Transcript Genital skin lesions and dermatitis

Genital skin lesions and
dermatitis
♂♀
Matiu Bush
Nurse Practitioner Candidate
Melbourne Sexual Health Centre
Clinical Photography
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Take photos!
Any digital camera with a macro function
Patient consent form
Policy and procedure
Secure location on hard drive to store images
Causes
Herpes Type 2
Nodular
scabies
Varicella virus
Candida
Primary Syphilis
Lichen sclerosis
Causes
STI
• Herpes type 1 and 2
(95% of genital ulcers)
• Syphilis
(>1% of genital ulcers)
• LGV
(<1% of genital ulcers)
NON STI
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Bacterial
Viral
Fungal
Dermatoses
Trauma
Drug reactions
Symptom history
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How long has it been there?
Is it new or reoccurring?
Any other associated symptoms?
Is it getting worse or resolving?
What hygiene products do you use?
Any new medications?
Any new sexual contacts?
Any self treatment?
Symptom history
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How long has it been there? Acute or chronic
HSV past infection
Is it new or reoccurring?
Prodrome, other
Any other associated symptoms?
rashes on body
Is it getting worse or resolving?Too late for treatment
washing,
What hygiene products do you Over
use?
chemical irritant
Any new medications? Drug reaction
related, partner
Any new sexual contacts? STI
symptomatic
Any self treatment? Hydrocortisone, tea tree
oil etc- has it made it
worse?
Clear Instructions
Privacy
Consent
Limit nudity
Examination
etiquette
Good lighting
Genital exam
Chaperone
Good examination couch
Clinical
photography
HSV History
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Multiple vesicular lesions
Painful lesions
Itchiness and tingling sensation
Developed over a period of days after sexual
contact
Lymphadenopathy
Systemic signs such as fever, myalgia
Previous lesions that have become ulcerative
Recurrent lesions in same area
Partner with HSV infection
Vesicles
HSV
Dry lesion
Moist ulcer
Diagnostics
• HSV swab- it will give you the type
• PCR – DNA
• Use cotton swap and rub over lesion with
vigour
• Syphilis swab- for those who are at risk of
syphilis
Clinical Diagnosis
• Start treatment before results are back
• Back up clinical diagnosis with positive swab
results
• Review if symptoms persist
Symptom management
•Genital Skin Care
•Salt baths
•Paracetamol/codeine as required
•Potassium permanganate
•Xylocaine 2%jelly topically
•Promote hydration to avoid urinary retention
•Supportive voiding measures
What’s next
• Follow up results
• Discuss the effects of HSV in relation to
sexual activity
• Information
• Promote self efficacy and positive body image