Genital ulcers Flashcards
Causes of genital ulcers
Herpes simplex virus 1 and 2
Syphilis
Chancroid
Herpes simplex virus 1 presentation
Cold sores
Chills
Muscle ache
Dysuria
Can spread to genitals if oral sex:
Vulval soreness
Vulval blisters and ulcers
Herpes simplex virus 2 presentation
Vulval soreness Vulval blisters and ulcers Chills Muscle ache Dysuria
HSV1
- presentation
- seropositivity
- recurrence in 1 year
- recurrence after year 1
- Orofacial
- 80% seropositive
- 60% recurrence
- unusual
HSV2
- presentation
- seropositivity
- recurrence in 1 year
- recurrence after year 1
- genital
- 7% seropositive
- 90% recurrence
- variable
4 stages of HSV
- painful, tingling, macular, red lesion
- fluid filled ulcers
- Burst ulcers and painful
- gradual healing, less likely to be swabbed
HSV transmission
May be passed on through asymptomatic shedding
Tests for HSV
HSV PCR swab
Full STI screen
- Syphilis serology
- HIV antibody test
Management of HSV 2
Rest
Analgesia - lidocaine ointment
Saline washing
Vaseline
Systemic antivirals
Treat before results come back
Antivirals for HSV 2
Aciclovir tds for 5 days
Complications of HSV
Urinary retention Adhesions Meningism Emotional distress Recurrence
HSV counselling
Recurrence rate
Contact tracing
Asymptomatic shedding
HSV in pregnancy
Recurrence - low risk to pregnancy
Primary infection in last trimester - C - section
Do not swab in 3rd trimester
Avoid UPSI in pregnancy
HSV serology considered
Ulcer history
Pain Bleeding Previous STIs Sexual Hx Travel Hx Features causing immunocompromisation
Ulcer examination
Genital exam
Lymph nodes
Syphilis course
Primary:
- chancre
Secondary:
- systemically unwell
- rash
- alopecia
Latent
- early latent < 2 yrs
- late latent > 2 yrs
Tertiary
- neurological complications
- CVD complications
Chancre
Painless indurated ulcer
When is syphilis infectious
Primary stage
Secondary Stage
Early latent phase
Diagnosis of syphilis
Microscopy
Treponemal PCR swab
Blood tests:
- Treponemal enzyme essay
- Treponema pallidum particle agglutination assay (TPPA)
- Rapid plasma reagin test (RPR)
- Full STI screening including HIV
Syphilis treatment
IM benzylpenicillin
Early latent - 1 dose
Late latent - 3 doses, 1 per week
Risk factors for syphilis
Anal sex
MSM
Unprotected sex
Multiple sexual partners
