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Infectious lesions of the vulva

Chancroid Syphilis Lymphogranuloma HPV Genital herpes (HSV 2) Donovanosis?


(Haemophilus ducreyi) (Treponema pallidum) venereum (LGV)
Primary lesion Pustule Papule Papule, vesicle, pustule Warts Vesicule Papule
Number of Multiple Singular Single Multiple Multiple Variable
lesions
Diameter Variable 5 15mm 2 10mm 1 2mm? 1 2mm Variable
Edges Ragged Sharply demarcated, elevated Elevated, round or oval Demarcated Erythematous, polycyclic Elevated, irregular
Depth Excavated Superficial or deep Superficial or deep Raised Shallow Raised
Base Purulent, dirty grey base Broad; Variable Can be fleshy, vascular tumour- Erythematous Red, velvety, bleeds easily
Smooth, non-purulent; like
Covered with serous
exudate;
Induration No Button hole No No No No
Appearance Small, tender papules - Primary chancre: single Primary: small, painless Genital warts small, raised, Initially vesicular
that break down small, firm, indurated, papule, vesicle or ulcer rounded lesions, usually eruption shallow,
ragged, tender, non- painless ulcer with a dull multiple tender ulcers (single,
indurated ulcers red base Secondary: enlargement of multiple or grouped)
inguinal glands to form a Condylomata acuminata:
- Secondary: macular, painful mass sinus irregular, fleshy, vascular
popular, papulosquamous formation tumours
or pustular widespread
rash with flu-like sx
NB: unilateral tonsilitis

Condyloma lata:
confluent, spongy gray
mass with flat tops and
broad bases (in flesh
folds)

- Late: gummas
squamous
lesions/subcutaneous
lesions +/- ulceration
- Tertiary: disseminated;
extra-genital organs
affected
Painful? Yes No No Yes No??? Yes No
Lymph nodes Unilateral; tender, Bilateral, non-tender, firm, Unilateral, tender, Dunno Bilateral, non-tender, firm, None;
suppurative lead-shot, non-suppurative suppurative non-suppurative Pseduo-bulbo seen
Location Labia, fourchette, Vulva; periphery (in Fourchette (most common); Vulva Labia majora & minora
perineum, perianal condyloma lata) May also be on labia or cervix (most common)
Clitoris, perineum, perianal
Incubation 3 14 days 2 3 weeks 3 days 3 weeks; (30 days??) 3 weeks 8 months 2 10 days; (5 21 days??) 1 day year
Spontaneous 1 3 months 3 weeks 3 months 2 5 days Dunno Doesnt heal
healing time
Management Erythromycin Penicillin Tetracycline 1. Trichloroacetic acid Acyclovir (does not affect
Azithromycin 2. Podophyllin rate of recurrence)
Ciprofloxacin 3. Topical imiquimod
Ceftriaxone (Aldara)
4. Cryotherapy
5. Laser surgery
Microscopy Gram stain Dark field direct immuno- Direct immuno-staining ELISA ?? Antigen detection by DFA; Giemsa stain;
fluorescence rapid essay Immuno-peroxide staining; Tissue smear
ELISA
Culture Enriched gonococcal agar N/A Cell culture; ?? Human diploid; N/A
base; HeLa-229; Fibroblast cell culture;
Mueller Hinton agar +5% McCoy cells; Green monkey kidney
chocolate;
Horse blood agar
Molecular PCR PCR PCR PCR PCR Not available
Histopathology Degeneration of Perivascular infiltrate of Small areas of necrosis with 3 zones: NB: requires biopsy
keratinocytes lymphocytes; proliferating epitheloid cells 1. Surface zone
acantholysis; Plasma cells; with stellate abscess (neutrophils, fibrin, Acanthosis;
2 types of degeneration Endarteritis obliterans RBC, necrosis) Pseudo-carcinomatous
1. Ballooning 2. Middle zone (wide with hyperplasia;
2. Reticular angiogenesis) Histiocytes;
3. Deeper zone (dense Plasma cells with absence
inflammatory reaction of lymphocytes;
with plasma & Donovan bodies**
lymphoid cells)