Thursday, 18 November 2010

MRCP revision battle 53.1: Genital ulcers

A day of randomness that starts with the delights of genital ulcers and ends in a cat's scratch...

MRCP revision battle 53.1: Genital ulcers
MRCP revision battle 53.2: Vertebral artery dissection
MRCP revision battle 53.3: Intracranial venous thrombosis
MRCP revision battle 53.4: Infective endocarditis
MRCP revision battle 53.5: Upper GI bleeds
MRCP revision battle 53.6: Meckel's diverticulum
MRCP revision battle 53.7: Cat scratch disease

MRCP revision battle 53.1: Genital ulcers

Genital ulcers.  Such a lovely topic.  If you really can't face it there is a summary table at the end.

1. Chancroid
  • This is a sexually transmitted infection, most prevalent in third world countries.
  • Chancroid begins as a small lump that then turns into an ulcer.  
  • It is painful
  • The ulcer bleeds easily when rubbed 
  • The ulcer has a greeney-yellow base
  • One third of affected people will develop inguinal lymph node involvement, with half of these developing abscesses after the lymph nodes become so big they break through the skin.
  • Chancroid is caused by the gram negative bacteria haemophillus ducreyi
  • Treatment options are:
    • 1g azithromycin orally or
    • IM ceftriaxone or
    • 7 days erythromycin
Chancroid lesion filled with pus prior to rupture.  From wiki commons, uploaded by Joe Miller

2.  Granuloma inguinale = Donovanosis
  • This is a sexually transmitted infection mainly found in 3rd world countries.
  • Granuloma inguinale begins as a small lump which then bursts into an ulcer/open lesion that continues to spread until treated
  • The ulcer is painless and has a 'beefy red' appearence
  • There is not usually inguinal lymphadenopathy
  • Granuloma inguinale is caused by klebsiella granulomatis
  • Donovan bodies are rod-shaped klebsiella granulomatis found in the cytoplasm of phagocytes in infected individuals.  They stain dark purple with Wright's stain.
  • Treatment is
    • 3 weeks erthyromycin or tetracyline

3. Lymphogranuloma venereum
  • This is a sexually transmitted infection
  • It is caused by chlamydia trachomatis (L type)
  • There are several stages of infection:
    • Primary:
      • painless pustule which bursts into a painless ulcer
      • often not noticed by women as may be internal
      • 10% of patients will have accompanying erythema nodosum
    • Secondary
      • tender inguinal lymphadenopathy
    • Tertiary
      • up to 20 yrs later - protocolitis, tenesmus
  • Treatment options:
    • doxycycline or
    • erythromycin

 Image from wiki commons, uploaded by Dr Fred

4. Genital herpes
  • This is a sexually transmitted infection
  • Up to 8 in 10 people who contract it have no symptoms
  • Those who have symptoms tend to develop groups of painful ulcers
  • Primary infection may last up to 3 weeks
  • Subsquent infections tend to be less severe
  • It is highly infective when ulcers are present
  • It is classically caused by HSV 2 but can be caused by HSV 1.
  • Oral aciclovir may be given within the first 5 days of symptoms starting as a 5 day course but there is no cure
  • Subsequent recurrences tend to be less severe.

5. Behcet's disease
  • This is NOT sexually transmitted
  • It is associated with oral ulcers and anterior uveitis
  • See battle 25.2 for more information

Summary of sexually transmitted causes of genital ulcers:

Now for something completely different...