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ital ulcers
Genital ulcers
Genital ulcers, d efined as sing le or m ultiple v esicular, ulcerativ e or erosiv e lesions of
th e g enital tract, w ith or w ith out ing uinal lym ph ad enopath y, sh ould lead to
consid eration of sexually transm itted infection.
T h e principal causativ e org anism s are Treponema pallidum (syph ilis), Haemophilus ducreyi
(ch ancroid ) and Herpes simplex (g enital h erpes). Chlamydia trachomatis (lym ph og ranulom a
v enereum ) and Calymmatobacterium granulomatis (d onov an1osis) are less frequent.
Case management
P atient com plains of g enital sore or ulcer
T ake h istory and exam ine Look for
S ore/ulcer/v esicle is present? anoth er g enital
YE S N O d isord er.
If present, treat
appropriately.
If not, reassure
th e patient.
S m all painful v esicles, som etim es in clusters, YE S Treat for
or sm all ulcers with h istory of recurrent v esicles? genital herpes
NO
– Treat for syphilis AND chancroid
– In endemic areas, also treat for lymphogranuloma venereum AND/OR donovanosis
– Refer if necessary
Laboratory
Laboratory testing av ailable in th e field is of little v alue: e.g ., in syph ilis, a neg ativ e RP R
or V DRL result d oes not exclud e prim ary syph ilis in early stag e, and a positiv e test m ay
reflect prev ious infection in a successfully treated patient.
1 Lymphogranuloma venereum is endemic in East and West Africa, India, Southeast Asia, South America and the
Caribbean. Donovanosis is endemic in South Africa, Papua New Guinea, India, Brazil and the Caribbean.
236
Genital ulcers
Genital ulcers, d efined as sing le or m ultiple v esicular, ulcerativ e or erosiv e lesions of
th e g enital tract, w ith or w ith out ing uinal lym ph ad enopath y, sh ould lead to
consid eration of sexually transm itted infection.
T h e principal causativ e org anism s are Treponema pallidum (syph ilis), Haemophilus ducreyi
(ch ancroid ) and Herpes simplex (g enital h erpes). Chlamydia trachomatis (lym ph og ranulom a
v enereum ) and Calymmatobacterium granulomatis (d onov an1osis) are less frequent.
Case management
P atient com plains of g enital sore or ulcer
T ake h istory and exam ine Look for
S ore/ulcer/v esicle is present? anoth er g enital
YE S N O d isord er.
If present, treat
appropriately.
If not, reassure
th e patient.
S m all painful v esicles, som etim es in clusters, YE S Treat for
or sm all ulcers with h istory of recurrent v esicles? genital herpes
NO
– Treat for syphilis AND chancroid
– In endemic areas, also treat for lymphogranuloma venereum AND/OR donovanosis
– Refer if necessary
Laboratory
Laboratory testing av ailable in th e field is of little v alue: e.g ., in syph ilis, a neg ativ e RP R
or V DRL result d oes not exclud e prim ary syph ilis in early stag e, and a positiv e test m ay
reflect prev ious infection in a successfully treated patient.
1 Lymphogranuloma venereum is endemic in East and West Africa, India, Southeast Asia, South America and the
Caribbean. Donovanosis is endemic in South Africa, Papua New Guinea, India, Brazil and the Caribbean.
236
