Transcript Genital Lesion

Genital Lesion
By: Group B
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Introduction
Herpes simplex virus (II)
Granuloma inguinalae
Soft chancer
Candidiasis
Human papilloma virus
Syphilis
Management and prevention
Introduction:
• Genital sores may be painful, itchy, produce a
discharge, or cause no symptoms at all.
• Because genital lesions or sores can have a
negative affect on a person's self-image, many
people do not seek proper medical care. All genital
sores should be evaluated by a medical
professional.
• Itching, painful urination, or painful sexual
intercourse often occur with genital lesions.
Herpes simplex
virus (II)
Herpes simplex virus (II)
• Associated with genital infections , young
sexually active adults mainly.
• The primary lesions are:
An erythematous plaque which is often
noted initially, followed soon by grouped
vesicles, which may evolve to pustules; these
become eroded. Erosions are punched out
and may enlarge to ulcerations.
• Incubation period:
o 2-7 days
• Lesions appear on the:
I. Glans or penile shaft in of males
II. Uvula in females
III. Herpes lesions may found around the
anus also (in case of homosexual men)
Group of vesicles with
early central crusting
on a red base arising
on the shaft of the
penis.
• shallow ulcers on
the edematous
vulva and
perineum.
Micturition is often
very painful.
Associated
inguinal
lymphadenopath
y is common.
• Anal type of HSV(II)
• Lesions are painful associated with:
headache, myalgia, Fever, local
lymphadenopathy.
• Paraesthesiae may develop (urinary retention.,
constipation).
• Skin and mucosal lesions resolves within 2-3
weeks
• Recurrent genital herpes: with milder and
shorter manifestations and more localized
lesions (after exposure to sunlight, UV light, trauma
to sensory nerves).
Neonatal HSV(II) infection :
• Occurs during parturition when the mother has
genital herpes (primary type).
• Clusters of vesicles , start to appear after few
day to several weeks after birth..
• Complications:
o Encephalitis
o Pneumonia
o Hepatitis (with high mortality).
Management :
• 5 days of oral Acyclovir topical
cream or systemic treatment (200
mg, 5 times per day )+ analgesics
and saline baths
• For recurrence hygiene is all that
required, in addition to counseling
and prevention of transmission
Granuloma inguinalea
Granuloma inguinale:
• Granuloma: is a nodular type of
inflammatory reaction.
• Inguinale: refer to inguinal region.
• It’s also known as donovanosis after the
donovans bodies which are diagnostic
sign.
• It’s bacterial disease caused by klebsiella
granumatis.
• Characterized by ulcerative genital lesions
and the ulcers ultimately progress to
destruction of internal and external tisse with
extensive leakage of mucus and blood from
highly vascular lesions.
• The ulcer can be mistaken for sypillis.
Symptoms:
1. Small, painless nodules, later the nodule
burst creating open fleshy, oozing lesions.
2. The lesions typically found on the shaft of
the penis, the labia, or the perineum.
3. In contrast to syphilitic ulcer there’s no
lymphadenopathy.
Transmission:
• The organism transmitted from one host to
another through contact with open sores.
• Diagnosis:
1. Patient’s sexual history.
2. Physical examination revealing painless, beefy red
ulcer with granulation tissue edge.
3. Tissue biopsy confirm the presence of donovan
bodies.
Treatment:
1. three weeks of treatment with: erythromycin
streptomycin or tetracycline.
2. Or 12 weeks of treatment with: ampicillin.
• Prevention:
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Avoidance of sexual contact in endemic regions.
Sexually transmitted disease (STD) testing before
beginning of sexual relationship.
Chancroid
Chancroid:
• also known as soft chancre.
• Is a bacterial sexually transmitted
infection characterized by painful sores on the
genitalia.
• Chancroid is known to spread from one individual to
another through sexual contact
• Is a bacterial infection caused by the fastidious Gram –
ve Haemophilus ducreyi
• It is a disease found primarily in developing countries.
Pathogenesis:
• H. ducreyi enters skin through
microabrasions incurred during sexual
intercourse. A local tissue reaction leads
to development of
erythomatous papule, which progresses
to pustule in 4–7 days. It then undergoes
central necrosis to ulcerate.
Symptoms and signs:
 These are only local and no systemic manifestations are
present
 The ulcer characteristically :
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Ranges in size dramatically from 3 to 50 mm (1/8 inch to two
inches) across
Is painful
Has sharply defined, undermined borders
Has irregular or ragged borders
Has a base that is covered with a gray or yellowish-gray
material
Has a base that bleeds easily if traumatized or scraped
Painful lymphadenopathy occurs in 30 to 60% of patients.
Dysuria (pain with urination) and dyspareunia (pain with
intercourse) in females
• The initial ulcer may be mistaken as a
"hard" chancre, the typical sore of
primary syphilis, as opposed to the "soft
chancre" of chancroid.
• Approximately one-third of the infected
individuals will develop enlargements of
the inguinal lymph nodes
• Half of those who develop swelling of the
inguinal lymph nodes will progress to a point
where the nodes rupture through the skin,
producing draining abscesses. The swollen
lymph nodes and abscesses are often referred
to as buboes.
Diagnosis:
 By laboratory findings :
1. From bubo pus or ulcer secretions ,
H.ducreyi can be identified
2. PCR-based identification of organisms is
available
3. Simple, rapid, sensitive and inexpensive antigen
detection methods for H. ducreyi identification
are also popular.
4. Serologic detection of H. ducreyi is and
uses outer membrane protein and lipooligosaccharide.
Comparison with syphilis:
Chancroid
lesion typical of infection with
the bacterium Haemophilus
ducreyi
Chancre
lesion typical of infection with
the bacterium that
causes syphilis, Treponema
pallidum
typically painful
typically painless
have a grey or yellow
purulent exudate
non-exudative
have a soft edge
have a hard (indurated) edge
CHANCROID
CHANCRE
Treatment:
• Single oral dose (1 gram) of Azithromycin, or a
single IM dose of Ceftriaxone, or
oral Erythromycin for seven days.
• Abscesses are drained.
Genital
Candidiasis
Candidiasis:
• Candidiasis or thrush is a fungal infection (mycosis) of
any species from the genus Candida , Candida
albicans is the most common agent of Candidiasis in
humans.
• Candidiasis may be divided into:
1. Mucosal candidiasis
2. Cutaneous candidiasis
3. Invasive candidiasis
Candidal vulvovaginitis:
Up to 75% of women will have this infection at
some point in their lives, and approximately 5% will
have recurring episodes , It is the second most
common cause of vaginal inflammation after
bacterial vaginosis.
• The Candida species of fungus is found naturally in
the vagina, and is usually harmless, Symptoms of
thrush can also be caused by Candida glabrata,
Candida krusei, Candida parapsilosis, and
Candida tropicalis.
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Symptoms:
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Vulval itching.
Vulval soreness and irritation.
Superficial dyspareunia.
Dysuria.
vaginal discharge, which is
usually odourless,This can be
thin and watery, or thick and
white, like cottage cheese.
Diagnosis
Candidal balanitis:
• Not common.
• Candidal balanitis, infection of the
glans penis, almost exclusively
occurring in uncircumcised males.
• Symptoms of infection of the male
genitalia include red, patchy sores
near the head of the penis or on the
foreskin, severe itching, or a burning
sensation. Candidiasis of the penis
can also have a white discharge,
although uncommon.
Treatment:
• Candidiasis is commonly treated with antimycotics;
these antifungal drugs include topical clotrimazole,
topical nystatin, fluconazole, and topical
ketoconazole.
• A one-time dose of fluconazole is 90% effective in
treating a vaginal yeast infection, Local treatment
may include vaginal suppositories or medicated
douches.
Prevention:
General advice:
1. Routine recommendation of use of
vulval moisturisers as soap substitute
and regular skin conditioner .
2. Loose-fitting, natural fibre underwear.
3. Avoidance of topical irritants.
4. Good hygiene.
Human
papilloma virus
Human papilloma
virus:
• Genital warts may occur singly but are more
often found in clusters.
• They may be found anywhere in the anal or
genital area, and are frequently found on
external surfaces of the body, including the
penile shaft, scrotum, labia majora of the
vagina, or around the anus
• They can also occur on
internal surfaces like the
opening to the urethra,
inside the vagina, on the
cervix, or in the anus. In
males they are frequently
found on or around the
head of the penis.
• They can be as small as 1-5mm in diameter, but can
also grow or spread into large masses in the genital or
anal area. In some cases they look like small stalks.
• They may be hard ("keratinized") or soft. Their color can
be variable, and sometimes they may bleed. In most
cases, there are no symptoms of HPV infection other
than the warts themselves
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Sometimes warts may
cause itching, redness, or
discomfort, especially when
they occur around the anus.
Although they are usually
without other physical
symptoms, an outbreak of
genital warts may cause
psychological distress, such
as anxiety, in some people
Syphilis
Definition:
• Syphilis is an infectious disease caused by the
spirochete Treponema pallidum.
• It is almost always transmitted by sexual contact
with infectious lesions.
• But can be transmitted in utero and via blood
transfusion.
The Great Pox
• Epidemic in late 15th century Europe
• Rapid spread and severe symptoms in
early stages
• Epidemic coincided with Columbus’
return from America in 1493
o ? A gift from the new world
Treponema pallidum
Clinical Presentation
Syphilis
Acquired
Primary
Secondary
Congenital
Tertiary
Primary Syphilis:
• Chancre:
o Appears 10-90 days after infection
o Typically single, painless, clean-based lesion with rolled edges
Secondary Syphilis:
• Signs and Symptoms:
o Usually occurs 3-6 weeks after primary chancre:
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Rash (75-90%).
Generalized lymph node swelling (70-90%).
Constitutional symptoms (50-80%).
Mucous patches (5-30%).
Condyloma lata (5-25%).
Patchy alopecia or hair loss (10-15%).
Symptoms of neurosyphilis (1-2%).
Less common: meningitis, hepatitis, arthritis, nephritis.
Tertiary Syphilis:
• 70% of untreated patients remain asymptomatic.
• 30% of untreated patients progress to tertiary stage in 520 years:
1. Gummas: destructive lesions of soft tissue, cartilage, internal
organs and bone.
2. Cardiovascular involvement: aortic aneurysm, aortic
insufficiency.
3. Central nervous system involvement: general paresis, tabes
dorsalis, optic atrophy.
• Progressive inflammatory disease.
Diagnostic Tests for Syphilis:
1. Darkfield / DFA-TP
2. VDRL/RPR
3. FTA-abs
Treatment of Syphilis:
• PCN is drug of choice for treatment of all stages of
syphilis.
• HIV testing is recommended in all patients
• PCN-allergic; Tetracycline 500mg for 14 days
Management and prevention:
Management:
• Prevention offers the best approach to
managing STIs.
• Not all genital ulcer cause by STIs there for;
there are specific tests for evaluation of the
genital ulcer.
• The specific tests include:
1. Syphilis serology for T.pallidum.
2. Culture or antigen test for HSV.
3. Biopsy of genital ulcers that are un usual or
that don't respond to initial therapy.
4. HIV/AIDS test.
• the health care providers frequently
must treat patient before test results
are available.
Prevention:
• The most effective way to prevent transmission of
STIs is to avoid sexual intercourse with an infected
partner.
• Ideally both new partner should get test for STIs
before initiating sexual intercourse.
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Correct use of condom and safer sex practice.
Immunization: against hepatitis B.
Reduce mother to child transmission .
Ensure safety of the blood for transfusion.
Vaccination: HPV vaccine
Avoid sharing the under clothes.
Education about STIs.
Thank you