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Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 17) Diagnosis Although most genital ulcerations cannot be diagnosed confidently on clinical grounds alone, clinical findings plus epidemiologic considerations (Table 124-7) can usually guide initial management (Table 124-8) pending results of further tests. Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and a dark-field or direct immunofluorescence test (or PCR test, where available) for T. pallidum in all lesions except those highly characteristic of infection with HSV (i.e., those with herpetic vesicles). All patients presenting with genital ulceration should be counseled and tested for HIV infection. Table. | Chapter 124. Sexually Transmitted Infections Overview and Clinical Approach Part 17 Diagnosis Although most genital ulcerations cannot be diagnosed confidently on clinical grounds alone clinical findings plus epidemiologic considerations Table 124-7 can usually guide initial management Table 124-8 pending results of further tests. Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and a dark-field or direct immunofluorescence test or PCR test where available for T. pallidum in all lesions except those highly characteristic of infection with HSV i.e. those with herpetic vesicles . All patients presenting with genital ulceration should be counseled and tested for HIV infection. Table 124-7 Clinical Features of Genital Ulcers Feature Syp hilis Herp es Cha ncroid Lympho granuloma Venereum Don ovanosis Incubati on period 9- 90 days 2-7 days 1-14 days 3 days-6 weeks 1-4 weeks up to 6 months Early primary lesions Pap ule Vesic le Pust ule Papule pustule or vesicle Papu le No. of lesions Usu ally one Multi ple Usua lly multiple may Usually one often not detected despitelymphad Vari able coalesce enopathy Diamete r 5- 15 mm 1-2 mm Vari able 2-10 mm Vari able Edges Sha rPly demarcate d elevated round or oval Eryth ematous Und ermined ragged irregular Elevated round or oval Elev ated irregular Depth Sup erficial or deep Supe rficial Exca vated Superfici al or deep Elev ated Base Sm ooth nonpurulen t relatively Sero us erythematou s Puru lent bleeds easily Variable nonvascular Red and velvety bleeds .
