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Genital Ulcers
🧠 Simple clinical clue: painful ulcers → think HSV 🔥. painless ulcer → think syphilis 🧬 until proven otherwise. If the ulcer is atypical or not healing, consider non-infectious causes and malignancy.
🦠 Causes
- HSV-1/HSV-2 🔥 - most common; painful ulcers/vesicles, dysuria, systemic symptoms in primary infection.
- Syphilis 🧬 - painless chancre + non-tender nodes; secondary syphilis can be systemic and subtle.
- Chancroid 🦠 - painful ragged ulcers (rare in UK).
- LGV 📍 - certain chlamydia serovars; ulcer + lymphadenopathy/proctitis in some groups.
- Non-infectious 🌿 - Behçet’s, aphthous ulcers, drug reactions, trauma, malignancy.
🔍 Clinical Tests
- Ulcer swab NAAT ✅ for HSV; add chlamydia/LGV NAAT if relevant.
- Syphilis serology 🧪 (treponemal + RPR/VDRL).
- HIV test 🩸 recommended for all with genital ulcers.
- Culture 🧫 for chancroid only if epidemiology suggests.
- Biopsy 🔬 if persistent, atypical, or non-healing ulcer.
💊 Treatment
- HSV: aciclovir/valaciclovir (early treatment reduces symptom duration; consider suppression if recurrent).
- Syphilis: benzathine penicillin G (early syphilis) - follow guideline dosing; alternatives if allergic.
- LGV: doxycycline 100 mg BD for 21 days (specialist follow-up).
- Behçet’s: specialist care (topical/systemic steroids, colchicine, immunosuppression).
- Partner notification 🤝 + STI screen; abstain until lesions healed.
⚠️ Urgent referral: severe pain/urinary retention, extensive ulceration, pregnancy, immunosuppression, or suspected malignancy.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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