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Sexually transmitted scabies in elderly people

about nosocomial outbreaks of scabies in elderly people. Persons over the age of 65 years are usually defined as ‘elderly’ but we would like to emphasize that most of them are still sexually active. The elderly population shares the full spectrum of sexually transmitted diseases (STDs) with the general population and their incidence is significant for newly acquired diseases and complications of previous infections (particularly syphilis 2 and human immunodeficiency virus (HIV) 3 ). Working in an STD practice, we have often encountered elderly persons with scabies and their history sometimes reveals that they had been infected during sexual intercourse. In our opinion, scabies in the elderly may therefore also be considered an STD and not exclusively a nosocomial disease. A 77-year-old man who had been diagnosed with prurigo nodularis and treated with topical and systemic corticosteroids was referred to us with penal and scrotal papules (fig. 1). We suspected scabies and microscopic examination of skin flakes obtained by scraping was positive. As he had had sexual intercourse with prostitutes, we performed tests for HIV and other STD laboratory diagnostic tests, including serological tests for syphilis (venereal disease research laboratory (VDRL), treponema pallidum haemagglutination (TPHA), fluorescent treponemal absorption (FTAabs)) and hepatitis B surface antigen (HBsAg) enzyme linked immuno sorbent assay (ELISA) as well as polymerase chain reaction (PCR) for hepatitis C. All were negative. We prescribed benzylbenzoate for the patient and his wife, who refused to be examined. This case is not isolated. In the period 1990–2004 we have seen 1652 elderly patients, both males and females, in our STD clinic. The most frequent pathology (1105 cases) has been scabies followed by condylomatosis (224 cases), pubic pediculosis (132 cases), and genital herpes (105 cases). We also observed 61 cases of syphilis (primary lesions in 28, and serological positivity in 33 cases), and 35 cases of gonorrhoea. In 13 cases, an HIV test, performed with tests for STDs and routine procedures, was positive. Scabies was diagnosed and confirmed by positive microscope examination in 997 patients. Only in 265 cases, including the present one, did medical history indicate sexual transmission. We believe that this is an underestimate, as we have noted that elderly patients are often more reluctant to report having had sexual intercourse at risk than young people. We agree with Gimènez Garcìa et al . that atypical presentations of scabies may be encountered in the elderly. 1,4