Updated: 2/17/2019

Ulcerative Genital Lesions

Topic
Review Topic
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Snapshot
  • A 25-year-old man presents to the urgent care center for a new lesion on his genitals. He reports that he recently went to a bachelor party in Las Vegas, where he engaged in sexual intercourse with multiple female partners. He reports only sometimes using protection. In the past week, he reports having fevers and chills along with a few painful lesions on his penis. On physical exam, there are multiple clear vesicles on his penis. He is tested for the appropriate sexually transmitted diseases and prescribed acyclovir. (Genital herpes)
Introduction
  • Introduction
    • ulcerative genital lesions
      • chancroid
      • genital herpes
      • granuloma inguinale
      • lymphogranuloma venereum
      • syphilis
    • transmission
      • sexually, often through a break in the skin
    • risk factors
      • multiple sexual partners
      • unprotected sexual intercourse
Chancroid
  • Introduction
    • organism 
      • Haemophilus ducreyi
      • gram-negative, facultative anaerobic coccobacillus
  • Presentation
    • painful ulcer with exudate
      • yellow-grey base with irregular borders
      • may bleed when touched
    • unilateral tender inguinal lymphadenopathy
    • no systemic symptoms
  • Studies
    • Gram stain
      • gram-negative coccobacilli
    • culture on Nairobi medium or Mueller-Hinton agar
    • detection of DNA with polymerase chain reaction (PCR)
  • Treatment
    • ceftriaxone
    • azithromycin
Genital Herpes
  • Introduction
    • organism
      • herpes simplex virus 2
      • herpes simplex virus 1 (less common)
      • enveloped linear double-stranded DNA virus
    • pathogenesis
      • latent in sacral ganglia
  • Presentation
    • painful clear vesicles
    • may have ulcers if the roofs of vesicles fall off
    • systemic symptoms
      • fevers
      • headaches
      • myalgias
  • Studies
    • Tzanck prep
      • multinucleated giant cells
    • detection of DNA with PCR
  • Treatment
    • acyclovir, valacyclovir, or famciclovir
    • foscarnet
      • resistance to acyclovir
Granuloma inguinale (Donovanosis)
  • Introduction
    • organism
      • Klebsiella (Calymmatobacterium) granulomatis
      • gram-negative, oxidase-negative bacillus
    • demographics
      • not common in the US
    • risk factors
  • Presentation
    • beefy red ulcer that bleeds when touched
    • irregular borders
  • Studies
    • bipolar staining
      • Donovan bodies in cytoplasm
    • mucoid colonies on MacConkey agar
  • Treatment
    • doxycycline
    • trimethoprim-sulfamethoxazole
    • azithromycin
 

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