title: Advances in sexually transmitted infections of the gastrointestinal tract.
abstract: The gastrointestinal mucosa is a target of many sexually transmitted infections, and major advances have increased our understanding of the consequences of such infections within the gastrointestinal system. HIV-1 is associated with a marked loss of mucosal CD4(+) T cells that express CC-chemokine receptor 5. This process seems to be more rapid and more severe in mucosa-associated lymphoid tissue than in the peripheral blood. Mechanistic insights into the underlying cause of acute and chronic gastrointestinal damage with HIV infection-microbial translocation, defects in intestinal epithelial barrier function and activation of a systemic immune response-have also been achieved. Increased understanding of the pathogenesis of mucosal HIV-1 infection may identify therapeutic targets to restore immunological function and the integrity of the intestinal mucosal epithelial barrier. The increasing prevalence of lymphogranuloma venereum in Europe, mostly in HIV-positive men who have sex with men, suggests a change in the epidemiology of what was previously considered to be a 'tropical' disease. The increasing incidence of acute HCV infection transmitted via sexual contact has also been fueled by high-risk sexual behaviors among men who have sex with men, many of whom are also HIV-positive. The first part of this Review discusses the pathogenesis and gastrointestinal complications of HIV infection, and the second part summarizes advances in our understanding of other sexually transmitted infections of the gastrointestinal system.
authors.affiliation: Department of Gastroenterology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
mesh_terms: D005767:Gastrointestinal Diseases / Q000503:physiopathology / Q000821:virology*; D041981:Gastrointestinal Tract / Q000503:physiopathology / Q000821:virology; D015658:HIV Infections / Q000150:complications* / Q000209:etiology / Q000635:transmission; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D007413:Intestinal Mucosa / Q000503:physiopathology / Q000821:virology; D012725:Sexual Behavior / Q000502:physiology; D015229:Sexually Transmitted Diseases, Viral / Q000150:complications* / Q000209:etiology / Q000635:transmission
references.citation: JAMA. 1990 Sep 19;264(11):1413-7
references.pmid: 2144026
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006085
references.pmid: 19370624
references.citation: J Infect Dis. 2001 Jul 1;184(1):93-7
references.pmid: 11398115
references.citation: Nat Med. 2006 Dec;12(12):1365-71
references.pmid: 17115046
references.citation: FASEB J. 2004 Jan;18(1):155-7
references.pmid: 14630697
references.citation: Dis Colon Rectum. 1990 Dec;33(12):1048-62
references.pmid: 2242700
references.citation: Gut. 1985 Sep;26(9):869-75
references.pmid: 3896960
references.citation: AIDS Read. 1999 May-Jun;9(3):167-9
references.pmid: 12728901
references.citation: Bull World Health Organ. 1999;77(8):651-66
references.pmid: 10516787
references.citation: N Engl J Med. 1978 Mar 2;298(9):490-5
references.pmid: 340953
references.citation: J Infect Dis. 2008 Jun 1;197(11):1558-66
references.pmid: 18419344
references.citation: J Clin Microbiol. 2007 Mar;45(3):1029-31
references.pmid: 17251405
references.citation: Gastroenterology. 2003 Feb;124(2):368-76
references.pmid: 12557143
references.citation: Nat Med. 2008 Apr;14(4):421-8
references.pmid: 18376406
references.citation: Clin Gastroenterol. 1975 Sep;4(3):659-69
references.pmid: 810279
references.citation: J Exp Med. 2004 Nov 15;200(10):1299-314
references.pmid: 15545355
references.citation: J Immunol. 2003 Dec 1;171(11):6164-72
references.pmid: 14634132
references.citation: Sex Transm Dis. 2008 Jul;35(7):637-42
references.pmid: 18520976
references.citation: AIDS. 2006 Jan 9;20(2):233-40
references.pmid: 16511416
references.citation: Curr Opin Infect Dis. 2005 Oct;18(5):427-35
references.pmid: 16148530
references.citation: Clin Infect Dis. 2007 Feb 1;44(3):335-7
references.pmid: 17205437
references.citation: Sex Transm Dis. 2005 Apr;32(4):220-6
references.pmid: 15788919
references.citation: Ann Intern Med. 1996 Aug 15;125(4):257-64
references.pmid: 8678387
references.citation: JAMA. 1977 Nov 7;238(19):2046-7
references.pmid: 578904
references.citation: J Exp Med. 2003 Sep 15;198(6):963-9
references.pmid: 12963696
references.citation: Sex Transm Infect. 2007 Apr;83(2):120-5; discussion 125
references.pmid: 17090569
references.citation: Scand J Gastroenterol. 2007 Dec;42(12):1422-7
references.pmid: 17994468
references.citation: BMC Infect Dis. 2008 Nov 13;8:156
references.pmid: 19014537
references.citation: AIDS. 1996 Oct;10(12):1385-91
references.pmid: 8902068
references.citation: J Infect Dis. 2008 Jan 1;197(1):126-33
references.pmid: 18171295
references.citation: Ann Clin Lab Sci. 1976 Mar-Apr;6(2):184-92
references.pmid: 946385
references.citation: Int J STD AIDS. 2007 Aug;18(8):514-20
references.pmid: 17686211
references.citation: J HIV Ther. 2007 Mar;12(1):3-6
references.pmid: 17589389
references.citation: Sex Transm Infect. 2005 Dec;81(6):448-52
references.pmid: 16326843
references.citation: Medicine (Baltimore). 1982 Nov;61(6):390-405
references.pmid: 6815407
references.citation: Sex Transm Dis. 2009 Jun;36(6):331-5
references.pmid: 19556925
references.citation: Nat Med. 2008 Oct;14(10):1077-87
references.pmid: 18806803
references.citation: Curr Opin Immunol. 2005 Aug;17(4):366-73
references.pmid: 15955686
references.citation: AIDS. 1992 Mar;6(3):307-9
references.pmid: 1567575
references.citation: Genitourin Med. 1995 Jun;71(3):150-4
references.pmid: 7635489
references.citation: Nat Med. 2002 Feb;8(2):150-6
references.pmid: 11821899
references.citation: Euro Surveill. 2006 Sep;11(9):152-4
references.pmid: 17075161
references.citation: Science. 1983 May 20;220(4599):865-7
references.pmid: 6601823
references.citation: Gut. 2006 Aug;55(8):1188-96
references.pmid: 16120756
references.citation: Science. 1983 May 20;220(4599):868-71
references.pmid: 6189183
references.citation: J Infect Dis. 2008 Feb 1;197(3):420-9
references.pmid: 18199035
references.citation: J Dtsch Dermatol Ges. 2008 Nov;6(11):935-40
references.pmid: 18992036
references.citation: J Clin Gastroenterol. 2004 Oct;38(9):733-40
references.pmid: 15365396
references.citation: Nat Immunol. 2005 Nov;6(11):1133-41
references.pmid: 16200068
references.citation: AIDS. 1998 Jan 1;12(1):43-51
references.pmid: 9456254
references.citation: Sex Transm Infect. 2009 Oct;85(6):447-51
references.pmid: 19497918
references.citation: Lancet. 2000 Nov 25;356(9244):1800-5
references.pmid: 11117912
references.citation: Postgrad Med J. 1998 Mar;74(869):168-9
references.pmid: 9640444
references.citation: Emerg Infect Dis. 2005 Jul;11(7):1090-2
references.pmid: 16022786
references.citation: Gut. 1995 Oct;37(4):524-9
references.pmid: 7489940
references.citation: Trans R Soc Trop Med Hyg. 1995 Jul-Aug;89(4):403-5
references.pmid: 7570880
references.citation: Sex Transm Infect. 2004 Aug;80(4):255-63
references.pmid: 15295121
references.citation: Clin Infect Dis. 2004 Oct 1;39(7):996-1003
references.pmid: 15472852
references.citation: Scand J Gastroenterol. 1995 Sep;30(9):909-14
references.pmid: 8578192
references.citation: J Infect Dis. 2002 Oct 1;186(7):1019-22
references.pmid: 12232844
references.citation: Nat Rev Immunol. 2005 Oct;5(10):783-92
references.pmid: 16200081
references.citation: J Immunol. 1999 Sep 15;163(6):3539-48
references.pmid: 10477629
references.citation: N Engl J Med. 2006 Jan 19;354(3):284-9
references.pmid: 16421370
references.citation: J Acquir Immune Defic Syndr. 2004 Oct 1;37(2):1228-36
references.pmid: 15385729
references.citation: Curr HIV/AIDS Rep. 2007 Feb;4(1):10-5
references.pmid: 17338855
references.citation: N Engl J Med. 1983 Apr 14;308(15):868-71
references.pmid: 6300674
references.citation: Br J Vener Dis. 1976 Oct;52(5):348-50
references.pmid: 1036464
references.citation: Sex Transm Dis. 1984 Apr-Jun;11(2):59-63
references.pmid: 6087479
references.citation: Lancet. 2003 Mar 22;361(9362):1025-34
references.pmid: 12660071
references.citation: J Antimicrob Chemother. 2006 Sep;58(3):587-93
references.pmid: 16816397
references.citation: AIDS. 2008 Jul 11;22(11):1287-92
references.pmid: 18580607
references.citation: Int J Colorectal Dis. 2006 Jan;21(1):71-8
references.pmid: 15856265
references.citation: Clin Infect Dis. 2005 Jul 1;41(1):67-74
references.pmid: 15937765
references.citation: Parasite Immunol. 2005 Jan-Feb;27(1-2):1-8
references.pmid: 15813717
references.citation: Ann Intern Med. 1988 Mar;108(3):328-33
references.pmid: 2829677
references.citation: J Endotoxin Res. 2000;6(3):205-14
references.pmid: 11052175
references.citation: Biochem Biophys Res Commun. 2004 Nov 12;324(2):518-28
references.pmid: 15474458
references.citation: Sex Transm Infect. 2004 Dec;80(6):451-4
references.pmid: 15572612
references.citation: Sex Transm Infect. 2003 Dec;79(6):456-9
references.pmid: 14663120
references.citation: Euro Surveill. 2005 Dec 22;10(12):E051222.4
references.pmid: 16794303
references.citation: J Immunol. 2007 Sep 1;179(5):3026-34
references.pmid: 17709517
references.citation: Sex Transm Dis. 1981 Jan-Mar;8(1):16-7
references.pmid: 6784255
references.citation: J Acquir Immune Defic Syndr. 2006 Jan 1;41(1):31-6
references.pmid: 16340470
references.citation: Sex Transm Dis. 2008 Oct;35(10):845-8
references.pmid: 18607315
references.citation: J Virol. 1996 Jun;70(6):3545-50
references.pmid: 8648688
references.citation: Sex Transm Infect. 2007 Jul;83(4):330-4
references.pmid: 17475689
references.citation: Immunity. 2004 Oct;21(4):527-38
references.pmid: 15485630
references.citation: Gastroenterology. 2001 Dec;121(6):1428-36
references.pmid: 11729122
references.citation: JAMA. 2006 Sep 27;296(12):1498-506
references.pmid: 17003398
references.citation: Sex Transm Dis. 2008 May;35(5):495-8
references.pmid: 18354345
references.citation: Euro Surveill. 2004 Dec;9(12):21-5
references.pmid: 15677851
references.citation: J Virol. 2008 Feb;82(3):1155-65
references.pmid: 18045946
references.citation: Gut. 1995 Nov;37(5):623-9
references.pmid: 8549936
references.citation: Euro Surveill. 2005 May;10(5):115-7
references.pmid: 16077209
references.citation: N Engl J Med. 1984 Jun 14;310(24):1545-50
references.pmid: 6328297
references.citation: Int J STD AIDS. 2008 Nov;19(11):729-40
references.pmid: 18931264
references.citation: Proc Natl Acad Sci U S A. 2007 Feb 27;104(9):3396-401
references.pmid: 17360657
references.citation: J Infect Dis. 1999 Apr;179(4):859-70
references.pmid: 10068581
references.citation: Gut. 2003 Feb;52(2):224-30
references.pmid: 12524404
references.citation: AIDS. 2007 Oct 1;21(15):2112-3
references.pmid: 17885306
references.citation: Nat Rev Immunol. 2006 Feb;6(2):148-58
references.pmid: 16491139
references.citation: Parasite Immunol. 1996 Oct;18(10):491-8
references.pmid: 9226686
references.citation: Clin Infect Dis. 2009 Mar 1;48(5):e53-6
references.pmid: 19191633
references.citation: J Clin Pathol. 1989 Mar;42(3):275-81
references.pmid: 2703544
references.citation: Adv Immunol. 1999;72:209-53
references.pmid: 10361577
references.citation: Rev Infect Dis. 1986 Mar-Apr;8(2):228-38
references.pmid: 2871619
references.citation: AIDS. 2004 Jan 23;18(2):303-9
references.pmid: 15075549
references.citation: Gastroenterology. 1999 May;116(5):1115-23
references.pmid: 10220503
references.citation: JAMA. 1982 Sep 3;248(9):1041-9
references.pmid: 7109193
references.citation: FASEB J. 2000 Sep;14(12):1749-53
references.pmid: 10973924
references.citation: Int J STD AIDS. 2004 Aug;15(8):533-7
references.pmid: 15307964
references.citation: Gut. 1999 Aug;45(2):191-8
references.pmid: 10403730
references.citation: Gut. 1995 Feb;36(2):283-6
references.pmid: 7883231
references.citation: Sex Transm Infect. 2009 Jun;85(3):173-5
references.pmid: 19221105
references.citation: Gastroenterology. 2005 Aug;129(2):550-64
references.pmid: 16083712
references.citation: J Clin Gastroenterol. 1993 Mar;16(2):109-12
references.pmid: 8463612
references.citation: Ann N Y Acad Sci. 2000;915:293-303
references.pmid: 11193591
references.citation: Sex Transm Dis. 1977 Jul-Sep;4(3):89-91
references.pmid: 337539
references.citation: Nature. 2005 Apr 28;434(7037):1093-7
references.pmid: 15793563
references.citation: Am J Physiol Gastrointest Liver Physiol. 2006 Apr;290(4):G827-38
references.pmid: 16537974
references.citation: Gastroenterology. 1992 Sep;103(3):919-33
references.pmid: 1499943
references.citation: Dis Colon Rectum. 2009 Mar;52(3):507-12
references.pmid: 19333054
references.citation: J Exp Med. 2007 Sep 3;204(9):2171-85
references.pmid: 17724130
references.citation: Curr Pharm Des. 2008;14(3):237-44
references.pmid: 18220834
references.citation: Dig Dis Sci. 1993 Jun;38(6):1119-27
references.pmid: 8508707
references.citation: Biochem Biophys Res Commun. 2005 Nov 18;337(2):505-9
references.pmid: 16198312
references.citation: Vet Parasitol. 2004 Dec 9;126(1-2):121-44
references.pmid: 15567582
references.citation: AIDS. 2007 Feb 19;21(4):433-9
references.pmid: 17301561
references.citation: Euro Surveill. 2005 Mar 03;10(3):E050303.3
references.pmid: 16702633
references.citation: Gastroenterology. 2001 Feb;120(3):607-21
references.pmid: 11179239
references.citation: Inflamm Bowel Dis. 2006 Aug;12(8):758-65
references.pmid: 16917232
references.citation: Cell. 2000 Mar 3;100(5):587-97
references.pmid: 10721995
references.citation: N Engl J Med. 1983 Apr 21;308(16):916-21
references.pmid: 6339923
references.citation: J Gastroenterol Hepatol. 2009 Jan;24(1):167
references.pmid: 19196401
references.citation: Ann Intern Med. 1984 Oct;101(4):421-8
references.pmid: 6476631
references.citation: Sex Transm Dis. 2008 Apr;35(4):377-82
references.pmid: 18209688
references.citation: AIDS. 2007 May 11;21(8):983-91
references.pmid: 17457092
references.citation: J Exp Med. 1999 Nov 1;190(9):1241-56
references.pmid: 10544196
references.citation: Am J Gastroenterol. 2000 May;95(5):1277-83
references.pmid: 10811339
references.citation: Euro Surveill. 2005 Sep 29;10(9):E050929.3
references.pmid: 16788240
references.citation: Clin Infect Dis. 2007 Jan 1;44(1):26-32
references.pmid: 17143811
references.citation: Clin Sci (Lond). 1991 Sep;81(3):327-34
references.pmid: 1655333
references.citation: Gut. 1996 Dec;39(6):824-32
references.pmid: 9038664
references.citation: Clin Infect Dis. 2004 Jan 15;38(2):300-2
references.pmid: 14699467
references.citation: Postgrad Med J. 2006 Nov;82(973):733-6
references.pmid: 17099092
references.citation: Nat Immunol. 2008 Mar;9(3):301-9
references.pmid: 18264102
references.citation: Nature. 2003 Jul 3;424(6944):88-93
references.pmid: 12840763
references.citation: Ann N Y Acad Sci. 2006 Aug;1072:288-99
references.pmid: 17057208
references.citation: Hepatology. 1997 Sep;26(3 Suppl 1):15S-20S
references.pmid: 9305658
references.citation: AIDS. 2005 Jun 10;19(9):969-74
references.pmid: 15905679
references.citation: Curr Opin HIV AIDS. 2008 Sep;3(5):541-7
references.pmid: 19373019
references.citation: Sex Transm Infect. 2004 Dec;80(6):492-7
references.pmid: 15572622
references.citation: J Infect Dis. 1989 Jun;159(6):1126-8
references.pmid: 2656880
references.citation: Arch Intern Med. 2005 Feb 28;165(4):409-15
references.pmid: 15738369
references.citation: N Engl J Med. 1974 Nov 28;291(22):1194
references.pmid: 4608062
references.citation: Clin Infect Dis. 2001 Aug 15;33(4):562-9
references.pmid: 11462196
references.citation: Emerg Infect Dis. 2005 Nov;11(11):1787-8
references.pmid: 16318741
references.citation: Curr Pharm Des. 2008;14(17):1690-7
references.pmid: 18673193
references.citation: Int J STD AIDS. 2009 May;20(5):300-9
references.pmid: 19386965
references.citation: J Infect Dis. 2002 Apr 15;185(8):1043-50
references.pmid: 11930313
references.citation: Expert Rev Anti Infect Ther. 2008 Jun;6(3):337-49
references.pmid: 18588498
references.citation: J Clin Invest. 1981 Nov;68(5):1305-13
references.pmid: 6271810
references.citation: Hepatology. 2007 Oct;46(4):1016-25
references.pmid: 17668881
references.citation: Am J Epidemiol. 1974 Nov;100(5):414-23
references.pmid: 4371067
references.citation: Clin Infect Dis. 2007 Feb 1;44(3):327-34
references.pmid: 17205436
references.citation: J Virol. 2007 Jan;81(2):599-612
references.pmid: 17065209
references.citation: N Engl J Med. 1984 Jun 14;310(24):1551-6
references.pmid: 6328298
references.citation: Gastroenterology. 2003 May;124(5):1465-75
references.pmid: 12730885
references.citation: Infect Dis Clin North Am. 1988 Jun;2(2):475-84
references.pmid: 3060531
references.citation: J Leukoc Biol. 2003 Nov;74(5):642-9
references.pmid: 12960227
references.citation: Ann Intern Med. 1991 Mar 1;114(5):366-72
references.pmid: 1992878
references.citation: JAMA. 1988 Sep 9;260(10):1429-33
references.pmid: 3404600
references.citation: Nat Immunol. 2006 Mar;7(3):235-9
references.pmid: 16482171
references.citation: J Infect Dis. 2000 Dec;182(6):1625-35
references.pmid: 11069233
references.citation: Curr Opin Immunol. 2009 Jun;21(3):274-80
references.pmid: 19524429
references.citation: Lancet. 1998;351 Suppl 3:5-7
references.pmid: 9652712
references.citation: J Immunol. 2007 Sep 1;179(5):3035-46
references.pmid: 17709518
references.citation: AIDS Rev. 2008 Jan-Mar;10(1):36-46
references.pmid: 18385779
references.citation: Proc Natl Acad Sci U S A. 2005 Jul 12;102(28):9860-5
references.pmid: 15980151
references.citation: AIDS. 2002 May 3;16(7):983-91
references.pmid: 11953464
references.citation: Future Microbiol. 2009 Feb;4(1):105-18
references.pmid: 19207103
references.citation: Clin Infect Dis. 2006 Jan 15;42(2):186-94
references.pmid: 16355328
references.citation: Genitourin Med. 1989 Aug;65(4):239-43
references.pmid: 2807281
references.citation: Emerg Infect Dis. 1999 Nov-Dec;5(6):820-3
references.pmid: 10603219
references.citation: Euro Surveill. 2006 Sep;11(9):155-6
references.pmid: 17075158
references.citation: Nat Med. 2005 May;11(5):469-70
references.pmid: 15875046
references.citation: Ann Intern Med. 1977 Mar;86(3):340-6
references.pmid: 402879
references.citation: Expert Rev Mol Med. 2008 Oct 20;10:e30
references.pmid: 18928579
references.citation: N Engl J Med. 1981 Jul 23;305(4):195-200
references.pmid: 7017409
references.citation: Lancet. 1996 Aug 10;348(9024):379-83
references.pmid: 8709738
references.citation: Interdiscip Perspect Infect Dis. 2009;2009:547090
references.pmid: 19584941
references.citation: Virology. 2003 Jul 20;312(1):84-94
references.pmid: 12890623
references.citation: Gut. 1999 Jul;45(1):70-6
references.pmid: 10369707
references.citation: Gastroenterology. 2009 May;136(5):1609-17
references.pmid: 19422083
references.citation: Sex Transm Infect. 2004 Aug;80(4):326-7
references.pmid: 15295139
references.citation: Sex Transm Dis. 2007 Oct;34(10):783-90
references.pmid: 17495592
references.citation: Gut. 2007 Jan;56(1):61-72
references.pmid: 16822808
references.citation: Sex Transm Infect. 2007 Apr;83(2):106-12
references.pmid: 17020893
references.citation: N Engl J Med. 1978 Feb 23;298(8):428-35
references.pmid: 340951
references.citation: Ann N Y Acad Sci. 1998 Nov 17;859:139-48
references.pmid: 9928377
references.citation: Science. 1998 Apr 17;280(5362):427-31
references.pmid: 9545219
references.citation: JAMA. 1988 Feb 19;259(7):1048-50
references.pmid: 2828700
references.citation: Nat Med. 1997 Jan;3(1):42-7
references.pmid: 8986739
references.citation: Gastroenterology. 2005 May;128(5):1258-67
references.pmid: 15887109
references.citation: Emerg Infect Dis. 2007 Mar;13(3):516-7
references.pmid: 17552123
references.citation: AIDS. 2003 Sep 5;17(13):1881-8
references.pmid: 12960820
references.citation: N Engl J Med. 1983 Sep 8;309(10):576-82
references.pmid: 6308444
references.citation: AIDS. 2006 Jan 2;20(1):5-10
references.pmid: 16327313
references.citation: Genome Res. 2008 Jan;18(1):161-71
references.pmid: 18032721
references.citation: MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94
references.pmid: 16888612
references.citation: Eur J Immunol. 2002 May;32(5):1445-54
references.pmid: 11981833
references.citation: Am J Med. 1991 Feb;90(2):269-71
references.pmid: 1996598
references.citation: Gut. 2009 Feb;58(2):220-7
references.pmid: 18936106
references.citation: Sex Transm Infect. 2005 Feb;81(1):91-2
references.pmid: 15681732
references.citation: Sex Transm Infect. 1999 Feb;75(1):3-17
references.pmid: 10448335
references.citation: Sex Transm Dis. 2009 Aug;36(8):507-11
references.pmid: 19455081
references.citation: AIDS. 2007 Oct 18;21(16):2177-82
references.pmid: 18090044
references.citation: Euro Surveill. 2006 Sep;11(9):150-2
references.pmid: 17075162
references.citation: PLoS Negl Trop Dis. 2008 Feb 27;2(2):e175
references.pmid: 18301730
references.citation: J Endotoxin Res. 2002;8(6):441-8
references.pmid: 12697087
references.citation: J Acquir Immune Defic Syndr (1988). 1991;4(8):760-5
references.pmid: 1856788
references.citation: Nature. 2005 Apr 28;434(7037):1148-52
references.pmid: 15793562
references.citation: J Immunol. 1993 Mar 15;150(6):2356-63
references.pmid: 8450217
references.citation: CMAJ. 2005 Jun 21;172(13):1674-6
references.pmid: 15928239
references.citation: J Exp Med. 2005 Oct 17;202(8):1063-73
references.pmid: 16216890
references.citation: J Dtsch Dermatol Ges. 2004 Aug;2(8):676-80
references.pmid: 16279230