultations.

Primary hyperhidrosis means excessive focal sweating and it has a negative effect on the mental health of those affected. Although there is no gender difference regarding the prevalence of the disease, men are less likely to seek help for this condition. The aim of this study was to explore the meaning of living with primary hyperhidrosis in men. Interviews with 15 men, selected by purposive sampling, were performed at Umeå University Hospital in Sweden between June 2016 and October 2017, and analyzed using qualitative content analysis technique according to Graneheim and Lundman (2004). This study found one theme, namely, to be captured in a filthy body, based on the categories: surrender to the condition reluctantly; prepare for a sweat attack; withdraw from close contacts; and worry about others’ perceptions. The theme describes men living with hyperhidrosis feeling filthy while they struggle to control or hide the excessive sweating. Insufficient understanding from others and being reminded from the sweating is stressful and results in a sense of captivity. Interpreting the result, we conclude that the disease could stigmatize the individual, which has a negative effect on mental health and the will to seek help. Meanwhile, providing information about the disease early, as in schools, could increase the willingness of men to seek medical help. The results of this study also reinforce quantitative studies reporting the negative effects of primary hyperhidrosis on mental health.

Primary hyperhidrosis (PH) is a disease characterized by focal and excessive sweating.

Purpose: The aim of this study was to describe the experiences of men and women with PH when seeking help for their condition.

Method: A qualitative interview study with 30 men and women diagnosed with PH was conducted. Data was inductively analysed using manifest and latent content analysis.

Results: The analysis resulted in a theme: Navigating in the fog, based on the categories doubtful encounters with health care professionals, helpful encounters with health care professionals, delays due to inadequate knowledge, and supported urge for help.

Conclusions: Deficient knowledge and understanding about PH create a sense of resignation in individuals, resulting in delay of seeking treatment. Support from others, life-changing events, and finding information about PH were important motivating factors in seeking help and demanding access to treatment. A holistic approach towards patients with PH is important to reduce stigma and acknowledge the problems that are encountered in their daily lives. Educating health care professionals and students so that patients can be identified and assessed without delay and making information available about PH in schools and pharmacies could improve the general knowledge and facilitate obtaining treatment for individuals with PH.