Genital ulcers Flashcards
What are causes of genital ulcerations?
Trauma
Candida
Dermatological
Herpes
Syphilis
LGV
M-Pox
What are symptoms of herpes simplex virus?
Painful ulceration
Dysuria
Vaginal/urethral discharge
Fever
Myalgia
How is HSV diagnosed?
NAAT - swab taken from base of the ulcer
Serology
Explain the progression of herpes
- Erythema of skin
- Thin-walled vesicles on erythematous base - filled with purulent/clear fluid
- Ulcers
- Scabbing
- Healed skin
What are complications of HSV?
Super infection of lesions with candida/streptococcal species
Autonomic neuropathy - urinary retention
Auto inoculation to fingers/adjacent skin
Aseptic meningitis
Herpes proctitis
What is the management of the first episode of genital herpes?
Saline bathing
Analgesia
Topical anaesthetics
Antiretrovirals:
- Aciclovir 400mg TDS PO 5d
- Valaciclovir 500mg BD PO 5d
What is the management of recurrent genital herpes?
Episodic antiviral therapy:
- Aciclovir 800mg TDS 2d
- Famaciclovir 1g BD 1d
- Valaciclovir 500mg BD 3d
(taken each time they have an episode)
What are complications of vertical transmission of HSV?
Skin/eye/mouth infection
Encephalitis
Disseminated infection e.g. liver
What is the management of HSV in pregnancy if infection is in 3rd trimester?
Oral aciclovir 400mg TDS until delivery
Elective C-section
What is the management of HSV in pregnancy if infection is in 1st/2nd trimester?
Abstain from sex from 26 weeks
Antiviral prophylaxis e.g. aciclovir 400mg TDS
What is treponema pallidum?
Syphilis
What is primary presentation of syphilis?
painless ulcer
lymphadenopathy
What is secondary presentation of syphilis?
mucosal lesions
rash
arthralgia
lymphadenopathy
meningitis
cranial nerve palsies
uveitis
What is tertiary presentation of syphilis?
CVS - aortic aneurysm, aortic regurgitation, gummatous syphilis
Neurosyphilis - tabes dorsalis, meningovascular, general paresis
How is syphilis diagnosed?
Darkground microscopy
Antigen based assays
Treponema (TTPA/TPHA) - remains positive for life
