10 STDs that Causes Genital Ulcers in the Private Part (Painless and Painful) including Treatment
SEXUALLY TRANSMITTED DISEASES CAUSING GENITAL ULCERS.
Genital ulcers are open soft-tissue sores or lesions on the vagina, penis, perineal and anorectal surface almost always caused by sexually transmitted infections
Sexually transmitted diseases (STDs) or Sexually transmitted infections (STIs) or venereal diseases (VDs) occurs due to transfer of the infectious organisms during sexual contact.
Some sexually transmitted diseases are more commonly spread by other means other than during coitus.
Patients with STDs are more susceptible to HIV, while the infectivity of HIV patients is increased if the they have STD. In effect, STDs facilitate the spread of HIV.
COMMON SEXUALLY TRANSMITTED INFECTIONS THAT CAUSES EITHER PAINFUL OR PAINLESS GENITAL ULCERS IN THE PRIVATE PART.
Yes, a sore in the private area may is usually caused by STDs, for simplicity, a genital ulcer or genital sore may be group based on symptoms (is the ulcer painful or painlesss) or based on the offending organism causing it – bacterial, virus, fungi, protozoa, and parasites.
The common genital ulcer, their symptoms and causative organism are discussed below:
1. Chancroid: caused by bacteria. A small bump in the genitals, which becomes a painful ulcer within a day of its appearance; perineal lesions are common in women or in men who have sex with men; painful inguinal lymphadenitis.
2. Syphilis: of bacteria origin. Small, painless open sore or ulcer [called a chancre] on the genitals; painless inguinal lymphadenopathy in first infection.
3. Granuloma inguinale or donovanosis: a STD of bacteria origin. A persistent, painless, small beefy-red bumps or ulcer affecting the genitals, groin and perineum.
4. Lymphogranuloma venereum (LGV): Caused by a bacteria. LGV manifests as a small, shallow, painless, genital or rectal bump or ulcer; tender inguinal lymphadenopathy)
5. Yeast infection- Candidiasis: a very common vaginal fungal infection that presents as a red, wet, swollen vulva with scratch marks.
6. Trichomoniasis- Apart from the foul smelly fishy vagina discharge, trichomoniasis can cause labial ulcerations; cervical erosion and multiple, small punctate haemorrhages, and swollen papillae on the cervix [‘strawberry’ cervix] and vagina seen on speculum exam)
7.Genital herpes: Genital herpes is caused by a virus. The sore can be described as small, painful blisters filled with clear or straw-coloured fluid; lymphadenopathy in first infection.
8. Genital warts: also of viral origin. The ulcers are fleshly spots that are raised or flat, and may look like the top of a cauliflower; usually sexually transmitted and often coexist with other STDs.
9. Scabies: Caused by the parasite called Sarcoptes scabiei hominis- threadlike burrows are classical with vesicules and papules on genitals as it is intensely pruritic.
10. Pubic lice/ Crab (Pthirus pubis)– bluish-gray macules secondary to bites, also crusts and pin-point blood stains in underwear. It is also intensely pruritic.
Other causes of genital ulcers
Other types of genital sores may be caused by rashes such as psoriasis, molluscum contagiosum, allergic reactions, and non-sexually transmitted infections like Epstein-Barr virus, cytomegalovirus, varicella zoster-the virus that causes chickenpox and shingles
RISK FACTORS FOR GENITAL ULCERS
A. Adolescents
➡️Multiple partners
➡️Sequential/Serial monogamy
➡️Unconcerned
➡️Uniformity
B. Racial or ethnically skewed
➡️Black: Chlamydia more common
C. Homosexual men or women
D. Coasts or Ports of entry
E. Prostitutes
F. Teenage runaways
G. Immigrants
H. Low income in urban setting
I.Prison Inmate (current or former)
J. Military recruits
K. Mental Illness
L. Injection drug user (IV Drug Abuse)
M.Sexual Abuse history
LABORATORY TESTING
A. Herpes Simplex Virus Testing
1. HSV PCR from ulcer scraping or vesicle aspirate (preferred over HSV culture)
2. HSV Serology (type specific)
B. Chancroid testing (if high Incidence in community)
1. Outside the U.S., PCR testing may be available, which is much more sensitive than culture
2. Haemophilus ducreyi Gram Stain and culture
a. May be treated empirically despite negative testing
b. Indicated in painful ulcers, Regional Lymphadenopathy and other tests negative
C. Syphilis Testing
1. Chancre testing with dark field microscopy or direct fluorescent Antibody
2. VDRL or RPR with reflex to confirmatory testing
D. Lymphogranuloma venereum
1. Test Genital swab or bubo aspirate for Chlamydia trachomatis types L1, L2, L3 (culture, PCR, direct immunofluorescence)
E. Other testing
➡️HIV Test
➡️Chlamydia Test (Chlamydia PCR)
➡️Gonorrhea Test (Gonorrhea PCR)
➡️Hepatitis B Surface Antigen
➡️Trichomonal Vaginitis (women)-microscopy and culture of cervical and vaginal swabs.
TREATMENT OF GENITAL ULCERS
A. General
1. Cause may not be identified on lab testing in more than 25% of cases
2.Treatment may be empiric based on history and examination
3. Sexual partners should be tested for Sexually Transmitted Disease
4. Abstain from sexual activity until ulcers have healed and treatment is completed
a. HIV Transmission is at much higher risk when
genital ulcers are present
B. Initial empiric management (start before lab results back)
➡️Genital Herpes treatment (start early to prevent HSV transmission, HIV Transmission and speed healing)
➡️ Withdraw medications suspected as cause of possible Fixed Drug Eruption (diagnosis of exclusion)
➡️Consider empiric Syphilis management while awaiting results in high risk patients (e.g. Men who have Sex with Men)
C. Cause Specific Management
💥Genital Herpes
💥Primary Syphilis
💥Chancroid
💥Lymphogranuloma venereum (Donovanosis)
D. Ulcer Treatment
➡️Keep ulcers clean and bandaged
➡️Sitz baths may be soothing
➡️Topical antimicrobials (e.g. silvadene) may be beneficial for extragenital ulcers, but evidence of effectiveness is limited
➡️Consider cool compress with Burow Solution
PREVENTION
👉Limit number of sexual partners
👉Consistent Condom use
👉Regular Sexually Transmitted
👉 Infection Screening
SOURCES:
2. https://fpnotebook.com/id/Derm/GntlUlcr.htm
3.https://medlineplus.gov/ency/article/003221.htm
4. http://www.medcape.com
This article was written by: ODEMUYIWA ADEYEMI J (MBBS, Ibadan)
