GENITAL ULCERS

Aetiology
1.Genital herpes
2.Syphilis
3.Chancroid
4.LVG
5.Granuloma inguinale (donovanosis)
Genital herpes
Grouped vesicles that rupture to
produce painful superficial ulcer on
erythematous base.
Associated tender inguinal
lymphadenopathy.
Diagnosis
1.Gemsawright papanivolaoa stain of
scrappings
2.Viral culture to confirm diagnosis
Chancroid
Aetiology
Haemophilus ducreyi
Clinical features
Initial ulcer erythematous papules
pustules followed by
2.Deep ulcer which is
a)Painful
b)Produce haemorrhagic or purulent
discharge
c)Accompanied by painful
suppurative & inguinal
lymphadenopathy
Diagnosis
Iroloation of H ducreyi
Treatment
Erythromycin cefriaxone
LVG
Aetiology
Chlamydiatrachomatis
Clinical features
Transient ulcer & marked inguinal
lymphadenopathy
Granuloma inguinale
Aetiology
Calymmatobacterium granulomatis
( a gram negative bacillus)
Clinical features
Granulating ulcer
No lymphadopathy
Treatment
For both is tetracycline
Genital ulcers
Precautions (general approach)
1.VDRL or other alternatives
2.Dark field microscopy if not
suggestive of HSV
3.Culture for H Ducreyi & initiation of
treatment for chanchroid
4.Biopsy to exclude donovanosis or
other cause
Vaginitis (cervitis)
Aetiology
1. Bacterial -gardnerella (several
anaerobic bacteria)
C.trachomatis
N.gonorrhoea
2. Trichomonas vaginalis
3. Candida albicans
4. KOH +vaginal fluid (fishy odor) wet
microscopy- skiff test positive.
Treatment
Tab metronidazole 500mg B.D for 7/7
DID
Aetiology
Most common
1.C. Trachomatis
2.N.Gonorrhoea
3.Aerobic bacteria
Peptostreptococcus
Peptococcus
Bacteroids
Less common
1.Mycoplasma
2.Ureaplasma urealytininum
3.Gardnerella vaginalis
4.Streptococcus species
5.Esel coli
6.influenza
Clinical features
1.Lower abnomen
2.Lower abdominal tenderness
3.Cervical motion tenderness
4.Adnexial tenderness
5.Plus one or more of the following:
1.Fever T 38c or higher
2.Leucocytosis
3.ESR
4.Positive smear for:
N.Gonorrhoea
C.Trachomatis
Treatment
Aims
1.Prevention of infertility
2.Prevention of chronic residual of
infection
Drugs
1.I.V cefexitin
2.Doxycyeline
3.Admission to hospital because of
non-compliance
Urethritis
Gonococcal (GU) N gonorrhoea
Non gonoccal (NGU)
1. Most common
C. trachomatis
2. Less common
a)U. Urealyticum
b)Mycoplasma
c)Haemophillus
d)Bacteroids
e)HSV
f) T vaginalis