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Genital ulcers

Background knowledge ๐Ÿง 

Definition

  • Genital ulcers are sores or lesions that appear on the genital area.
  • They can be painful or painless and vary in size and number.
  • Often associated with sexually transmitted infections (STIs).

Epidemiology

  • Prevalence varies by region and population.
  • Higher incidence in sexually active individuals.
  • Commonly affects both males and females.
  • Risk factors include multiple sexual partners and unprotected sex.

Aetiology and pathophysiology

  • Herpes simplex virus (HSV) – recurrent painful ulcers.
  • Treponema pallidum (syphilis) – painless chancre.
  • Haemophilus ducreyi (chancroid) – painful ulcers.
  • Other causes: trauma, Behรงet’s disease, malignancies.
  • Pathophysiology involves local infection and immune response.

Types

  • Herpetic ulcers: recurrent, painful, grouped vesicles.
  • Syphilitic ulcers: single, painless, indurated chancre.
  • Chancroid: multiple, painful, soft ulcers with ragged edges.
  • Non-infectious ulcers: trauma-induced, autoimmune-related.

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Pain or discomfort in the genital area.
  • Ulceration: size, number, and appearance vary.
  • Possible systemic symptoms: fever, malaise.
  • Dysuria if ulcers are near the urethra.
  • Lymphadenopathy: swollen lymph nodes.

Signs

  • Visible ulcers on genital examination.
  • Tenderness or pain on palpation.
  • Possible discharge or secondary infection.
  • Inguinal lymphadenopathy.
  • Induration or swelling around the ulcer.

Investigations ๐Ÿงช

Tests

  • Viral swabs for HSV PCR.
  • Dark field microscopy for Treponema pallidum.
  • Serological tests: syphilis serology (RPR, TPHA).
  • Culture for Haemophilus ducreyi.
  • HIV testing if indicated.
  • Biopsy for non-infectious causes or malignancy suspicion.

Management ๐Ÿฅผ

Management

  • Antiviral therapy for HSV: aciclovir or valaciclovir.
  • Antibiotics for syphilis: benzathine penicillin.
  • Treatment for chancroid: azithromycin or ceftriaxone.
  • Pain management: analgesics, topical lidocaine.
  • Counseling on safe sex practices and partner notification.
  • Regular follow-up to monitor healing and recurrence.

Complications

  • Secondary bacterial infection.
  • Scarring and strictures.
  • Increased risk of HIV transmission.
  • Psychological impact and sexual dysfunction.
  • Disseminated infection in immunocompromised patients.

Prognosis

  • Good with appropriate treatment.
  • Recurrent HSV infections are common.
  • Syphilis has excellent prognosis with early treatment.
  • Complications affect prognosis if untreated.
  • Prognosis worsens with delayed diagnosis and treatment.

Key points

  • Consider STIs in all cases of genital ulcers.
  • Accurate diagnosis is essential for effective treatment.
  • Partner notification and treatment is crucial.
  • Educate patients on prevention and safe sex practices.
  • Follow-up is essential to ensure resolution and manage recurrences.

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