Genital ulcers, defined as lesions vesicular, erosive ulcerous or genitals, single or multiple, with or without inguinal lymphadenopathy, should evoke a sexually transmitted infection.
The main causative organisms are Treponema pallidum (syphilis), Haemophilus ducreyi (chancroid) and herpes simplex (genital herpes). Chlamydia trachomatis (lymphogranuloma venereum) and Calymmatobacterium granulomatis (donovanosis) 1 are rarer.
The achievable field reviews are not very useful: for example, syphilis, RPR test or VDRL negative does not exclude primary syphilis at an early stage and a positive test may reflect an earlier infection in a patient cured.
1* The lymphogranuloma venereum is endemic in East and West Africa, India, Southeast Asia, South America, Caribbean donovanosis in South Africa, Papua New Guinea, India, Brazil, Caribbean.
Patient treatment:
– Genital Herpes
• Local treatment: Water toilet soap and possible application of violet
0.5% gentian for 5 days.
• Antiviral treatment: aciclovir PO
In case of primary infection, an administration within 5 days after the onset of symptoms can reduce the duration: 1200 mg / day in 3 divided doses for 7 days.
In case of repetition, same dosage for 5 days but the treatment is only effective if it is started at the prodrome or within 24 hours of the onset of symptoms.
In patients with frequent recurrences (more than 6 episodes / year), see HIV infection and AIDS.
• Pain: paracetamol PO
– Syphilis
benzathine benzylpenicillin IM: 2.4 MIU single dose (half the dose in each
buttock) or if allergic to penicillin:
doxycycline PO: 200 mg / day in 2 divided doses for 14 days 2
or
erythromycin PO: 2 g / day divided into 2 or 4 doses for 14 days
– Chancroid
azithromycin PO: 1 g single dose
or
ceftriaxone IM: 250 mg single dose
or
ciprofloxacin PO: 1 g / day in 2 divided doses for 3 days 3
or
erythromycin PO: 2 g / day divided into 2 or 4 doses for 7 days
It may be necessary to puncture the fluctuating ganglion (Suction syringe through intact skin). Do not incise and drain lymph nodes.
Note: simultaneously treat syphilis and chancroid because these common infections are difficult to distinguish clinically.
– Lymphogranuloma venereum
doxycycline PO: 200 mg / day in 2 divided doses for 14 days 2
or
erythromycin PO: 2 g / day divided into 2 or 4 doses for 14 days
It may be necessary to puncture the fluctuating ganglion (Suction syringe through intact skin). Do not incise and drain lymph nodes.
2* Doxycycline is contra-indicated in pregnant or lactating women.
3* Ciprofloxacin should be avoided in pregnant women.
– Donovanosis
The treatment lasts a minimum of 14 days or longer if necessary, until complete disappearance of lesions (otherwise risk of recurrence)
azithromycin PO: 1 g the first day followed by 500 mg / once daily
or
doxycycline PO: 200 mg / day in 2 divided doses 4
or
erythromycin PO: 2 g / day divided into 2 or 4 sockets
In patients infected with HIV, add gentamicin IM: 3 to 6 mg / kg / day in one or two injections.
Partner treatment:
The sexual partner receives the same treatment as the patient, whether symptomatic or not, except in cases of herpes (the partner is treated only if symptomatic).
4* Doxycycline is contra-indicated in pregnant or lactating women.