Genital ulcer disease is a sexually transmitted infection causing ulcerative lesions on the genitals. It affects over 20 million people worldwide annually. Common causes are Herpes simplex virus 1 and 2. Classification includes syphilis, chancroid, genital herpes, inguinal granuloma, and lymphogranuloma venereum. Syphilis symptoms range from primary ulcers to rashes and can affect multiple organ systems if untreated. Chancroid causes painful ulcers. Herpes genitalis presents with grouped vesicles and recurrent outbreaks. Inguinal granuloma forms fleshy lesions that can spread. Lymphogranuloma venereum involves lymph vessels and nodes in the genital
Genital ulcer disease is a sexually transmitted infection causing ulcerative lesions on the genitals. It affects over 20 million people worldwide annually. Common causes are Herpes simplex virus 1 and 2. Classification includes syphilis, chancroid, genital herpes, inguinal granuloma, and lymphogranuloma venereum. Syphilis symptoms range from primary ulcers to rashes and can affect multiple organ systems if untreated. Chancroid causes painful ulcers. Herpes genitalis presents with grouped vesicles and recurrent outbreaks. Inguinal granuloma forms fleshy lesions that can spread. Lymphogranuloma venereum involves lymph vessels and nodes in the genital
Genital ulcer disease is a sexually transmitted infection causing ulcerative lesions on the genitals. It affects over 20 million people worldwide annually. Common causes are Herpes simplex virus 1 and 2. Classification includes syphilis, chancroid, genital herpes, inguinal granuloma, and lymphogranuloma venereum. Syphilis symptoms range from primary ulcers to rashes and can affect multiple organ systems if untreated. Chancroid causes painful ulcers. Herpes genitalis presents with grouped vesicles and recurrent outbreaks. Inguinal granuloma forms fleshy lesions that can spread. Lymphogranuloma venereum involves lymph vessels and nodes in the genital
Genital ulcer disease is a sexually transmitted infection causing ulcerative lesions on the genitals. It affects over 20 million people worldwide annually. Common causes are Herpes simplex virus 1 and 2. Classification includes syphilis, chancroid, genital herpes, inguinal granuloma, and lymphogranuloma venereum. Syphilis symptoms range from primary ulcers to rashes and can affect multiple organ systems if untreated. Chancroid causes painful ulcers. Herpes genitalis presents with grouped vesicles and recurrent outbreaks. Inguinal granuloma forms fleshy lesions that can spread. Lymphogranuloma venereum involves lymph vessels and nodes in the genital
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GENITAL ULCER DISEASE
Supervisor : dr. Sari Handayani Pusadan. M.Kes, Sp.KK
By Budi Hartono 12 17 777 14 185 DEFINITION • Genital Ulcer Disease is a symptom of a sexually transmitted infection (STI) during which the course of the disease finds ulcerative / erosive / pustular lesions or vesicular genital lesions with or without lymphadenopathy EPIDEMIOLOGY • More than 20 million cases worldwide • The most common cases are HSV 1 and HSV 2 • Women 1 : 5 • Men 1 : 9 • Usually found in human ages 14 to 49 years CLASSIFICATION 1.Syphilis 2.Mole Ulcers 3.Genital Herpes 4.Inguinal Granuloma 5.Lymphogranuloma Venereum 1. SYPHILIS • Caused by the bacterium treponema pallidum, is a chronic disease and can affect all organs of the body. • Classification : 1. Congenital syphilis a. Early congenital syphilis (appearing before 2 years old) b. Further congenital syphilis (appearing after 2 years old) 2. Akuisita syphilis (epidemiological classification) a. Early syphilis (syphilis occurring within 1 year after infection) i. Primary syphilis (S I) ii. Secondary syphilis (S II) iii. Early latent syphilis (early latent syphilis) b. Further syphilis (syphilis that occurs more than 1 year after infection) i. Latent syphilis (late latent syphilis) ii. Tertiary Syphilis (S III) .....CONTINUE SYPHILIS • Clinical representation 1. Primary syphilis, primary ulcers occur at the site of inoculation, 3 weeks (10-90 days) after "coitus suspectus" (sexual intercourse suspected of causing the infection), commonly called durum ulcus or chancre ulcer (syphilitic ulcer), can be genital or extra genital .....CONTINUE SYPHILIS 2. Secondary syphilis, lesion on the skin is roseola, papul, and pustul, lesion on the mucosa is angina siphylityca erythematous, and mucous patch, lesion on the hair is alopecia areolaris, lesion on the nail is onikia sifilitica and paronikia sifilitica . .....CONTINUE SYPHILIS • Differential diagnosis : 1. Primary syphilis - chancroid - Granuloma inguinale - Herpes genitalis 2. Secondary syphilis - Pitiriasis rosea - Tinea versikolor - Psoriasis - Scabies - Drug eruption - Eksantema virus .....CONTINUE SYPHILIS • Laboratory examination : 1. Direct examination, examination material from ulcer (Reitz serum), - Dark field examination - PCR. 2. Undirect examination, serologic test for syphilis (STS), - Treponema test : TPI ( T. pallidum Immobilization ), FTA-ABS ( Fluorescent Antibody Absoption Test), TPHA (Treponema Pallidum Haemagglutination Assay) - Non treponema test : VDRL ( Venereal Diseases Research Laboratory ), RPR (Rapid Plasma Reagin ) VDRL: High sensitivity screening TPHA: High specificity confirm the diagnosis .....CONTINUE SYPHILIS • Therapy : 1. Early syphilis - Benzathine benzylpenicillin G 2,4 million IU intra muscular, single dose - Procaine benzylpenicillin 0.6 million IU / day, intramuscularly for 10 consecutive
days - For patients who are allergic to penicillin : i. Doxycycline 2 x 100 mg / day orally, for 30 days ii. Tetracycline 4 x 500 mg / day, for 30 days iii. Erythromycin 4 x 500 mg / day for 30 days .....CONTINUE SYPHILIS 2. Further Syphilis - Benzathine benzylpenicillin G 2.4 million IU / week, intramuscularly, for 3 consecutive weeks, or - Procaine of benzylpenicillin 0.6 million IU / day, intramuscularly for 3 consecutive weeks. - For patients with penicillin allergy: i. Doxycycline 2 x 100 mg / day for 30 days or more ii. Tetracycline 4 x 500 mg / day for 30 days or more iii. Erythromycin 4 x 500 mg / day for 30 days or more 2. MOLE ULCERS • Caused by haemophilus ducreyi, with an incubation period of 4-10 days. • Characteristics : - multiple ulcers, pain in> 50% of cases, uneven edges, induration (-).
- The base of dirty ulcers, easily bleeding and necrotic, the skin around the reddish ulcer - There is a mild uni / bilateral inguinal lymphadenopathy in 50% of cases, suppuration occurs, perforation, fistula, ulcer - Can occur autoinokulasi - Location of the lesion: often in the vulva, cervix, prepuce, coronarius, and anal region; oral to oral sexual contac; other body parts (rare) due to autoinoculation. .....CONTINUE MOLE ULCERS .....CONTINUE MOLE ULCERS • Differential diagnosis : - Syphilis - Herpes genitalis • Laboratory examination : - Gram stain from ulcer (40-60% sensitivity) Gram-negative small bacilli, which are lined up in pairs like a collection of fish (school of swimming fish) - Culture - PCR .....CONTINUE HERPES GENITALIS • Therapy : 1. Ciprofloxacin 2 x 500 mg / day orally, for 3 days 2. Erythromycin base 4 x 500 mg / day, orally for 7 days 3. Azithromycin 1 gram per oral, single dose 4. Ceftriaxone 250 mg intramuscular, single dose 3. HERPES GENITALIS • Caused by Herpes Simplex Virus (HSV) types 1 and 2 (90% of genital herpes cases induced by HSV type 2), with typical events with grouped vesicles on erythema basis and recurrent occurrence.
• Clinical manifestations : 1. First episode - primer 2. First episode - not primer 3. Recurrent episodes 4. Asymptomatic .....CONTINUE HERPES GENITALIS • Differential diagnosis : - Chancroid - Syphilis with secondary infection - Genital ulcers due to trauma - Contact dermatitis • Laboratory examination : • A simple laboratory examination with a Tzanck smear stained with Giemsa or Wright will appear to be a multinucleated giant cell, but this examination has a low sensitivity and specificity. • PCR • Serology .....CONTINUE HERPES GENITALIS • Therapy : 1. Primary first episode: a. Aciclovir 5 x 200 mg / day, orally, for 7 days, or b. Valaciclovir 2 x 500 mg / day, orally, for 7 days 2. Recurrent episodes: a. Aciclovir 5 x 200 mg / day, orally, for 5 days, or b. Valaciclovir 2 x 500 mg / day, orally, for 5 days c. When moderate enough is given acyclovir cream 3. Treatment suppressive (recurrence> 6 times / year) a. Aciclovir 2 x 400 mg / day, orally, continuously, or b. Valaciclovir 1 x 500 mg / day 4. INGUINAL GRANULOMA • Inguinal granuloma is a granulomatous process that usually concerns the anogenital and inguinal areas. • The transmission of this disease is low, chronic, progressive transmission of autoinoculation, about the genitalia and surrounding skin, and sometimes the lymphatic system. .....CONTINUE INGUINAL GRANULOMA • Clinical Representation - The most prominent clinical forms are fleshy, red meat, soft, tasteless, non-tender and
- The general clinical representation of primary lesions extends slowly through direct spread, autoinoculation, resulting in new lesions in adjacent lesions ("kissing lesions"). • Type of Clinical Representation 1. Nodular Type 2. Ulseru-vegetatif Type 3. Hypertrophic Type 4. Sikatrisial Type .....CONTINUE INGUINAL GRANULOMA • Diagnosis : 1. History of the disease 2. Clinical representation 3. Smear the network (tissue smears 4. Culture 5. Biopsy 6. Serum test 7. Inoculsions 8. Skin test .....CONTINUE INGUINAL GRANULOMA • Differential diagnosis : 1. Syphilis 2. Condyloma lata 3. Squamous cell carcinoma 4. Amubiasis 5. Molle ulcers 6. LGV 7. Tuberculosis 8. Rhinoscleroma, leishmaniasis, and histoplasmosis .....CONTINUE INGUINAL GRANULOMA • Therapy : 1. Sulfonamide and penisiline 2. Ampicillin 3. Streptomycin 4. Tetracycline 5. Chloramphenicol 6. Erythromycin 7. Gentamicin 8. Linkomycin 9. Cotrimoxazole 5. LYMPHOGRANULOMA VENEREUM • Caused by Chlamydia trachomatis serotype L1, L2, L3, primary affects are usually rapidly disappearing, systemic, of the lymph vessel system and lymph nodes, particularly in the genital, inguinal, anal and rectal areas, with clinical, acute, sub- acute, or chronic depending on the patient's immunity and usually form of inguinal syndrome. • Clinical Symptoms in the form of malaise, headache, arthralgia, anorexia, nausea and fever. • Clinical representations can be divided into : - early forms, consisting of primary affects and inguinal syndrome, - advanced forms consisting of genital, anorectal and urethral syndromes. .....CONTINUE LYMPHOGRANULOMA VENEREUM .....CONTINUE LYMPHOGRANULOMA VENEREUM • Diagnosis : • Differential diagnosis : 1. Frei Test 1. Skrofuloderma 2. Serology Test 2. Pyogenic lymphadenitis 3. Plant Tissue Isolation Method 3. Lymphadenitis due to mole ulcers 4. Cytology 4. Malignant lymphoma 5. Polymerase Chain Reaction (PCR) 5. Inguinal hernia 6. Biopsy-Histopathology 7. GPR Test .....CONTINUE LYMPHOGRANULOMA VENEREUM • Therapy : • • Doxycline: is the first choice of treatment for LGV, a dose of 2 X 100 mg / day for 14-21 days or tetracycline 2 gr / day or minocycline 300 mg followed by 200 mg 2X / day. • Sulfonamides: 3-5 g / day dose for 7 days. • • Erythromycin: a second option, a dose of 4 X 500 mg / day for 21 days, especially in cases of tetracycline drug allergies in pregnant and lactating women. • • Eritrhomycin ethylsuccinate: dose 800 mg 4 X / day for 7 days. • • Crimrimoxazole (Trimethropin 400 mg and sulfamethoxazole 80 mg): dose of 3 X 2 tablets for 7 days. • • Ofloxacin: dose of 400 mg 2 X / day for 7 days. • • Levof loxacin: dose 500 mg 4 X / day for 7 days • • Azithromycin: 1 g of single dose. PROGNOSIS • If trained early, the prognosis is good, but if there is a change it can cause death. • Reinfection and relapse may occur, especially in patients with human immune deficiency virus (HIV), in these patients may develop with multiple abscesses, which last longer because the resolution is delayed. THANKYOU
