Genital Ulceration

Description

This is an infection caused by spirochaetes called Treponema pallidum, a corkscrew-shaped organism with an incubation period of 9 to 90 days.

Signs and Symptoms

• Primary:
  • Painless papule/ulcer called a chancre found on the glans penis, shaft, anus and rectum in men, whereas in women it is found on the vulva, cervix and perineum.
  • Bilateral inguinal lymphadenopathy 
• Secondary:
  • Cutaneous rashes may affect the soles and palms
  • Patchy hair loss
  • Oral ulcers
  • Condylomata lata
  • Generalised lymphadenopathy
  • Uveitis
  • Arthritis
  • Meningitis
  • Glomerulitis
• Tertiary:
  • Aortic aneurysm
  • Aortic valvular insufficiency
  • Dementia
  • Manic syndrome
  • Neurosyphilis:

Congenital syphilis presents with clinical features as those of secondary syphilis in adults.

Investigations

• Screening: VDRL (Venereal Disease Research Laboratory), RPR (Rapid Plasma Reagin)
• Confirmatory test: Treponema Palidum Haemaglutinin Assay (TPHA)

Treatment

Refer to Recommended Treatment Regimens for Syndromic Treatment of STIs

Treatment of Genital Ulcers

Most patients with primary or secondary syphilis infection have Jarisch - Herxheimer reaction within 6 hours to 12 hours of initial treatment. The reaction is manifested by generalized malaise, fever, headache, sweating, rigours and a temporary exacerbation of syphilitic lesions. This usually subsides within 24 hours and poses no danger other than the anxiety it produces.

Description

This is an acute, localized, contagious disease characterised by painful genital ulcers and suppurative inguinal lymph nodes caused by Haemophilus ducreyi

Signs and Symptoms

• Small, painful papules
• Shallow ulcers in various sizes with ragged undermined edges, painful non-indurated, with a reddish border
• Enlarged, tender and matted inguinal lymph nodes (Bubo)
• The skin over the abscess can become red and shiny and may break down to form a sinus

Complications

• Phimosis, Urethral stricture, Urethral fistula
• Severe tissue destruction leading to a phagedenic ulcer which may grow rapidly and cause auto amputation of the penis.
• Biopsy the ulcer to distinguish from squamous cell carcinoma.

Description

This is characterized by transitory primary ulcerative lesion followed by suppurative lymphadenitis. It is caused by serotypes of Chlamydia trachomatis L1, L2, L3 which are distinct from those causing trachoma, urethritis, cervicitis and inclusion conjunctivitis.

Signs and Symptoms

• A small, transient, non-indurated vesicular rapidly healing ulcer
• Unilateral, tender enlarged inguinal lymph nodes, with groove sign
• Multiple sinuses with purulent or bloodstained discharge
• Constitutional symptoms of fever, malaise, joint pain, anorexia, and vomiting
• Backache is common in women in whom the lesion may be on the cervical or upper vagina resulting in the enlargement and suppuration of perirectal and pelvic lymph nodes. This results in the formation of rectovesical and rectovaginal fistulas.

Aspirate suppurating glands with a wide bore needle through intact skin. Avoid incision and drainage through a fluctuant area which results in chronic sinus formation

Description

Herpes Genitalis is an infection of the genital or anogenital area by herpes simplex virus (herpesvirus hominis type 2). Lesions usually develop 4 to 7 days after sexual contact. The condition tends to recur because the virus establishes a latent infection of the sacral sensory nerve from which it reactivates and re-infects the skin

Signs and Symptoms

• A small group of painful vesicles develops, they erode and form several superficial, circular ulcers with a red areola, which coalesce.
• The ulcers become crusted after a few days and generally heal with scarring in about 10 days
• The inguinal lymph nodes are usually slightly enlarged
• Tender lesions in men may occur on the prepuce, glans penis, and penile shaft whereas in women may occur on the labia, clitoris, perineum, vagina and cervix.
• Generalized malaise, fever, difficulty in micturition or difficulties in walking

Investigations

• RDT for Herpes
• Tissue culture
• Skin Scraping for Cytology

Complications

• Aseptic meningitis
• Transverse myelitis
• Autonomic nervous dysfunction involving the sacral region leading to urinary retention 

Rare in Zambia

Description

This is a chronic granulomatous condition usually involving the genitalia and spreads by sexual contact caused by Klebsiella granulomatis.

Signs and Symptoms

• Painless, multiple beefy-red nodule which coalesce to form a large elevated, velvety, ulcerated lesion appearing in men on penis, scrotum, groin and thighs, whereas in women on the vulva, vagina and perineum
• There is no lymphadenopathy

Investigations

• Do a punch biopsy of the lesion for histology

Treatment

• Erythromycin 500mg orally 6 hourly for 14 to 21 days
   OR
• Azithromycin 1g PO once weekly times 3 doses

Description

This is a fleshy growth found around the anogenital region caused by Human papillomavirus infection HPV6 and 11

Signs and Symptoms

• Lesions can be subclinical or overt anogenital warts
• Fleshy multi-focal growth of the lower genital tract
• For Cervical Warts DO NOT CAUTERISE

Investigations

• Biopsy

Treatment

Refer to Recommended treatment regimens for syndromic treatment of STIs