GENITAL INJURIES AND ULCERS

Genital ulcers

Ulceration of the genitals is often due to a sexually transmitted pathogen. To make a diagnosis, it is important to know the number of ulcers, the relationship between their occurrence and sexual intercourse, and the severity of the disorder caused by them. From a clinical point of view, we can classify ulcerative lesions of the genitals into: painful multiple ulcers, painless multiple ulcers, solitary painless ulcers and solitary painful ulcers.

Ulcerative lesions of the genitals

Painful

Not painful

Painful

Not painful

Genital herpes
Behçet's disease
Cancer
Scabies
Other

Secondary syphilis
Donovanosis

Tuberculosis
Recurrent genital herpes
Carcinoma

Primary syphilis
Tertiary syphilis
Carcinoma
Balanitis circinata (Reiter's syndrome)
Venereal lymphogranuloma
Donovanosis

Multiple painful ulcers

L"Genital herpes it is the most frequent cause of genital ulcers in industrialized countries. About 90% of cases are caused by Herpes Simplex type 2 and the remaining 10% by type 1. Within 1-2 weeks of infection, a small group of blisters surrounded by erythema of the foreskin appear on the penis. The blisters rupture. , causing small superficial ulcers, very painful, which heal in 5-7 days, but which can serve as a gateway for other germs. The patient is in pain, the inguinal lymph nodes are enlarged and generally very painful. Neurological symptoms are often present due to involvement of the nerve roots found in that anatomical site (sacral) such as: retention of urine, constipation, tingling sensation (paraesthesia), and general symptoms (fever, myalgia, headache). Clinical diagnosis (by looking directly at the lesions) is almost always easy; it is certain if it is possible to isolate the virus on a culture medium and / or in the blood, even if its lack of documentation does not exclude Herpes. As with all cases of genital ulcers with enlargement and pain of the lymph nodes, it is It is necessary to exclude other causes, in particular syphilis.
Less common causes of multiple painful ulcers are Behçet's disease and chancroid. There Behçet's disease it is a rare condition characterized by aggressive and recurrent ulcerations in the mouth and genitals. Compared to genital herpes, there is no involvement of the lymph nodes and it is common to observe numerous retracted scars at the level of the oral mucosa. Its association between Behçet's disease and an infection of the eye and / or meninges (meningitis) is not rare.
The chancroid (or soft venereal ulcer) is a "suppurative infection (with pus), caused by a bacterium called Hemophilus Ducrey, which affects the genitals, although it can also be extragenital. It is rare in our latitudes and is almost always contracted abroad or by a sexual partner who has recently returned from a trip abroad. In the West it is particularly common among prostitutes and those who habitually use drugs. The lesion begins as a small pink papule that rapidly becomes a pustule (filled with pus) and enlarges to form an "ulcer with irregular margins; the base is covered with a greyish crust secreting abundantly pus. Ulcerations are multiple and very painful; in 50-60% of cases the inguinal lymph nodes are swollen, painful and often filled with pus. The isolation of the bacterium in the laboratory, done on special culture media, is diagnostic.
A rarer cause of multiple, painful ulcers is scabies, dermatological disease caused by parasites belonging to the order of Mites which causes multiple itchy, painful papules, which subsequently ulcerate by scratching (its name derives from the Latin "scabere"which means to scratch).
Also, ulcerative lesions can manifest as elements of the Reiter's syndrome (complex disease characterized by the "combination of urethritis, conjunctivitis, arthritis, mouth ulcers and skin spots) or be due to erythema multiforme (which causes eruptive patches on the skin), dermatitis of various types, impetigo (bacterial disease caused by Streptococcus or Staphylococcus, resulting in skin blisters or blisters which then burst to form a crust), folliculitis (the banal "pimples") ed drug rashes.

Multiple painless ulcers

Ulcers of the secondary syphilis, evident as eroded papules on the skin or plaques on the mucous membranes, are characteristically multiple but not painful.