Genital ulcer disease: Difference between revisions

Latest revision as of 06:37, 20 February 2022

Differential Diagnosis

Sexually-Transmitted Infections

Organism	Disease	%	Incubation	Treatment
Painless
Treponema pallidum pallidum	primary syphilis	1%	3-90 days	penicillin 2.4 MU IM once
Chlamydia trachomatis serovars L1-L3	lymphogranuloma venereum	<1%	3-30 days	doxycycline 100 mg PO bid for 21 days
Painful
Herpes simplex virus	genital herpes	95%	2-7 days (1º)	acyclovir or valacyclovir for 5 to 10 days
Haemophilus ducreyi	chancroid	<1%	5-14 days	ciprofloxacin 500 mg PO once
Klebsiella granulomatis	donovanosis (granuloma inguinale)	<1%	1-180 days	azithromycin 1 g PO weekly for 21 days (and healed)

Other Infectious Causes

Fungal
- Candida
- Deep fungal infection
Viral
Bacterial
Scabies

Non-Infectious Causes

Bullous dermatoses
- Non-autoimmune
  - Contact dermatitis
  - Erythema multiforme (usually secondary to HSV)
  - Toxic epidermolysis
- Autoimmune
  - Pemphigus
  - Pemphigoid
Non-bullous dermatoses
- Nonspecific vulvitis/balanitis
- Aphthous ulcer
- Lichen planus
- Lichen sclerosus
- Behçet disease
- Pyoderma gangrenosum
- Fixed drug eruption
- Systemic lupus erythematosus
- Crohn disease
- Vasculitis
Malignancy
- Squamous cell carcinoma
- Vulvar intraepithelial neoplasia
- Extramammary Paget disease
- Basal cell carcinoma
- Lymphoma
- Leukemia
- Langerhans cell histiocytosis
Trauma
Idiopathic (12-51%)

@@ Line 1: / Line 1: @@
-== Differential Diagnosis ==
+==Differential Diagnosis==
-=== Sexually-Transmitted Infections ===
+===Sexually-Transmitted Infections===
 {| class="wikitable"
 !Organism
@@ Line 9: / Line 9: @@
 !Treatment
 |-
+! colspan="5" |Painless
-|[[Herpes simplex virus]]
-|
-|95%
-|2-7 days (1º)
-|
 |-
 |[[Treponema pallidum pallidum]]
@@ Line 20: / Line 16: @@
 |3-90 days
 |[[penicillin]] 2.4 MU IM once
-|-
-|[[Haemophilus ducreyi]]
-|chancroid
-|<1%
-|5-14 days
-|
 |-
 |[[Chlamydia trachomatis]] serovars L1-L3
@@ Line 32: / Line 22: @@
 |3-30 days
 |[[doxycycline]] 100 mg PO bid for 21 days
+|-
+! colspan="5" |Painful
+|-
+|[[Herpes simplex virus]]
+|genital herpes
+|95%
+|2-7 days (1º)
+|[[acyclovir]] or [[valacyclovir]] for 5 to 10 days
+|-
+|[[Haemophilus ducreyi]]
+|chancroid
+|<1%
+|5-14 days
+|[[ciprofloxacin]] 500 mg PO once
 |-
 |[[Klebsiella granulomatis]]
@@ Line 37: / Line 41: @@
 |<1%
 |1-180 days
+|[[azithromycin]] 1 g PO weekly for 21 days (and healed)
-|
 |}
-=== Other Infectious Causes ===
+===Other Infectious Causes===
-* Fungal
+*Fungal
-** [[Candida]]
+**[[Candida]]
-** Deep fungal infection
+**Deep fungal infection
-* Viral
+*Viral
-** [[Cytomegalovirus]]
+**[[Cytomegalovirus]]
-** [[Varicella-zoster virus]]
+**[[Varicella-zoster virus]]
-** [[Epstein-Barr virus]]
+**[[Epstein-Barr virus]]
-* Bacterial
+*Bacterial
-** [[Staphylococcus species]]
+**[[Staphylococcus]]
-** [[Streptococcus species]]
+**[[Streptococcus]]
-** [[Salmonella species]]
+**[[Salmonella]]
-** [[Pseudomonas species]]
+**[[Pseudomonas]]
-** [[Mycobacterium species]]
+**[[Mycobacterium]]
-* [[Scabies]]
+*[[Scabies]]
-=== Non-Infectious Causes ===
+===Non-Infectious Causes===
-* Bullous dermatoses
+*Bullous dermatoses
-** Non-autoimmune
+**Non-autoimmune
-*** [[Contact dermatitis]]
+***[[Contact dermatitis]]
-*** [[Erythema multiforme]] (usually secondary to [[HSV]])
+***[[Erythema multiforme]] (usually secondary to [[HSV]])
-*** [[Toxic epidermolysis]]
+***[[Toxic epidermolysis]]
-** Autoimmune
+**Autoimmune
-*** [[Pemphigus]]
+***[[Pemphigus]]
-*** [[Cicatricial pemphigoid|Pemphigoid]]
+***[[Cicatricial pemphigoid|Pemphigoid]]
-* Non-bullous dermatoses
+*Non-bullous dermatoses
-** Nonspecific [[vulvitis]]/[[balanitis]]
+**Nonspecific [[vulvitis]]/[[balanitis]]
-** [[Aphthous ulcer]]
+**[[Aphthous ulcer]]
-** [[Lichen planus]]
+**[[Lichen planus]]
-** [[Lichen sclerosus]]
+**[[Lichen sclerosus]]
-** [[Behçet disease]]
+**[[Behçet disease]]
-** [[Pyoderma gangrenosum]]
+**[[Pyoderma gangrenosum]]
-** [[Fixed drug eruption]]
+**[[Fixed drug eruption]]
-** [[Systemic lupus erythematosus]]
+**[[Systemic lupus erythematosus]]
-** [[Crohn disease]]
+**[[Crohn disease]]
-** [[Vasculitis]]
+**[[Vasculitis]]
-* Malignancy
+*Malignancy
-** [[Squamous cell carcinoma]]
+**[[Squamous cell carcinoma]]
-** [[Vulvar intraepithelial neoplasia]]
+**[[Vulvar intraepithelial neoplasia]]
-** Extramammary [[Paget disease]]
+**Extramammary [[Paget disease]]
-** [[Basal cell carcinoma]]
+**[[Basal cell carcinoma]]
-** [[Lymphoma]]
+**[[Lymphoma]]
-** [[Leukemia]]
+**[[Leukemia]]
-** [[Langerhans cell histiocytosis]]
+**[[Langerhans cell histiocytosis]]
-* Trauma
+*Trauma
-* Idiopathic (12-51%)
+*Idiopathic (12-51%)
-== Further Reading ==
+==Further Reading==
-* [https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sexually-transmitted-infections/canadian-guidelines-sexually-transmitted-infections-21.html Management and treatment of specific syndromes – Genital Ulcer Disease (GUD)]. ''Canadian Guidelines on Sexually Transmitted Infections''. 2016.
+*[https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/sexually-transmitted-infections/canadian-guidelines-sexually-transmitted-infections-21.html Management and treatment of specific syndromes – Genital Ulcer Disease (GUD)]. ''Canadian Guidelines on Sexually Transmitted Infections''. 2016.
 [[Category:Infectious diseases]]