Genital Ulceration

Submitted by amh10 on 21 March, 2007 - 13:25

Bacterial:

  • Klebsiella granulomatis (previously Calymmatobacterium granulomatis)
  • H. ducryei
  • Treponoma pallidum
    • Primary, secondary, tertiary
    • VDRL: floculation test, anti-cardiolipin antibody.
      • Positive in late primary, secondary.
      • If VDRL↑ on Rx: re-infection, re-activation or failure of compliance.
      • REM: Prozone effect.
      • Congenital disease: parallel VDRL baby & mum - neonatal IgM.
    • TPHA/TPPA - not specific for T. pallidum - non pathogenic species are used for the test.
      • Positive for life.
    • FTA (IgG/IgM can be used for neonatal infection screening).
    • Penicillin for 3/52 - no resistance.
  • LGV (C. trachomatis L1-L3)

Viral:

  • HSV 1&2
  • Can be divided into:
    • Primary (first contact with HSV) or Initial (contact with HSV-1 when already have HSV-2 or vice versa)
      • Severe pain
      • Lasts longer
      • Longer to heal
      • Systemic Manifestations
    • Reactivation/reinfection:
      • Less symptomatic
      • Multiple lesions
      • Heals quickly
      • Constitutional symptoms
    • Ix:
      • Viral isolation
      • IF
      • EM
      • Ag
      • PCR (non are serotype specific)
    • If 4-5 attacks per year - consider prophylaxis.
    • Rx consists of aciclovir 200mg tds.
    • Pregnancy & HSV:
      • if Primary - foetal risk is much higher, pt maybe asymptomatic
      • if recurrent - lower risk - immunity alrteady present
      • Prev HSV is important - suppress from 32/40 with aciclovir - consider C/S if ulcers present during the pregnancy.
    • Mollaret's Meningitis.

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