Genital Ulcer Disease (GUD) Syndrome
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Genital ulcer syndrome is one of the commonest syndromes that affect men and women. Single or multiple ulcers can be present.
Causes
Multiple organisms can cause genital sores, commonly:
- Treponema pallidum bacteria: syphilis
- Herpes simplex virus: genital herpes
- Haemophilus ducreyi: Chancroid
- Donovania granulomatis: Granuloma inguinale
- Chlamydia strains: lymphogranuloma venerium (LGV)
Clinical features
Mixed infections are common
- Primary syphilis: the ulcer is at first painless and may be between or on the labia or on the penis
- Secondary syphilis: multiple, painless ulcers on the penis or vulva
- Genital Herpes: small, multiple, usually painful blisters, vesicles, or ulcers. Often recurrent
- Granuloma inguinale: an irregular ulcer which increases in size and may cover a large area
- Chancroid: multiple, large, irregular ulcers with enlarged painful suppurating lymph nodes
Differential diagnosis
- Cancer of the penis in elderly men
- Cancer of the vulva in women >50 years
Investigations
- Swab: for microscopy
- Blood: for VDRL/TPR
Management
Treatment
Multiple painful blisters or vesicles: likely herpes
- Aciclovir 400 mg every 5 hours for 7 days
- If RPR positive add Benzathine penicillin 2.4 MU IM single dose (half in each buttock)
- If lesions persist, repeat acyclovir for 7 days
All other cases
- Ciprofloxacin 500 mg every 12 hours for 3 days plus Benzathine penicillin 2.4 MU IM single dose (half into each buttock)
- In penicillin allergy, give Erythromycin 500 mg every 6 hours for 14 days
If ulcer persists >10 days and partner was treated
- Add Erythromicin 500 mg every 6 hours for 7 days
If ulcer still persists
- Refer for specialist management
Note
- Negative RPR does not exclude early syphilis
- Genital ulcers may appear with enlarged and fluctuating inguinal lymph nodes (buboes). Do not incise buboes