Genital lesions Flashcards
Sexually transmitted causes of genital ulceration?
Herpes simplex types 1 and 2
Primary and secondary syphilis
Primary HIV infection
Lymphogranuloma venereum
Mpox (previously known as monkeypox)
Non - sexually transmitted causes of genital ulceration?
Varicella zoster
- Chicken pox
- Shingles
Fixed drug eruption
Crohn’s disease
Dermatosis (skin irregularities/lesions)
Behcet’s disease
Trauma
Lipschutz ulcers (non-sexually transmitted genital ulcers)
Idiopathic
Management of primary genital herpes simplex?
Investigation:
• Swab lesion for HSV 1 and 2 PCR
• Recommend a full STI screen (chlamydia, gonorrhoea, syphilis and HIV)
Anti-viral treatment:
• Aciclovir 400mg three times daily for 5 days
Supportive treatment:
• Rest, fluids, analgesia (including topical)
Vulval toiletting advice
AAA
Encourage to pass urine before leaving clinic (tips and tricksl)
Reassurance (“it will never be this bad again”)
Admit if: urinary retention, can’t swallow
Counselling:
• Explanation of condition - natural history, recurrences, transmission, prevention
Features of primary syphilis?
Incubation 10-90 (usually 14-21) days
“Chancre”
Site of infection
70% painless
Commonly seen in mouth
Or other extra-genital sites
Resolves without treatment 3-6 weeks
Primary vs secondary syphilis?
Primary syphilis is the stage of initial inoculation of T pallidum; in secondary syphilis there is a bacteraemia and wide dissemination of T pallidum.
Primary syphilis can present with a single chancre, secondary syphilis as multiple cutaneous lesions,
What is chancre in primary syphilis?
Usually, a single ulcer (chancre) appears at the site where the bacteria entered the body. The genitals are the most common location for chancres to develop.
Can also develop in mouth or anus
chancre is firm and painless, and it oozes fluid that contains syphilis bacteria.
Features of secondary syphilis?
Incubation <2 years (usually 3-6 weeks)
Haematogenous and lymphatic dissemination
Multi-system disease
Clinical features of secondary syphilis?
Low-grade fever
Sore throat
Headache
Lymphadenopathy
Rash
Management of primary and secondary syphilis?
Single dose
Benzathene penicillin
2.4MU im
Management of late latent syphilis?
Weekly doses x 3
Benzathene penicillin
2.4MU im
Management of tertiary syphilis?
Specialist advice:
+/- steroid
+/- iv therapy
Sexually transmitted/infective causes of genital lumps?
Genital warts (HPV)
Molluscum contagiosum
Monkeypox
Scabies
Non-sexually transmitted causes of genital lumps?
Physiological
Folliculitis
Hydradenitis suppurativa
Seborrhoeic keratoses
Cancers
Bartholin’s abscess
Skin tags
Lichen planus
Pyoderma granuloma
