Pocket ObGyn – Genital Ulcers
See Abbreviations
| Ulcerative lesions of the genital tract | |||||
|
Syphilis |
Herpes |
Chancroid |
Lymphogranuloma venereum | Granuloma inguinale/ Donovanosis | |
| Organism | Treponema pallidum | Herpes simplex I or II | Haemophilus ducreyi | Chlamydia trachomatis Serovars L1, L2, L3. More prevalent in Africa, India, SE Asia, Caribbean | Klebsiella granulomatis (gram neg encapsulated bacterium). Needs rpt exposure, long incubation. |
| Lesion characteristic | Single painless indurated ulcer w/ rolled edges | Painful fluidfilled vesicles w/ erythematous base | One or more painful ulcers varying in size | Single ulcer or papule; can be painful or painless.
Infected lymph tissue ® necrosis in nodes ® abscess. |
Painless nodules
® ulcerative lesions that bleed easily on contact; can become sclerotic & very large. Usually on genitalia, cervix. Resemble keloids. |
| LAD | Bilateral, nontender | Unior bilateral, tender | Unilateral, tender, suppurative, often fluctuant | Unilateral tender, can suppurate or mat together. Stages: Ulcer
®healed ®LAD ®fibrosis/ strictures (Clin Infect Dis 2006;42:186). |
None |
| Dx | Dark field microscopy, serology w/ treponemal test confirmation | Culture or PCR of lesions | Culture or special PCR testing | Chlamydia serology correlated w/ presentation, PCR testing. IgG >1:64.
Low success w/ cx. PCR testing exists. |
Donovan bodies on microscopy (safety pin appearance) on Wright–Giemsa stain. |
| Rx | Benzathine PCN G.
See section for algorithm based on stage of presentation. |
Acyclovir or Val-acyclovir. See section for specific dosing. | Azithromycin 1 g PO or CTX 250 mg
IM or Ciprofloxacin 500 mg PO BID ´ 3 d or Erythromycin 500 mg PO TID ´ 7 d |
Doxycycline 100 mg PO BID ´ 3 w (nonpregnant)
Alt: Erythromycin 500 mg QID ´ 3 w or Azithromycin 1 g weekly ´ 3 w. Aspirate buboe to prevent rupture. Check & treat <60 d sexual contacts. (MMWR Recomm Rep 2010;59:1) |
Doxycycline 100 mg BID ´ 3+ weeks & resolution of lesions
Alt:Azithromycin 1 g weekly; Ciprofloxacin 750 mg BID; Erythromycin 500 mg QID (preferred for Preg) or Bactrim BID, all ´ 3+ weeks & resolution of lesions Add aminoglycoside if no resp. |
| From Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010;59(RR-12):1–110 and Holmes K, Sparling P, Stamm W. Sexually Transmitted Diseases. 4th ed. New York, NY:
McGraw-Hill; 2008. |
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