Wednesday, 21 June 2017

Genital Ulcers

Genital Ulcers are specifically mentioned on our syllabus. They are more likely to be non sexually tramsitted than sexually transmitted (surprisingly!).

HSV1 is now the most common cause of genital herpes. HSV2 is more likely to result in recurrent episodes. The majority of infections are subclinical and symptomatic viral shedding, or symptomatic lesions can occur.

Get painful ulceration, dysuria, urethral or vaginal discharge. May get fever and myalgia. On examination, you get blistering and ulceration with painful lymphadenopathy.

Treat with a full sexual health screen, and oral aciclovir. Condoms won't reliably prevent transmission - abstain for a week after symptoms resolve.

Syphillis should be treated in specialist GUM clinics. It is more common in MSM. It normally presents with a painless ulcer, with a clean base. Secondary infection has multisystem involvement.

A systemic vasculitis of unknown aetiology (not considered to be auto-immune), that typically starts in young adults. You get recurrent oral and genital ulceration, uveitis, skin changes, arthritis, neuro involvement and tendency to thrombosis. It is prevalent in Japan, the middle East, and some Mediterranean countries. Treatment depends on which organ is involved.
Genital ulcers are less common than oral ulcers.

EBV, CMV and parathyphoid can cause post infective or reactive genital ulcers (lipschutz ulcers). They can be very painful, and associated with lymphadenopathy. They normally resolve within a few weeks. The ulcers normally have a yellowish centre, that may become black due to tissue necrosis, with a surrounding red rim. They may be associated with swelling.
Take viral and bacterial swabs. Look for underlying illness, and test for EBV. Treat according to the cause.

Steven-Johnson syndrome
Erythema multiforme


1 comment:

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