1. STD LESIONS Things that we love to discuss in detail at lunch

2. Outline SyphilisSyphilis HerpesHerpes Genital WartsGenital Warts Misc. LesionsMisc. Lesions Q & AQ & A

3. Syphilis - The Great Pretender Primary Lesions – “classically” are painless, clean-based & firmly indurated ulcers (but, only 1/3 fit this description)Primary Lesions – “classically” are painless, clean-based & firmly indurated ulcers (but, only 1/3 fit this description) Secondary Lesions – 75% develop a rash; usually maculopapular, non- puritic, may involve the trunk, extremities, palms & soles. Condylomata lata - Mucous patches in mouth or perineal area (papulosquamous rash).Secondary Lesions – 75% develop a rash; usually maculopapular, non- puritic, may involve the trunk, extremities, palms & soles. Condylomata lata - Mucous patches in mouth or perineal area (papulosquamous rash).

12. Syphilis (cont.) Latent lesions – none expectedLatent lesions – none expected Tertiary lesions – 30% untreated may develop chronic skin inflammatory lesions (Gumma), skin ulcerations, &/or jaundice.Tertiary lesions – 30% untreated may develop chronic skin inflammatory lesions (Gumma), skin ulcerations, &/or jaundice. Congenital lesions – rash, dental malformations.Congenital lesions – rash, dental malformations.

16. Remember: Syphilis lesions do not always follow the typicalSyphilis lesions do not always follow the typical You must look for these lesions to find themYou must look for these lesions to find them Superimposed infections can distort the pictureSuperimposed infections can distort the picture

17. HERPES The (usually) painful “bobo” down there.

18. Herpes (cont) There are ½ million new infections per year in the U.S., so expect to see this a lot.There are ½ million new infections per year in the U.S., so expect to see this a lot. First outbreak usually lasts 2-3 weeksFirst outbreak usually lasts 2-3 weeks Begins with tingling or burning feelingBegins with tingling or burning feeling Small red bumps appearSmall red bumps appear

19. Herpes (cont) The bumps turn into blisters or open sores, scab over & heal without scarringThe bumps turn into blisters or open sores, scab over & heal without scarring May also include: swollen lymph glands, muscle aches, headache, fever, nausea, & painful or difficult urinationMay also include: swollen lymph glands, muscle aches, headache, fever, nausea, & painful or difficult urination

25. Herpes (cont) Symptoms in women > menSymptoms in women > men Subsequent outbreaks are usually milderSubsequent outbreaks are usually milder Lesions will be where ever the virus entered the body (penis, vagina, mouth, fingers, anus, thighs, etc)Lesions will be where ever the virus entered the body (penis, vagina, mouth, fingers, anus, thighs, etc)

26. GENITAL WARTS Bumps on their privates

27. Genital Warts (cont) More than 20 viruses cause these lesionsMore than 20 viruses cause these lesions Types 6 & 11 cause the warts we can seeTypes 6 & 11 cause the warts we can see Over 1 million new cases each year – so, expect to see these every dayOver 1 million new cases each year – so, expect to see these every day

29. Genital Warts (cont) Virus can be passed without seeing a wartVirus can be passed without seeing a wart Most people with warts have no symptomsMost people with warts have no symptoms May appear at first as small, hard spots at the place where the virus entered the body (mouth, penis, anus, vagina, etc)May appear at first as small, hard spots at the place where the virus entered the body (mouth, penis, anus, vagina, etc)

30. Genital Warts (cont) May appear smooth, or have stalks & a rough surfaceMay appear smooth, or have stalks & a rough surface Most often they are ¼ inch across & 3/8 inch highMost often they are ¼ inch across & 3/8 inch high May itch, bleed, become chaffedMay itch, bleed, become chaffed Can occur alone or in clustersCan occur alone or in clusters Usually painlessUsually painless

31. Genital Warts (cont) No cure – treat with TCA or self- applied creamsNo cure – treat with TCA or self- applied creams May return after treatmentMay return after treatment Long-term side effects include abnormal pap smears, cervical or vulvular cancerLong-term side effects include abnormal pap smears, cervical or vulvular cancer Often enlarge during pregnancyOften enlarge during pregnancy

32. MISCELLANEOUS LESIONS Things that may fool us

33. Miscellaneous Lesions (cont) ScabiesScabies CandidiasisCandidiasis FolliculitisFolliculitis Herpes ZosterHerpes Zoster Skin tagsSkin tags Pearly penile papulesPearly penile papules Epidermal cystsEpidermal cysts Tinea CruisTinea Cruis Bartholin Gland cysts Dermoid cysts Vitilago Chancroid (painful,dirty base, bulboe, adenopathy) Crohn’s Disease Molluscum

35. Descriptive Terms PapulePapule MaculeMacule PlaquePlaque PatchPatch NoduleNodule MorMor VesicleVesicle BullaBulla pustulepustule Wheal Comedo Scale Fissure Erosion Ulcer Crust Scar lichenification

36. Descriptive Terms (cont) NumberNumber ColorColor TypeType ConfigurationConfiguration DistributionDistribution Other: tenderness, pruitis, depth, base, consistency, lymphaden- opathy

37. IN CONCLUSION STD Lesions are common—you will see them more than you might care toSTD Lesions are common—you will see them more than you might care to After you have seen may of these lesions over & over, you will become better at differentiationAfter you have seen may of these lesions over & over, you will become better at differentiation

38. In Conclusion (cont) Follow your STD standing orders when dealing with any STD lesion If in doubt, refer

39. In Conclusion (cont) REMEMBER —REMEMBER — STD Can be FUN!!!!!! STD Can be FUN!!!!!!