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Dermatology

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STD

Question
2 out of 42
 

A 29 yr old man presented with history of erythematous rashes all over the body with small ulcers on the penis. There is also previous history of painless small ulcer on penis. Which of the following is most likely diagnosis?(LQ)



A Toxic necrolysis
B Chancroid

C Secondary syphilis
D Herpes infection

Ans. C
Secondary syphilis (Ref. Park 19th/279)

STD IN HIV
Sexually transmitted herpes simplex virus (HSV) infections now cause most genital ulcer disease throughout the world and an increasing proportion of cases of genital herpes in developing countries with generalized HIV epidemics, where the positive feedback loop between HSV and HIV transmission is a growing, intractable problem.

Herpes Simplex type II is the most common cause of genital ulcer in developing countries.

Disease

%

Herpes

62 &

Chanchroid

12 to 20 %

Syphilis

13 %

LGV and

Granuloma Inguinale

5%

Herpes Ulcers are painful, vesicular, multiple and are associated with firm tender lymphadenopathy.

1. Herpes genitalis is the most common cause.

2. Oral lesions, including thrush, hairy leukoplakia, and aphthous ulcers, are particularly common in patients with untreated HIV infection..

3. Typical primary chancre usually begins as a single painless papule that rapidly becomes eroded and usually becomes indurated, with a characteristic cartilaginous consistency on palpation of the edge and base of the ulcer.

a. In heterosexual men the chancre is usually located on the penis, whereas in homosexual men it is often found in the anal canal or rectum, in the mouth, or on the external genitalia.

b. In women, common primary sites are the cervix and labia. Consequently, primary syphilis goes unrecognized in women and homosexual men more often than in heterosexual men..

Chancroid.

1. After an incubation period of 4 to 7 days, the initial lesion-a papule with surrounding erythema-appears.

2. In 2 to 3 days, the papule evolves into a pustule, which spontaneously ruptures and forms a sharply circumscribed ulcer that is generally not indurated.

3. The ulcers are :

a. Painful and

b. Bleed easily;

c. Little or no inflammation of the surrounding skin is evident.

Approximately half of patients develop

1. Enlarged,

2. Tender inguinal lymph nodes, which frequently become

3. Fluctuant and

4. Spontaneously rupture.

The presentation of chancroid does not usually include all of the typical clinical features and is sometimes atypical.

1. Multiple ulcers can coalesce to form giant ulcers.

2. Ulcers can appear and then resolve, with inguinal adenitis and suppuration following 1 to 3 weeks later; this clinical picture can be confused with that of lymphogranuloma venereum.

3. Multiple small ulcers can resemble folliculitis.

4. Other differential diagnostic considerations include the various infections causing genital ulceration, such as primary syphilis, condyloma latum of secondary syphilis, genital herpes, and donovanosis.

5. In rare cases chancroid lesions become secondarily infected with bacteria; the result is extensive inflammation.

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