1. Genital Ulcers

2. Outline Herpes Simplex Syphilis Chancroid Lymphogranuloma Veneruem
Donovanosis

5. 1. Herpes Simplex Relatively common ulcerative problem
Herpes Simplex Type 2
STD
Recurrent, incurable
Starts with a Rash  Blister  Pus formation  Healing

6. Diagnosis PCR (most accurate and sensitive) Serologic tests
Western Blot Assay (most sensitive for recurrent and subclinical)

7. Treatment No cure Primary episode Recurrent episodes
Valacycolvir 1000 mg
2x a day for 7-10 days
Recurrent episodes
Valacyclovir 1000 mg
Daily or 500 mg 2x daily for 5 days
Daily Suppressive Therapy
Valacyclovir 500 mg daily (≤8 recurrences/year) or 1000 mg/day or 250 mg bid ( 9 recurrences/year)

8. 2. Syphilis Treponema Pallidum (Spirochete) Screening tests:
VDRL
RPR
Confirmatory:
FTA-ABS
Screening (non-specific)
FTA-ABS (false positives)

9. Stages Primary Secondary Tertiary PAINLESS papule
Systemic (hematogenous spread)
Tertiary
Involvement of CNS, CVS, musculoskeletal

10. Treatment
Early (Primary, secondary and early latent syphilis of less than 1 year’s duration)
Parenteral Penicillin
Benzathine Penicillin G 2.4 million units, single dose
Alternative (Penicillin allergic non-pregnant patients)
Doxycycline 100 mg orally 2x/day for 2 weeks or
Tetracycline 500 mg 4x daily for 2 weeks
Late Latent Syphilis (more than 1 year’s duration, gummas and cardiovascular syphilis)
Benzathine Penicillin G 2.4 million units IM for 4 doses at 1-week intervals
Neurosyphilis
Aqueous crystalline Penicillin G, 3-4 million units IV ever 4 hours, for days or
Procaine Penicillin 2.4 million units IM daily for days plus Probenecid (adjuvant substance which allows penicillin to stay longer) 500 mg p.o. 4x daily for days

11. 3. Chancroid
Hemophilus ducreyi
Soft chancre

12. Diagnosis Always painful ulcer Manifests with the deepest scarring
The ulcers have a dirty, gray, necrotic, foul-smelling exudate, and there is an absence of induration at the base

13. Treatment Azithromycin 1 g orally, single dose or
Ceftriaxone 250 mg IM, single dose or
Ciprofloxacin (Quinolone) 500 mg orally for 4 days

14. 4. Lymphogranuloma Venereum (LGV)
A chronic infection of lymphatic tissue produced by Chlamydia trochomatis
3 Phases:
Shallow, painless ulcer of the vestibule or labia
Painful inguinal and peri-rectal adenopathy
Bubos
“Groove sign” – Double genito-crural fold
You have lymph that coalesces then forms pus and in-folding of crural folds

15. Treatment Doxycycline 2x daily for 21 days or
Azithromycin 1 gm orally once a week for 3 weeks or
Ciprofloxacin 750 mg orally 2x daily for 3 weeks or
Erythromycin 500 mg 4x daily for 21 days

16. 5. Donovanosis AKA: Granuloma Inguinale
Calymmatobacterium granulomatis
Close non-sexual contact
Asymptomatic nodule
Beefy-red ulcer with fresh granulation tissue
Ulcers are painless unless secondarily infected
asymptomatic nodule. The skin over the nodule ulcerates, and the characteristic lesion is a beefy-red ulcer with fresh granulation tissue. The area around the lesions is highly vascular, thus the ulcers bleed easily when touched. Usually there are multiple nodules and, subsequently, multiple ulcers of the vulva. Adjacent areas of ulceration grow and coalesce and, if untreated, will eventually destroy the normal vulvar architecture. The ulcers are painless unless secondarily infected. Adenopathy is not a prominent feature unless there is a superimposed infection.

17. Treatment Doxycycline 100 mg orally 2x daily for 3 weeks
Azithromycine 1 gm per week for 3 weeks
Ciprofloxacin 750 mg orally 2x a day for 3 weeks
Erythromycin base 500 mg or TMP-SMz double strength 2x daily for 3 weeks
Similar with LGV