STD LESIONS

Things that we love to discuss in detail at lunch

Outline

• Syphilis • Herpes• Genital Warts• Misc. Lesions• Q & A

Syphilis - The Great Pretender

• Primary Lesions – “classically” are painless, clean-based & firmly indurated ulcers (but, only 1/3 fit this description)

• Secondary Lesions – 75% develop a rash; usually maculopapular, non-puritic, may involve the trunk, extremities, palms & soles. Condylomata lata - Mucous patches in mouth or perineal area (papulosquamous rash).

Syphilis: Chancre/sore of penis

Syphilis: Chancre/Lesion- Vagina

Syphilis: Secondary stage -Maculopapular rash- abdomen

Syphilis: Secondary Stage-Rash on palms-soles

Syphilis: Secondary Stage -Alopecia (hair loss)

Syphilis: Primary Lesion - tongue

Syphilis: Secondary stage -mucous patches on genitalia

Syphilis: Secondary stage -Mucous Patches - Lips

Syphilis (cont.)

• Latent lesions – none expected• Tertiary lesions – 30% untreated

may develop chronic skin inflammatory lesions (Gumma), skin ulcerations, &/or jaundice.

• Congenital lesions – rash, dental malformations.

Syphilis: Tertiary Stage -Cardiovascular

Syphilis: Tertiary Stage -Gumma

Syphilis: Congenital syphilis “Snuffles”

Remember:

• Syphilis lesions do not always follow the typical

• You must look for these lesions to find them

• Superimposed infections can distort the picture

HERPES

The (usually) painful “bobo” down there.

Herpes (cont)

• There are ½ million new infections per year in the U.S. , so expect to see this a lot.

• First outbreak usually lasts 2-3 weeks

• Begins with tingling or burning feeling

• Small red bumps appear

Herpes (cont)

• The bumps turn into blisters or open sores, scab over & heal without scarring

• May also include: swollen lymph glands, muscle aches, headache, fever, nausea, & painful or difficult urination

Herpes:Herpes: Onset of Lesions- Penis

Herpes:Herpes: Lesion - Penis

Herpes:Herpes: Lesions- Vagina

Herpes:Herpes: Lesions - Cervix

Herpes complication: Infant

Herpes (cont)

• Symptoms in women > men• Subsequent outbreaks are usually

milder• Lesions will be where ever the virus

entered the body (penis, vagina, mouth, fingers, anus, thighs, etc)

GENITAL WARTS

Bumps on their privates

Genital Warts (cont)

• More than 20 viruses cause these lesions

• Types 6 & 11 cause the warts we can see

• Over 1 million new cases each year – so, expect to see these every day

Genital Warts:Condylomata Acuminata- Perianal

Genital Warts (cont)

• Virus can be passed without seeing a wart

• Most people with warts have no symptoms

• May appear at first as small, hard spots at the place where the virus entered the body (mouth, penis, anus, vagina, etc)

Genital Warts (cont)

• May appear smooth, or have stalks & a rough surface

• Most often they are ¼ inch across & 3/8 inch high

• May itch, bleed, become chaffed• Can occur alone or in clusters• Usually painless

Genital Warts (cont)

• No cure – treat with TCA or self-applied creams

• May return after treatment• Long-term side effects include

abnormal pap smears, cervical or vulvular cancer

• Often enlarge during pregnancy

MISCELLANEOUS LESIONS

Things that may fool us

Miscellaneous Lesions (cont)

• Scabies• Candidiasis• Folliculitis• Herpes Zoster• Skin tags• Pearly penile

papules• Epidermal cysts• Tinea Cruis

• Bartholin Gland cysts

• Dermoid cysts• Vitilago• Chancroid

(painful,dirty base, bulboe, adenopathy)

• Crohn’s Disease• Molluscum

Herpes Zoster (Dermatitis)

Descriptive Terms

• Papule• Macule• Plaque• Patch• Nodule• Mor• Vesicle• Bulla• pustule

• Wheal• Comedo• Scale• Fissure• Erosion• Ulcer• Crust• Scar• lichenification

Descriptive Terms (cont)

• Number• Color• Type• Configuration• Distribution

• Other: tenderness, pruitis, depth, base, consistency, lymphaden-opathy

IN CONCLUSION

• STD Lesions are common—you will see them more than you might care to

• After you have seen may of these lesions over & over, you will become better at differentiation

In Conclusion (cont)

• Follow your STD standing orders when dealing with any STD lesion

• If in doubt, refer

In Conclusion (cont)

• REMEMBER—

STD Can be FUN!!!!!!