Workspace for 'andrews diseases of the skin clinical dermatology, 12th ed - james,

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women over 25 and in men of all ages,

HSV-2 remains the most common cause
of genital herpes.

Genital herpes
women under age 25, HSV-1 represents
more than 50% of cases of genital herpes

spread by skin-to-skin contact

sexual activity

HSV-1 in the genital area is much less

likely to recur. Only 20–50%from totally asymptomatic to incubation
severe period averages
5 days
genital ulcer disease (erosive vulvovaginitis potentially infectious to a
or proctitis). sexual partner.
symptomatology HSV-2.

monogamous couples
chronic suppressive
transmission HSV-2

about 5–10% annually

Only 57% of new HSV-2
infections are symptomatic.

classic, grouped blisters on an the infected partner with

erythematous base. valacyclovir, 500 mg/day.
Only serology

with oral acyclovir, 200 mg

five times determin
initial clinical episode 400 mg three times daily

typical grouped blisters, totally HSV naïve and

famciclovir, 250 mg three times

Grouped blisters and or valacyclovir, 1000 mg twice daily,

continued development of new blisters
erosions appear all for 7–10 days.
over 7–14 days.

it is not curable,
experiencing a true
bilaterally symmetric emotional response primary episode

ften extensive,
inguinal lymph nodes can be enlarged
bilaterally

Fever and flulike

in women severe proctitis

vaginal pain

dysuria
(herpetic vulvovaginitis

3 weeks or more

CHANCROID

Chancroid (soft chancre

Workspace for 'andrews diseases of the skin clinical dermatology, 12th ed - james,
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Chancroid (soft chancre

gram-negative bacillus Haemophilus

ducreyi (the Ducrey bacillus)
One or more deep or superficial, tender
ulcers on the genitalia and painful inguinal
adenitis in 50%, which may suppurate,
are characteristic of the disease
Men outnumber women manyfold.

nflammatory macule or pustule

1–5
days,
rarely as long as 2 weeks

distal penis or perianal area

in men
the vulva, cervix, or perianal area
in women

extragenital infection on the hands,

eyelids, lips, or breasts have been
reported

pustule ruptures early with the

formation of a ragged ulcer that lacks the
induration of a chancre

The ulcers appear punched out or have

undermined, irregular edges surrounded by
mild hyperemia

The base is covered with a purulent, dirty

exudate. The ulcers bleed easily and are
very tender.

about half the cases

genital chancroid manifest

inguinal adenitis

Suppuration of the bubo (inguinal lymph

node) may occur despite early antibiotic
therapy
The lymph- adenitis of chancroid,
mostly unilateral, is tender and may
rupture spontaneously. Left untreated, the
site of

perforation of the broken-down bubo ceftriaxone, 250 mg intramuscularly in a

may assume the features of a soft single dose;
chancre (chancrous bubo).

Chronic, painful, destructiveazithromycin,

ulcers, 1 gciprofloxacin,
orally in a single dose.
500 mg orally twice
which begin on the prepuce or glans and a day for 3 days
Erythromycin, 500 mg four times a day
spread by direct extension along the shaft
for 7 days;
of the penis, are present.
They may sometimes attack the
scrotum or pubes.

edges of the ulcer are likely to be

elevated, firm, and undermined

granulat- ing base, which bleeds easily,

is covered with a thick, purulent exudate
and dirty, necrotic detritus.
Multiple infections may be present,
such as chancroid, syphilis, or gran-
neighboring skin may be edematous
uloma inguinale.
and dusky red, and the regional lymph
glands may be swollen, although this is
definitive diagnosis of chancroid requires not necessarily a marked feature.
identification by culture.

Specimens for culture should be taken

from the purulent ulcer base and active
border without extensive cleaning.

Smears are only diagnostic in 50% of

cases in the best hand

the diagnosis of chancroid does not rule Serologic tests for syphilis should be
out syphilis obtained initially, then monthly for the
next 3 months, and serologic testing for
since the incubation period of the
HIV infection should also be done
chancre is much longer than that of
chancroid. Repeated darkfield
examinations for Treponema pallidum are
necessary
even in a sore where the diagnosis of
chancroid has been established.