Genital Rash


Syphilis

Syphilis is a chronic systemic disease, which is acquired or congenital. In its early stages diagnosis and treatment are straightforward but untreated it can cause complex sequelae in many organs and eventually lead to death.

The causative organism, Treponema pallidum (TP), is a motile spirochaete that is acquired either by close sexual contact or can be transmitted transplacentally.

Both acquired and congenital syphilis have early and late stages, each of which has classic clinical features.

Classification and clinical features of syphilis

Diagnosis

  • Dark-ground microscopy
  • Syphilis serology (VDRL, RPR, FTA-abs, PHA, EIA)

Treatment

  • Early syphilis (primary or secondary) - single dose of benzathine penicillin G intramuscularly
  • For late-stage syphilis - benzathine penicillin G intramuscularly (three doses)
  • For patients sensitive to penicillin, either doxycycline or erythromycin orally for 2-4 weeks depending on the stage of the infection
  • The sexual partners and the parents and siblings of patients with congenital syphilis must be contacted and screened
  • Babies born to mothers who have been treated for syphilis in pregnancy are retreated at birth

Warts

Anogenital warts are amongst the most common sexually acquired infections. The causative agent is human papillomavirus (HPV) especially types 6 and 11. HPV is acquired by direct sexual contact with a person with either clinical or subclinical infection. Neonates may acquire HPV from an infected birth canal, which may result either in anogenital warts or in laryngeal papillomas.

Clinical features

Warts develop around the external genitalia in women, usually starting at the fourchette, and involve the perianal region. The vagina and cervix may also be infected. Cervical lesions are associated with cervical intraepithelial neoplasia. In men the penile shaft and subpreputial space are the most common sites. Perianal lesions are more common in men who practice anoreceptive intercourse but can be found in any patient. The rectum may become involved. Warts become more florid during pregnancy or in immunosuppressed patients.

They appear as skin colored dome shaped papules with hair like projections on the surface. The lesions may coalesce to form large plagues. They are usually asymptomatic. HPV subtypes 16 and 18 are potentially oncogenic and are associated with cervical and anal carcinomas.

Diagnosis

  • The diagnosis is essentially clinical
  • Biopsy (if the diagnosis is in doubt)

Treatment

  • Topical podophyllin
  • Topical trichloracetic acid
  • Topical 5% imiquimod cream
  • Cryotherapy
  • Patients with genital warts (and their sexual partners) must be screened for other sexually transmitted diseases

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