CASE REPORT Sexually transmitted diphtheria

Diphtheria is caused by diphtheria toxin-producing Corynebacterium species. While classical respiratory diphtheria is transmitted by droplets, cutaneous diphtheria often results from minor trauma. This report concerns the first case of sexually transmitted diphtheria in a patient with non-gonococcal urethritis after orogenital contact. Diphtheria and diphtheria-like illness is caused by Corynebacterium species harbouring the diphtheria toxin-encoding tox gene. Diphtheria is a WHO-notifiable disease and alerts both clinicians and public health authorities. Infections caused by toxigenic Corynebacterium diphtheriae are now extremely rare in industrialised countries and are mostly associated with travel or contact with a person from an endemic area such as India, Indonesia, Brazil or the newly independent states of the former Soviet Union.1 Respiratory diphtheria is usually transmitted by droplets, whereas cuta-neous diphtheria often results from minor trauma and frequently shows co-infection with other bacteria such as staphylococci and streptococci. Here, we report the first case of sexually trans-mitted diphtheria in a patient with non-gonococcal urethritis after orogenital contact. CASE REPORT In September 2011, a 40-year-old man attended a urologist with an 8-day history of urethritis presenting with alguria, dysuria and anamnestically with a light yellow discharge. In addition, the pres-ence of a tiny preputial wound was reported. Initial sexually transmitted disease work-up included enzyme immunoassay (EIA) tests (Virion, Würz-burg, Germany) for herpes simplex virus (HSV) 1 and 2 yielding positive results (HSV-1 IgG 103 U/ml