STI-related Genital Ulcer
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Cause
- Herpes simplex
- Treponema pallidum (syphilis)
- Haemophilus ducreyi (chancroid)
- Calymmatobacterium granulomatis (granuloma inguinale)
Symptoms
- Genital ulcer (painful or painless)
- Urethral discharge
- Inguinal swelling (lymphadenopathy)
Signs
- Inguinal lymphadenopathy
- Herpes simplex
- Multiple, recurrent vesicular lesions (Herpes simplex)
- Syphilitic ulcers
- Often single, painless and indurated lesions with a clear base and well-defined edges
- Occasionally multiple, painful, non-indurated or have a purulent base
- Discrete, firm, painless, inguinal lymphadenopathy a week after the primary lesion
- Primary ulcer usually heals within six weeks, usually without leaving a scar.
- Chancroid
- Painful with undermined ragged edges
- The base is covered with a purulent exudate and easily bleeds to touch
- Several ulcers may coalesce to form serpiginous lesions
- Lymphadenopathy is usually unilateral and may become fluctuant
- Granuloma inguinale
- Begins with a small papule that progresses into an enlarging granulomatous ulcer with trauma
- Edges are well defined
- Healing is not spontaneous and is accompanied by extensive scarring
Investigations
- VDRL (if available)
- TPHA (if available)
TreatmentTreatment Objectives
- To treat small ulcers and vesicles, especially if recurrent for Herpes simplex
- To direct initial management of all ulcers at herpes simplex, syphilis and chancroid concurrently
Non-pharmacological Treatment
Keep lesions dry and clean
Pharmacological Treatment
Evidence Rating: [C]
For Herpes simplex
- Aciclovir, oral, 200 mg 4-6 hourly for 7-10 days (5 doses daily)
Or
- Aciclovir, oral, 400 mg 8 hourly for 7-10 days
For individuals with herpes and HIV co-infection
- Aciclovir, oral, 400 mg 8 hourly for 7-10 days
Or
- Aciclovir, oral, 800 mg 12 hourly for 7-10 days
Episodic therapy for recurrent episodes
- Aciclovir, oral, 400 mg 8 hourly for 5 days
Or
- Aciclovir, oral, 800 mg 12 hourly for 5 days
Or
- Aciclovir, oral, 800 mg 8 hourly for 2 days
Suppressive therapy in HIV infected individuals
- Aciclovir, oral, 400-800 mg 8-12 hourly for 2-6 years
For Syphilis
- Benzathine Penicillin G, IM, 1.2 MU in each buttock (total dose 2.4 MU) stat
Or
- Procaine Penicillin Aqueous, IM (by deep injection), 1.2 MU daily for 10 days
For persons allergic to penicillin
- Doxycycline, oral, 100 mg 12 hourly for 14 days
Or
- Tetracycline, oral, 500 mg 6 hourly for 14 days
For pregnant women allergic to penicillin
- Erythromycin, oral, 500 mg 6 hourly for 14 days
Or
- Azithromycin, oral, 500 mg daily for 10 days
For Chancroid
- Ceftriaxone, IM, 250 mg stat.
Or
- Azithromycin, oral, 1 g stat.
Or
- Ciprofloxacin, oral, 500 mg 12 hourly for 3 days
Or
- Erythromycin, oral, 500 mg 6 hourly for 7 days