DOCSLIB.ORG

Diagnosis and Management of Genital Ulcers MICHELLE A

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis and Management of Genital Ulcers MICHELLE A Diagnosis and Management of Genital Ulcers MICHELLE A. ROETT, MD, MPH, Georgetown University/Providence Hospital Family Medicine Residency Program, Washington, District of Columbia MEJEBI T. MAYOR, MD, JD, Providence Hospital, Washington, District of Columbia KELECHI A. UDUHIRI, MD, MPH, MS, Franklin Square Hospital Family Medicine Residency Program, Baltimore, Maryland Herpes simplex virus infection and syphilis are the most common causes of genital ulcers in the United States. Other infectious causes include chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi. Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to genital ulcers. Although initial treatment of genital ulcers is generally based on clinical presentation, the following tests should be considered in all patients: serologic tests for syphilis and darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi in settings with a high prevalence of chancroid. No pathogen is identified in up to 25 percent of patients with genital ulcers. The first episode of herpes simplex virus infec- tion is usually treated with seven to 10 days of oral acyclovir (five days for recurrent episodes). Famciclovir and vala- cyclovir are alternative therapies. One dose of intramuscular penicillin G benzathine is recommended to treat genital ulcers caused by primary syphilis. Treatment options for chancroid include a single dose of intramuscular ceftriaxone or oral azithromycin, ciprofloxacin, or erythromycin. Lymphogranuloma venereum and donovanosis are treated with 21 days of oral doxycycline. Treatment of noninfectious causes of genital ulcers varies by etiology, and ranges from topical wound care for ulcers caused by sexual trauma to consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome. (Am Fam Physician. 2012;85(3):254-262. Copyright © 2012 American Acad- emy of Family Physicians.) ▲ Patient information: enital ulcers may be caused by venereum (Chlamydia trachomatis serotypes A handout on genital infectious or noninfectious eti- L1, L2, and L3). Secondary bacterial infec- ulcers, written by the 1-3 authors of this article, is ologies (Table 1). Sexually tions or fungi can also cause genital ulcers. provided on page 269. transmitted infections (STIs) Noninfectious etiologies include psoriasis, G characterized by genital ulcers include sexual trauma, Behçet syndrome, Wegener genital herpes simplex virus (HSV) infec- granulomatosis, and fixed drug eruptions.1,4 tion, syphilis (Treponema pallidum), chan- In the United States, most young, sexu- croid (Haemophilus ducreyi), granuloma ally active patients who present with geni- inguinale (donovanosis; Calymmatobacte- tal ulcers have HSV infection or syphilis.1,4 rium granulomatis), and lymphogranuloma Lymphogranuloma venereum, donovanosis, secondary bacterial infections, fungi, and noninfectious etiologies are rare. Table 1. Differential Diagnosis of Genital Ulcers Epidemiology Infectious (most common)* Noninfectious (less common) The global incidence of genital ulcer disease Genital herpes simplex virus Behçet syndrome is estimated to be more than 20 million cases 4 Syphilis Fixed drug eruption annually. HSV types 1 and 2 are the most Chancroid Psoriasis common causes of genital ulcers in the United 5 Lymphogranuloma venereum Sexual trauma States, followed by syphilis and chancroid. One Granuloma inguinale (donovanosis) Wegener granulomatosis in five women and one in nine men 14 to 49 6 Fungal infection (e.g., Candida) years of age has genital HSV type 2 infection. Secondary bacterial infection In 2009, the rate of syphilis was highest in men and women 20 to 24 years of age (20.7 *—Listed in order of frequency. and 5.6 cases per 100,000 persons, respec- Information from references 1 through 3. tively). However, syphilis rates increased in persons 15 to 19 years of age between 2002 Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright © 2012 American Academy of Family Physicians. For the private, noncommercial use of 254 Americanone Family individual Physician user of the Web site. All other rights reserved.www.aafp.org/afp Contact [email protected] for copyright questionsVolume and/or 85, permission Number requests. 3 ◆ February 1, 2012 Genital Ulcers enzyme inhibitors, beta blockers, lithium, salicylates, or Table 2. Risk Factors for Genital Ulcers corticosteroids.1 Behçet syndrome is associated with the human leukocyte antigen-B51/B5 allele (57.2 percent of 11 History of inflammatory disease (e.g., psoriasis) and exposure to patients with the allele have the condition). History and trauma or medications such as nonsteroidal anti-inflammatory physical examination findings associated with genital drugs, antimalarials, angiotensin-converting enzyme inhibitors, ulcers are summarized in Table 3.1,3,5,12-16 beta blockers, lithium, salicylates, or corticosteroids Genital HSV infection usually begins as multiple Lack of male circumcision vesicular lesions, sometimes painless, that are located Multiple sex partners, lifetime or current inside the foreskin, labia, vagina, or rectum. Vesicles Nonrecognition of ulcers in prodrome stage Serodiscordant sex partners (i.e., one partner with herpes may rupture spontaneously, becoming painful, shal- 17 simplex virus and one without) low ulcers (Figure 1). Prodromal symptoms may occur Unprotected sexual contact in 20 percent of HSV cases before ulceration. The pro- Unprotected skin-to-skin contact with ulcers drome may include a mild tingling sensation up to 48 hours before ulceration, or shooting pain in the but- Information from references 1 through 3, 5, and 6. tocks, legs, or hips up to five days before.12 Asymptom- atic viral shedding may occur in more than 60 percent of patients with HSV infection.18 First-time infections and 2009 (1.3 versus 6.0 cases per 100,000 males and 1.5 may also feature constitutional symptoms and regional versus 3.3 cases per 100,000 females).7,8 In 2006, most lymphadenopathy.3 cases of primary and secondary syphilis occurred in men Primary syphilis usually begins with a single, painless, who have sex with men.7,8 well-demarcated ulcer (chancre) with a clean base and Chancroid usually occurs in discrete outbreaks, but indurated border19 (Figure 2). When the patient seeks the disease may be endemic in some regions. The inci- treatment for signs or symptoms, the solitary chancre dence of chancroid has been declining in the United of primary infection may still be visible, or it may have States, with only 28 cases reported to state health progressed to secondary infection (e.g., rash, lymphade- departments in 2009.9 However, H. ducreyi infection is nopathy) or tertiary infection (e.g., gummatous lesions). challenging to confirm, likely leading to underreport- Chancroid ulcers are usually nonindurated and pain- ing.9 Approximately 10 percent of patients with chan- ful with a serpiginous border and friable base (Figure 3). croid are coinfected with syphilis or HSV; these are even The ulcers occur on the prepuce and frenulum of the more common coinfections for patients who acquired penis in men or on the vulva or cervix in women. Perineal chancroid outside the United States.5 lesions are common in women or in men who have sex Lymphogranuloma venereum primarily occurs in with men. Painful, unilateral, inguinal adenitis occurs men who have sex with men.10 Behçet syndrome is most in one-half of patients with chancroid and may develop common in young adults in the Eastern Mediterranean into buboes.19,20 Fluctuant buboes may rupture sponta- and in men in the Far East, whereas women are predomi- neously if not aspi- nantly affected in the United States.2 rated or incised and Herpes simplex virus infec- drained. Complica- tion is the most common Diagnostic Evaluation tions of chancroid The diagnosis of genital ulcer disease is based on the include phimosis cause of genital ulcers in presence of one or more mucocutaneous ulcers involv- in men and further the United States, followed ing the genitalia, perineum, or anus.5 Diagnosing the ulceration caused by syphilis and chancroid. specific cause of genital ulcers is based on history, phys- by secondary bac- ical examination, and laboratory findings. terial infection.20 Extragenital lesions on the inner thighs and fingers have been reported but are relatively rare.20 HISTORY AND PHYSICAL EXAMINATION Lymphogranuloma venereum infection is character- Risk factors for infectious causes of genital ulcers are simi- ized by a small, shallow, painless genital or rectal papule lar to those for STIs, whereas risk factors for non infectious that may ulcerate at the site of infection after an incu- causes vary (Table 21-3,5,6). For instance, patients with pso- bation period of three to 30 days. These ulcers may be riasis are at greater risk of geni tal ulcers after exposure to self-limited and remain primarily undetected within the trauma or medications such as nonsteroidal anti-inflam- urethra, vagina, or rectum. However, if left untreated, matory drugs, antimalarials, angiotensin-converting the condition may be complicated by secondary bacterial February 1, 2012 ◆ Volume 85, Number 3 www.aafp.org/afp American Family Physician 255 Table 3. Summary of the Diagnosis and Treatment of Genital Ulcers Etiology Clinical presentation
Load more

Recommended publications
  • Genital Herpes and Human Immunodeficiency Virus
    Genital herpes and human immunodeficiency virus: double trouble Connie Celum,1 Ruth Levine,2 Marcia Weaver,3 & Anna Wald1 Abstract The synergistic relationship between herpes simplex virus type 2 (HSV-2) and transmission of human immunodeficiency virus (HIV) can be substantial in developing countries that have high prevalences of both viral infections. Genital herpes, most frequently caused by HSV-2, has become the leading cause of genital ulcer disease worldwide. This review of recent research on genital herpes and enhanced susceptibility to, and transmission of, HIV is part of the “Advances in HIV/AIDS research series” which endeavours to form a bridge between the research into HIV and acquired immunodeficiency syndrome (AIDS) and the practice of HIV/AIDS prevention, care and support in developing countries. Research findings have shown that being seropositive for HSV-2 can increase the risk of HIV acquisition among high-risk HIV-negative people exposed to HIV and, likewise, the infectiousness of individuals co-infected with HIV-1 and HSV-2 can increase during periods of HSV-2 reactivation. These observations have led to the initiation of several intervention trials and could ultimately lead to the setting of new priorities in public health and clinical practice. WHO has recently issued new guidelines for the syndromic management of genital ulcer disease that include antiviral treatment for lesions consistent with genital herpes. The United States Centers for Disease Control and Prevention issued updated Sexually Transmitted Diseases Treatment Guidelines in 2002 that recommended the use of type-specific serological tests for diagnosing HSV-2. Recently launched proof-of-concept, HSV-2 intervention trials in several countries will help to determine the proportion of new HIV infections that could be prevented by suppression of HSV-2, and the findings from these studies will inform those involved in setting prevention and treatment priorities and strategies in developing countries.
    [Show full text]
  • LGV CEG June 2020
    Sandyford Protocols Lymphogranuloma Venereum and Proctitis (LGV – see also Genital Ulcer Protocol) LGV must be tested in MSM with rectal symptoms and/or who are HIV positive LGV accounts for about 5% of the rectal Chlamydia detections in MSM in Glasgow. Management Confirmed cases First line: Doxycycline 100mg po bd 21 days NB warn re photosensitivity, oesophageal ulceration Second Line: Erythromycin 500 mg QDS for 21 days or Azithromycin 1g po stat followed by 1g weekly for three weeks Contact management Doxycycline 100mg po bd 21 days (Offer if sexual contact with a case of LGV within 4 weeks before onset of symptoms in index case or contact in last three months if asymptomatic LGV in an index case) Certain medications including fluconazole, macrolide and quinolone antibiotics cause QT prolongation and should not be prescribed with interacting medications. This is unlikely to be of clinical significance for stat doses but is important for longer courses. Please use BNF Interaction Checker to ensure these medications are safe to prescribe for your patient and discuss with a senior colleague if necessary. LGV epidemiology: LGV is caused by lymphotropic invasive strains of C.trachomatis (serovars L1,2,3) is now established as endemic in MSM in UK (the L2b strain is the dominant strain) Approximately 80 cases per quarter in UK Over 2000 cases to 2012 99% MSM LGV cases 8 times more likely to be HIV+ than non LGV Chlamydia cases Strong association with sex-party scene (traumatic sex, toys, fisting and enema use where shared equipment) 78% of cases are HIV+.
    [Show full text]
  • Vulvar Ulcers
    ULCERS painless painful Vulvar Ulcers Lyne/e J. Margesson MD FRCPC Interna<onal Congress of Dermatology ISSVD Sister Society Mee<ng Buenos Aires, Argen<na syphilis April 14, 2017 Aphthae NO CONFLICTS Ulcer: Ulcer Erosion Result of full thickness loss of epidermis painful extending into dermis or deeper • Always secondary phenomenon • From Destruction, Necrosis, Inflammation (as in syphilis, aphthae, or tumor) 1 Erosion VULVAR ULCERS Result of loss of all or part of epidermis only ■ MULTIPLE causes spanning a variety of ages, ethnic groups, geographical regions • Result of broken vesicles, pustules or bullae ■ Differing pathologies may co-exist ■ NOT SPECIFIC ■ Classification of vulvar ulcers is difficult Vesicle or Bulla - Intraepidermal - contact dermatitis, Staph Sub epidermal - bullous disease, drug eruption Pustule: Candida, HSV Causes of Vulvar Ulcers Syndromic Approach § Used in areas where no good testing is available Infectious ulcers - commonest STIs # 1 – HSV § Lessens the dependence on laboratory tests # 2 – Syphilis (saves time and money) # 3 - Chancroid - Africa – chancroid Granuloma Inguinale - New Guinea – very rare North America § Simplifies a complex diagnostic process Non-infectious ulcers § Permits the treatment to begin immediately - Skin disorders – Aphthae, Crohn’s Disease, Trauma, cancer § STDs included are variable depending on locally prevalent STDs 2 Syndromic Protocol for Genital Ulcer Disease Commonest Causes of Vulvar Ulcers Patient complains of genital sore Infectious Non-infectious Counsel Take history and
    [Show full text]
  • CHANCROID: CLINICAL UPDATE Speaker: Patricia Coury-Doniger, FNP-C, ANC
    Clinical Education Initiative [email protected] CHANCROID: CLINICAL UPDATE Speaker: Patricia Coury-Doniger, FNP-C, ANC 2/8/2017 Chancroid: Clinical Update [video transcript] 00:00:11 I have no disclosures. 00:00:13 The learning objectives we're just gonna talk about the causative organism and the modes of transmission, and then describe the clinical course. And also the clinical variations, because always there are clinical variations for any of these STD manifestations. Then we're going to talk about the diagnostic criteria. So sometimes you're making the diagnosis totally on clinical criteria, and occasionally on laboratory-based findings, and we'll talk about that. And lastly, talk about the recommendations for treatment and for partner management. 00:00:48 So, there's been debate oftentimes around the use of the term STD versus STI, and I just wanna point out, that it isn't one or the other, it's both. There are STI's and there are STD's. And the STI's are the infectious organisms, and so the sexually transmitted infection is referred to as an STI. In the case of chancroid, the infection is due to a bacteria, hemophilus ducreyii is the name of the organism, it's a gram negative rod, and the disease syndrome, the STD, the disease that results, is chancroid. So the STI is hemophilus ducreyii, and the STD is chancroid. It is different than syphilis and herpes in the sense that the incubation period is very short, so one to 10 days is a very short incubation time, between when a person would become inoculated with the organism, and when the first clinical manifestations would appear.
    [Show full text]
  • Ulcerating Stds And
    Susan Blank, md, mph Ulcerating STDs and HIV: Director, Bureau of Sexually Transmitted Disease Control New York City Department of Health and Mental Hygiene A Cause for Concern New York, New York Reprinted from The prn Notebook® | june 2005 | Dr. James F. Braun, Editor-in-Chief | Tim Horn, Executive Editor. Summary by Tim Horn Published in New York City by the Physicians’ Research Network, Inc.® | John Graham Brown, Executive Director For further information and other articles available online, visit http://www.prn.org | All rights reserved. ©june 2005 Edited by James F. Braun, do and Jeffrey S. Roth, md, phd sexually transmitted infections (stis) are among the most common or erosion that appears at the site of inoculation and may or may not be infectious diseases in the United States today. More than 20 stis have painful. These lesions may be clinically similar to the lesions of genital now been identified, and they affect more than 13 million men and herpes, primary syphilis, or chancroid. The incubation period from women in this country each year. exposure to developing a lesion is approximately three to 30 days. The potential for hiv transmission is enhanced by the presence of A secondary stage of lgv can occur three to six months after exposure. stis, and ulcerative stis—by virtue of interrupting the body’s most im- It can manifest as an anogenitorectal syndrome, characterized by hem- portant defense (skin/mucosal membranes)—are of particular concern. orrhagic or non-hemorrhagic proctitis/proctocolitis. Symptoms include Overall, genital ulcer infections appear to increase hiv risk by a factor of purulent, mucous, or bloody anal discharge, rectal pain/spasms, tenesmus, 2.7 (approximately 170%).
    [Show full text]
  • Sexually Transmitted Diseases (Stds)
    exually transmitted diseases (STDs) are discussed in the following two chapters. We have chosen Sa different approach for this important public health topic because of the complexity, breadth, and multiple dimensions of these diseases. Persons may have one or more STDs. Some may be without symptoms, while others can present with an array of overlapping syndromes. The diagnosis is rarely made solely on a clinical basis, but usually requires laboratory and microbiological studies. With such diversity and so much overlap, Dr. Noreen Hynes of Johns Hopkins University Schools of Medicine and Public Health has graciously divided STDs into two broad clinical categories. Part I discusses the causes of genital “sores” while Part II focuses on the inflammatory STDs that cause “drips” or discharges. Rather than chapters on each specific disease, an anatomic approach has been taken that focuses on the specific site of the clinical findings. For each physical sign or symptom, such as a vaginal discharge or urethritis, the differential diagnosis is offered and discussed. We hope that this will be practical for clinicians in the field caring for homeless persons, and will help give a framework for approaching this increasingly complex topic. The following outlines are offered as a guide to the diseases discussed in the next two chapters. STDs, Part I: Genital Sores STDs, Part II: Drips and Discharges I. Ulcers (Genital Ulcer Disease) I. Acute Inflammatory STDs in Women Herpes Simplex Virus A. Lower Genital Tract STDs Primary Syphilis 1. Vaginitis Chancroid Bacterial Vaginitis (BV) Trichomoniasis II. Non-Ulcerative Genital Lesions Vulvovaginal Candidiasis (VVC) Genital Warts 2.
    [Show full text]
  • Management of Genital Ulcers and Discharges
    Management of Genital Ulcers and Discharges MOH Clinical Practice Guidelines 1/2009 Ministry of Health, Singapore College of Medicine Building 16 College Road Singapore 169854 TEL (65) 6325 9220 Academy of Chapter of Dermatologists College of Obstetricians College of Family Obstetrical & Dermatological FAX (65) 6224 1677 Medicine, College of Physicians, and Gynaecologists, Physicians, Gynaecological Society of May 2009 WEB www.moh.gov.sg ISBN 978-981-08-3340-4 Singapore Singapore Singapore Singapore Society of Singapore Singapore LevelsLevels of of evidence evidence and and grades grades of of recommendation recommendation Levels of evidence Level Type of Evidence + + 1+ + High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. + 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. - 1- Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + + 2+ + High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal + 2+ Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal - 2- Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case series 4 Expert opinion Grades
    [Show full text]
  • 15 – Sexually Transmitted Infections: Genital Ulcers Diseases (GUD) Speaker: Khalil Ghanem, MD
    15 –Sexually Transmitted Infections: Genital Ulcers Diseases (GUD) Speaker: Khalil Ghanem, MD Disclosures of Financial Relationships with Relevant Commercial Interests • None Sexually Transmitted Infections: Genital Ulcers Diseases (GUD) Khalil G. Ghanem, MD, PhD Professor of Medicine Division of Infectious Diseases Johns Hopkins University School of Medicine INCLUDED PHOTOS GENITAL ULCER DISEASES (GUD) • Syphilis (Treponema pallidum) Please note: all photos are freely available • HSV-2 • HSV-1 from the following website unless otherwise • Chancroid (Haemophilus ducreyi) noted: • Lymphogranuloma venereum (LGV) http://www.cdc.gov/std/training/clinicalslide (Chlamydia trachomatis) s/slides-dl.htm • Granuloma inguinale (Donovanosis) (Klebsiella granulomatis) PAIN AND GUD “KEY WORDS” IN GUD Which ulcers are Which ulcers are • SYPHILIS: Single, painless ulcer or PAINFUL? PAINLESS? chancre at the inoculation site with • HSV • Syphilis* heaped-up borders & clean base; painless • Chancroid • LGV (but bilateral LAD (>30% of patients have multiple painful lesions) lymphadenopathy • HSV: multiple, painful, superficial, is PAINFUL) vesicular or ulcerative lesions with • Granuloma *>30% of patients have multiple erythematous base painful lesions inguinale ©2020 Infectious Disease Board Review, LLC 15 –Sexually Transmitted Infections: Genital Ulcers Diseases (GUD) Speaker: Khalil Ghanem, MD “KEY WORDS” IN GUD CONTINUED GUD: CONCEPTS TO KNOW • CHANCROID: painful, indurated, ‘ragged’ genital ulcers & tender suppurative inguinal adenopathy • Organisms
    [Show full text]
  • LGV – See Also Genital Ulcer Protocol)
    Sandyford Protocols Lymphogranuloma Venereum and Proctitis (LGV – see also genital ulcer protocol) LGV accounts for about 5% of the rectal Chlamydia detections in MSM in Glasgow. Positive rectal chlamydia swabs in MSM with rectal symptoms or who have HIV infection must be sent for LGV testing Management Confirmed cases First line: Doxycycline 100mg po bd 21 days NB warn re photosensitivity, oesophageal ulceration Second line (if tetracycline allergy) Second Line: Erythromycin 500 mg QDS for 21 days or Azithromycin 1g po stat followed by 1g weekly for three weeks Contact management Doxycycline 100mg po bd 21 days (Offer if, sexual contact with a case of LGV within 4 weeks before onset of symptoms in index case or contact in last three months if asymptomatic LGV in an index case) LGV epidemiology: LGV is caused by lymphotropic invasive strains of C.trachomatis (serovars L1,2,3) is now established as endemic in MSM in UK (the L2b strain is the dominant strain) Approximately 80 cases per quarter in UK Over 2000 cases to 2012 99% MSM LGV cases 8 times more likely to be HIV+ than nonLGV Chlamydia cases Strong association with sex-party scene (traumatic sex, toys, fisting and enema use where shared equipment) 78% of cases are HIV+. Hepatitis C co-infection rate of 14% Recreational drug use including poppers and ‘slamming’ Most infections in UK MSM are rectal A UK-wide surveillance scheme is in place (most UK cases are seen in London, Manchester and Brighton) LGV CEG June 2018 Sandyford Protocols Clinical features LGV and proctitis/proctocolitis in MSM Incubation period 1-4 weeks Increasingly, LGV is asymptomatic: approx 20% cases in recent HPA Colindale surveillance project, compared to initial outbreak where 95% LGV were symptomatic.
    [Show full text]
  • Lymphogranuloma Venereum Causing a Persistent Genital Ulcer
    CASE REPORT Lymphogranuloma Venereum Causing a Persistent Genital Ulcer Terrence Marcotte, NP, MSN,* Yer Lee, BS,Þ Mark Pandori, PhD,Þ Vivek Jain, MD,*þ and Stephanie Elise Cohen, MD, MPHÞþ for LGV is limited.6 We describe here an unusual presentation Abstract: Lymphogranuloma venereum (LGV) is a sexually transmitted of LGV disease in an HIV-infected man with a persistent genital cause of inguinal lymphadenopathy and proctocolitis. We report a patient ulcer and minimal inguinal lymphadenopathy. with a persistent genital ulcer due to LGV (serovar L2b), an unusual pre- A 45-year-old HIV-positive man presented to his primary sentation among US men who have sex with men. Lymphogranuloma care provider with a penile lesion. He reported that the lesion venereum should be considered when evaluating persistent genital ulcers, had been present for 1 week and was painful and enlarging in and LGV-specific testing should be sought. size. One week before the onset of the lesion, he had insertive anal sex with a partner whom he suspected had anal herpes simplex virus (HSV). He denied fever, chills, fatigue, rash, CASE REPORT urethral discharge, dysuria, or rectal symptoms. Lymphogranuloma venereum (LGV) is a sexually trans- The patient’s medical history was significant for well- mitted disease caused by serovars L1, L2, L2a, L2b, and L3 of controlled HIV (plasma HIV RNA level was undetectable and + the bacterium Chlamydia trachomatis (CT). Lymphogranuloma recent CD4 T-cell count was 832 cells/KL while taking a fixed- venereum classically begins with a self-limiting, transient, dose combination of efavirenz, tenofovir, and emtricitabine), painless lesion at the site of inoculation after an incubation pe- chronic hepatitis C virus infection, depression, anxiety, and a riod of 3 to 30 days.1 This is followed several weeks later by self-reported history of genital herpes.
    [Show full text]
  • The Etiology of Genital Ulcer Disease and Coinfections with Chlamydia Trachomatis and Neisseria Gonorrhoeae in Zimbabwe: Results from the Zimbabwe STI Etiology Study
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Sex Transm Manuscript Author Dis. Author Manuscript Author manuscript; available in PMC 2019 January 01. Published in final edited form as: Sex Transm Dis. 2018 January ; 45(1): 61–68. doi:10.1097/OLQ.0000000000000694. The Etiology of Genital Ulcer Disease and Coinfections With Chlamydia trachomatis and Neisseria gonorrhoeae in Zimbabwe: Results From the Zimbabwe STI Etiology Study More Mungati, MBChB, MPH*, Anna Machiha, DNS*, Owen Mugurungi, MD*, Mufuta Tshimanga, MD, MPH†, Peter H. Kilmarx, MD‡,§, Justice Nyakura, MPH*, Gerald Shambira, MD, MPH†, Vitalis Kupara, DNS¶, David A. Lewis, FRCP (UK), PhD‖,**, Elizabeth Gonese, MPH‡, Beth A. Tippett Barr, DrPH‡, H. Hunter Handsfield, MD††, and Cornelis A. Rietmeijer, MD, PhD, MSPH‡‡,§§ *Zimbabwe Ministry of Health and Child Care †Department of Community Medicine, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe ‡US Centers for Disease Control and Prevention, Zimbabwe and Division of Global HIV/AIDS, CDC, Atlanta, GA §Fogarty International Center, National Institutes of Health, Bethesda, MD ¶Zimbabwe Community Health Intervention Research (ZiCHIRe) Project, Harare, Zimbabwe ‖Western Sydney Sexual Health Centre, Parramatta **Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School– Westmead, University of Sydney, Sydney, New South Wales, Australia ††School of Medicine, University of Washington, Seattle, WA ‡‡Colorado School of Public Health, University of Colorado Denver, Denver, CO §§Rietmeijer Consulting LLC, Denver, CO Abstract Background—In many countries, sexually transmitted infections (STIs) are treated syndromically. Thus, patients diagnosed as having genital ulcer disease (GUD) in Zimbabwe receive a combination of antimicrobials to treat syphilis, chancroid, lymphogranuloma venereum (LGV), and genital herpes.
    [Show full text]
  • Pathogen and Product Description H. Ducreyi + C. Trachomatis (LGV)
    H. ducreyi + C. trachomatis (LGV) Real Time PCR Detection Kit Pathogen and product description aemophilus ducreyi is the causative agent disease (PID), ectopic pregnancy, and infertility. Ct is of chancroid, a genital ulcer disease (GUD). also responsible for outbreaks of lymphogranuloma H The organism is usually spread during sexual venereum (LGV) and trachoma, a chronic ocular intercourse through microabrasions, and the disease disease that can lead to blindness. usually manifests as multiple painful superficial ulcers associated with inguinal lymphadenitis. As a result of LGV is caused by specific serovars of Chlamydia the painful nature of the lesions, patients usually seek trachomatis (L1, L2 and L3) and these strains are immediate treatment, and asymptomatic carriage is associated with a more chronic and invasive infection therefore uncommon. In addition to causing GUD, H. than other serovars. Although LGV symptoms can ducreyi has been found in several recent studies to vary according to site of entry and stage of infection, be a major cause of chronic skin ulceration in children genital ulceration and inguinal lymphadenopathy are from developing countries. the classical presentations of this disease. Chancroid or soft chancre is a sexually transmitted VIASURE H. ducreyi + C. trachomatis (LGV) Real Time disease (STD) of humans, characterized by painful PCR Detection Kit is designed for the diagnosis of genital ulcers. The primary ulcer is often followed by Haemophilus ducreyi and/or Chlamydia trachomatis multiple lesions, which can extend the duration of the (LGV strains) in clinical samples. After DNA isolation, illness to 1-3 months if appropriate treatment is not the identification of Haemophilus ducreyi and LGV- given.
    [Show full text]