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Úlcera genital

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Syphilis is the main diagnosis you must not miss. Because syphilitic chancre is healing spontaneously and syphilis is the most severe disease to face.
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  • DDx Úlcera Genital
    • Infectious
    • Non infectious
      • Lipschutz ulcer (non sexually acquired acute genital ulceration, NAGU) - EBV?
        • Juvenile Gangrenous Vasculitis of the Scrotum
      • Aphtae/Behçet disease
      • Crohn disease
      • Fixed drug eruption
      • Trauma
      • Malignancy
    • In summary
      • Most common: HSV vs Syphilis
      • “Tropical”: LGV, chancroid, donovanosis
  • História clínica
    • Painful vs painless
      • Acute vs non-acute (6 weeks)
      • In red are the STI
      • Acute (<6 weeks)
        • Main infectious
          • Herpes (HG)
          • Primary syphilis
          • Secondary syphilis
        • Other infectious
          • HIV primary infection
          • Chancroid
          • LGV
          • Donovanosis
          • Monkeypox
          • Herpes zoster
        • Non infectious
          • FDE
          • Aphtae
          • Mechanical/traumatic
          • Other
    • Infectious vs non-infectious?
    • Sexual history
    • Primary vs recurrent
    • Travel history
    • Dysuria/urethral discharge
    • Lymphadenopathy
    • Oral/perianal examination
  • Clinical exam is limited - HSV PCR and syphilis testing
    • If one vesicle is present, this is not syphilis
    • Associations are possible
  • Exames complementares de diagnóstico
    • PCR úlcera - HSV 1,2; LGV; VZV; Treponema pallidum; CMV
    • Biópsia rarely indicated
  • Tratamento
    • Penicilina G benzatínica