GENITAL ULCERS : Evaluation and Treatment - 09/09/11

Doi : 10.1016/S0733-8635(05)70032-2

Theodore Rosen, MD ^{^{*
Department of Dermatology, Baylor College of Medicine, Houston, Texas}}, Tricia J. Brown, MD ^{^{*
Department of Dermatology, Baylor College of Medicine, Houston, Texas}}

Résumé

Ulceration of the genitalia is a common presentation of sexually transmitted diseases. In the United States and most other developed countries, the majority of cases are due to either herpes progenitalis, syphilis, or chancroid. In developing nations, especially Africa, India, and portions of Latin America, chancroid and granuloma inguinale may be more common. It should be noted that, regardless of locality, more than one venereal disease may be detectable in 3% to 10% of patients with genital ulceration of infectious etiology when lesions are evaluated by traditional tests.^{14 Centers for Disease Control and Prevention 1998 Guidelines for treatment of sexually transmitted diseases MMWR 1998 ; 47 (RR-1) : 19-39

Cliquez ici pour aller à la section Références} The concomitant occurrence of two or more organisms causing genital ulcers may be even more common, as demonstrated when such lesions are evaluated by more sensitive means such as polymerase chain reaction (PCR).^{20 Dillon S.M., Cummings M.C., Rajagopalan S. , et al. Prospective analysis of genital ulcer disease in Brooklyn, New York Clin Infect Dis 1997 ; 24 : 945-950 [cross-ref]

Cliquez ici pour aller à la section Références, 59 Orle K.A., Gates C.A., Martin D.H. , et al. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers J Clin Microbiol 1996 ; 34 : 49-54

Cliquez ici pour aller à la section Références} Although not often considered in the differential diagnosis, genital ulcerations may also be encountered in conjunction with a host of unrelated inflammatory diseases. There is considerable overlap in the clinical signs and symptoms of both infectious and noninfectious genital ulcers. Therefore, diagnosis of genital ulceration based solely upon morphologic examination is fraught with difficulty and subject to a high degree of inaccuracy.^{19 DiCarlo R.P., Martin D.H. The clinical diagnosis of genital ulcer disease in men Clin Infect Dis 1997 ; 25 : 292-298

Cliquez ici pour aller à la section Références} The evaluation of any genital ulceration requires: consideration of local epidemiology and demographics; a careful and thorough history, including both a travel and sexual history; assessment of the ulcerative lesion for suggestive clinical features (such as pain, induration, and friability); an examination for regional lymphadenopathy; additional extragenital physical examination, as indicated; laboratory testing, as appropriate; and biopsy for histopathologic evaluation, if needed. The typical characteristics of each of the common etiologies of genital ulceration are summarized in Table 1.