Genital ulcers Flashcards
List 4 possible causes of Genital ulcers
Infective»_space; Herpes simplex, Herpes zoster, Syphilis, Tropical diseases (eg LGV, Granuloma inguinale, Chancroid)
Non-infective»_space; Trauma (physical/chemical)
Dermatological conditions»_space; Fixed drug reactions. Bechets disease. Apthosis. Lichen planus. Pemphigus.
Malignancy»_space; SCC
[Mainly consider HSV and Syphilis]
What does bilateral herpes simplex lesions suggest?
Bilateral herpes is caused by primary infection
What are the 4 stages of Herpes Simplex Virus lesions?
o Painful tingling red macular lesion
o Progresses to Fluid-filled vesicles
o Vesicles burst – become painful ulcers
o Ulcers gradually heal up – forming a crusty lesion
[best time to swab the lesions when they are moist and vesicles have just burst open]
What are the typical HSV causative serotypes for Orofacial and Genital lesions?
Genital HSV»_space; HSV 2
Oral HSV»_space; HSV 1
How is HSV investigated?
HSV PCR swab
(alo so perform a full STI screen, including Syphilis serology and HIV antibody test)
What is the management for Herpes?
Symptomatic = 5% Lidocaine ointment (analgesia). Rest. Saline washing.
Systemic antiviral treatment = Aciclovir 400mg 5 times a day
Avoid sexual contact while symptomatic. Contact tracing.
What are the complications of Herpes infections?
Urinary retention - affect the sacral nerves
Adhesions
Meningism
Emotional distress (especially as they know its a life-long condition which will likely reoccur)
Recurrences
What are the considerations for HSV in pregnancy?
If recurrent episode»_space; risk is low to baby
Primary infection + Last trimester = Caesarean section (as potentially fatal if lesions are passed on during normal vaginal delivery)
- PMHx of herpes»_space; give prophylactic Aciclovir in last trimester
If male partner has herpes + woman negative for herpes»_space; avoid unprotected sex in last trimester to avoid transmission to unprotected woman.
What is the distribution of Herpes zoster versus primary HSV
Primary HSV = bilateral.
Herpes Zoster (reinfection) = unilateral.
Which organism causes Syphilis?
Treponema Palladium
What is the presentation of Syphilis // Treponema Palladium?
PAINLESS penile ulcer (+Inguinal lymphadenopathy)
Primary Syphilis = Chancre (Primary syphilitic ulcers) – appears 9-90days post-exposure
o Chancre’s appear at the site of sexual contact (eg on the lip/mouth with oral sex).
Secondary syphilis = appears 6 weeks – 6 months later = systemically unwell (rash, patchy hair loss and other systemic symptoms)
o Typical maculopapular rash + Patchy alopecia is seen with secondary syphilis
Latent syphilis = Early latent (<2 years); Late latent (>2 years)
Tertiary syphilis = appears after prolonged latent phase (eg 30 years later) = Gummatous lesions can cause Neurological and cardiovascular
How is Syphilis // Treponema Palladium diagnosed?
From Lesions:
o Dark ground microscopy»_space; Treponema Palladium seen
o Treponemal PCR swab
From blood test:
o Treponemal enzyme immunoassay (EIA)
o Treponema palladium particle agglutination assay (TPPA)
o Rapid plasma reagin test (RPR)
Always perform FULL STI SCREEN including HIV testing
What is the treatment for Syphilis?
First line = Benzamine benzylpenicillin (Early - primary, secondary, early latent)
Late latent = Benzamine benzylpenicillin - given weekly for 3 weeks (3 doses in total given)
Neurosyphilis (including Ophthalmological syphilis) = Benzamine benzylpenicillin every 4 hours for 17 days
What is Lymphogranuloma Venerum (LGV)
Specific serotypes of Chlamydia (serovars L1-L3) that attacks lymph nodes - presenting as lumps/ulcerated lesions
Treated with Doxycycline 100mg BD for 21 days
