Genital Ulcers & lumps

Question 1

Genital Herpes

Answer 1

Painful blisters on genitals. Treat with saline wash, lidocaine and oral aciclovir (within 48 hours of primary presentation). Incubation period 2-12 days. Primary presentation often has tender inguinal lymphadenopathy. Most people have it, and it becomes asymptomatic with fewer recurrences. May cause sacroradiculomyelitis (retention/constipation). Worst if caught in pregnancy

Question 2

Genital Warts

Answer 2

Itchy lumps around genitals or anus. can leave them and they will go in a couple of years or treat.
Worse in smokers or immunosuppressed.
Caused by HPV 6 & 11 Condoms reduce risk of transmission but not 100%

Question 3

Molluscum Contagiousum

Answer 3

Painless spots with 2-12 week incubation. spontaneous resolution within 2-3 months
15-35% recur over 8-24 months
Caused by a pox virus with both sexual and non-sexual transmission

Question 4

Penile pearly papules

Answer 4

benign and harmless, treat with reassurance

Question 5

Primary Syphilis

Answer 5

Single painless ulcer on genitals.9-90 day incubation. A particular risk in HIV +ve or MSM. Confirm diagnosis and tract contacts. treat aggressively and follow up in-case of secondary syphilis

Question 6

Lymphogranuloma venereum (LGV)

Answer 6

Ulcers with systemic illness, and possibly with diarrhoea and blood/mucus PR. Mainly in HIV +ve MSM. treat aggressively and trace contacts

Question 7

Donovanosis (Granuloma inguinale)

Answer 7

Beefy red, painless ulcer. caused by species of klebsiella found in S america/vietnam. rare, needs specialist testing. treat with azithromycin 1g weekly for 4-6 weeks

Question 8

Chancroid (Haemophilus ducreyi)

Answer 8

painful lymphoadenopathy in africa and asia which is rare and requires specialist testing.
treat with Ciprofloxacin 500mg BD for 3 days

Question 9

Treatment of Genital Warts

Answer 9

1st line –>topical podophyllum (multiple non-keritanised) or cryotherapy (single keritanised)
2nd line –>Imiquimod

Question 10

Labial adhesions in a young girl

Answer 10

This occurs if there is recurrent infection or inflammation leading to adhesions/ appearance of malformation. Treat with topical estrogens if symptomatic (dysuria or pain).

Question 11

Secondary effects of Syphilis

Answer 11

Rash 2-8wks after the chancre develops – rash or skin sores affecting the hands and soles and well as the mucus membranes. If it is disseminated it may also cause: mild lower, sore throat, weakness, weight loss, patchy hair loss, lymphadenopathy and can have nervous system signs.