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  • Print publication year: 2008
  • Online publication date: December 2009

17 - Ulcerative Sexually Transmitted Diseases

from Part I - Systems

Summary

INTRODUCTION – AGENTS

Sexually transmitted infections can be divided into those that cause genital ulcers and those that do not. In North America, ulcerative sexually transmitted diseases are most commonly caused by herpes genitalis, syphilis, and, occasionally, chancroid; much rarer causes include lymphogranuloma venereum and granuloma inguinale. Definitive diagnostic tests often are not available in the acute care setting, and empiric treatment with close follow-up is often the best approach.

HERPES GENITALIS

Epidemiology

Genital herpes infection is caused by herpes simplex virus (HSV) types 1 and 2. This is by far the most common cause of ulcerating genital disease in North America: More than 50 million persons in the United States have the disease. Most U.S. cases are caused by HSV-2.

Clinical Features

Herpes genitalis can present with a broad range of symptoms. Serologic testing suggests that many infected patients are asymptomatic or have minimal symptoms. Those with an initial genital infection caused by HSV-1 tend to have milder symptoms than those infected with HSV-2. In addition, patients who already have antibodies to HSV-1 (e.g., those with a history of fever blisters) often have milder symptoms with initial HSV-2 genital infection. Symptomatic patients with genital infection caused by HSV-2 who have no prior HSV antibodies tend to present with the most severe disease. In all cases of genital herpes, recurrences may occur and are more common in patients infected with HSV-2.

REFERENCES
ACOG. Practice bulletin: management of herpes in pregnancy. Clinical guidelines for obstetrician-gynecologists. Int J Gynaecol Obstet 2000;68:165–73.
Armstrong, G L, Schillinger, J, Markowitz, L, et al. Incidence of herpes simplex type 2 infection in the United States. Am J Epidemiol 2001;153:912–20.
Augenbraum, M.Treatment of latent and tertiary syphilis. Hosp Pract 2000;35(4):89–95.
Centers for Disease Control and Prevention (CDC). Brief report: a treatment failures in syphilis infections – San Francisco, California, 2002–2003. MMWR 2004;53(9):197–8.
Centers for Disease Control and Prevention (CDC). Sex CDC. Sexually transmitted diseases: treatment guidelines, 2006. MMWR 2006;55(RR-11).
Gene, M, Ledger, W J. Syphilis in pregnancy. Sex Transm Infect 2000;76(2):73–9.
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Lukehart, S A, Godornes, C, Molini, B J, et al. Macrolide resistance in Treponema pallidum in the United States and Ireland. N Engl J Med 2004;351:154–8.
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Whittington, W L, Celum, C L, Cent, A, et al. Use of a glycoprotein G-based type-specific assay to detect antibodies to herpes simplex virus type among personnel attending sexually transmitted disease clinics. Sex Transm Dis 2001;28:99–104.
ADDITIONAL READINGS
Ernst, A A, Marvez-Valls, E, Martin, D H. Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid. Sex Transm Dis 1995;22:217–20.
Lewis, D A. Diagnostic tests for chancroid. Sex Transm Infect 2000;76:137–41.
Steen, R, Dallabetta, G, Genital ulcer disease control and HIV prevention. J Clin Virol 2004;29:143–51.