Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part pdf

Sexually Transmitted Infections: Overview and Clinical Approach Part 17 Diagnosis Although most genital ulcerations cannot be diagnosed confidently on clinical grounds alone, clinica

Chapter 124 Sexually Transmitted Infections:

Overview and Clinical Approach

(Part 17)

Diagnosis

Although most genital ulcerations cannot be diagnosed confidently on clinical grounds alone, clinical findings plus epidemiologic considerations (Table 124-7) can usually guide initial management (Table 124-8) pending results of further tests

Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and a dark-field or direct immunofluorescence test (or PCR test,

where available) for T pallidum in all lesions except those highly characteristic of

infection with HSV (i.e., those with herpetic vesicles) All patients presenting with genital ulceration should be counseled and tested for HIV infection

Table 124-7 Clinical Features of Genital Ulcers

Feature Syp

hilis

Herp

es

Cha ncroid

Lympho granuloma Venereum

Don ovanosis

Incubati

on period

9–

90 days

2–7 days

1–14 days

3 days–6 weeks

1–4 weeks (up

months)

Early

primary lesions

Pap ule

Vesic

le

Pust ule

Papule, pustule, or vesicle

Papu

le

No of

lesions

Usu ally one

Multi ple

Usua lly

multiple, may

Usually one; often not detected,

despitelymphad

Vari able

coalesce enopathy

Diamete

r

5–

15 mm

1–2

mm

Vari able

2–10 mm Vari

able

rply demarcate

d, elevated, round, or oval

Eryth ematous

Und ermined, ragged, irregular

Elevated, round, or oval

Elev ated, irregular

erficial or deep

Supe rficial

Exca vated

Superfici

al or deep

Elev ated

ooth, nonpurulen

t, relatively

Sero

us, erythematou

s,

Puru lent, bleeds easily

Variable, nonvascular

Red and velvety, bleeds readily

r

nonvascular

Indurati

on

Fir

m

None Soft Occasion

ally firm

Firm

ommon

Freq uently tender

Usua lly very tender

Variable Unco

mmon

Lympha

denopathy

Fir

m, nontender, bilateral

Firm, tender, often bilateral with initial episode

Tend

er, may suppurate, loculated, usually unilateral

Tender, may suppurate, loculated,

usually unilateral

None

; pseudobubo

es

Source: From RM Ballard, in KK Holmes et al (eds): Sexually Transmitted

Diseases, 4th ed New York, McGraw-Hill, 2008