MRCEM Notes

STI: ulcers

Genital herpes is most often caused by the herpes simplex virus (HSV) type 2 (cold sores are usually due to HSV type 1). Primary attacks are often severe and associated with fever whilst subsequent attacks are generally less severe and localised to one site

Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. Infection is characterised by primary, secondary and tertiary stages. A painless ulcer (chancre) is seen in the primary stage. The incubation period= 9-90 days

Chancroid is a tropical disease caused by Haemophilus ducreyi. It causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.

Lymphogranuloma venereum (LGV) is caused by Chlamydia trachomatis. Typically infection comprises of three stages
  • stage 1: small painless pustule which later forms an ulcer
  • stage 2: painful inguinal lymphadenopathy
  • stage 3: proctocolitis

LGV is treated using doxycycline.

Other causes of genital ulcers
  • Behcet's disease
  • carcinoma
  • granuloma inguinale: Klebsiella granulomatis*

*previously called Calymmatobacterium granulomatis
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