GENITALIA

MINI POSTER
ULCER

FIKRIATUL FADHILLAH 110 209

0083
ANDI FIRMAN MUBARAK 110
209 0088
DZUL IKRAM
110 209 0108

PATIENTS IDENTITY

Name : Mr. S
Gender : Male
Age: 58 y.o
Marital Status : Married
Religion : Moslem
Address : Limbung, Gowa
Occupation : Farmer
Registered : 16 February 2013

HISTORY TAKING
Anamnesis
: (Heteroanamnesis)
Chief complaint : pain on the genital area
Further Anamnesis :
Since 3 years ago (2011), Intermitten. On the last 3
months, become more severe. And 20 days ago, wound
appeared on the penis, the patient felt pain on his
wound. and now the wound is bleeding. The patient also
had swelling at the penis and scrotum. Next 5 days
reddish bumps like a corn seed to murbles appears at
the right and left thigh, lower stomach and scrotum.
History of urinating: bloody urine with pus since 2 years
ago and there is pain after urinating. Patient felt pain
when he had sexual intercourse. Hip pain on the left side
since last year, the pain is intermitten and getting severe
in the night. And its getting worst in the last week

 Appearance of the bumps as big as marble in

large amount on the inner of right thigh since
20 days ago, started by swelling of the penis
and scrotum. 5 days after the swelling, there
were a lot of new bumps around the genital &
thigh area.
Systematical Anamnesis :
Fever (-), decrease of appetite, dyspnea when
doing activity and release by rest.
Cough (-), chest pain (-), nausea (+), vomit (-)
Defecation : since registered, the patient has
not been defecating.

 Sexual intercourse to others disclaim

Patient had the same complaint : ( - )
Family History with the same
complaint : ( - )
Treatment history : had been treated
by
Puskesmas in 2011 for
hip pain
Lifestyle
: smoking (-)
alcohol (+)
exercise (+),
Allergic
: (-)
Systemic disease : Hypertension

PRESENT STATUS
General condition: Severe
Consciousness : Compos mentis
Vital sign : BP: 150/80 mmHg
Pulse: 96x/minute, reguler
Breathing: 28x/
minute
Temperature: 36,8 0 C

 Head Examination : icteric (-)

Anemic (-)
cyanosis (-)
Cor / Pulmo : Normal/Normal
Thorax : Symetrical Rh (-)/Wh(- )
Abdomen : Normal, Peristaltic (+)
Extremities : Symmetric pretibial oedema,
pitting (+)
Lhymp Nodus : lhympadenopati (+) at
inguinal sinistra and dextra
Localization : Genital area and inferior
extremities.

 Dermatology Status
- Location : Regio Femoralis Dextra et Sinistra
Efflorescence : Papul, Nodul
- Location : Regio Suprapubic
Efflorescence : Papul, Nodul
Venerology Status
- Location : Regio Penis
Efflorescence : Ulcus, Nodul, Tumor, OUE Erithema
- Location : Regio Scrotum
Efflorescence : Papul, Nodul
Additional Examination
- Laboratory : VDRL (-), PLT 435!H 103/mm3, RBC 3,81
106/mm3 , WBC 16,3 !H 103/mm3 ,,
GDS 111, Ureum 48
Creatinin 14, GOT 47, GPT 14, Xray Normal thorax, elongation
aorta, (In order : Sensitivity and Culture)

RESUME

Patient 58 y.o registered on 16 february 2013 with chief complaint is pain on

the genital area Since 3 years ago (2011), Intermitten. On the last 3 months,
become more severe. And 20 days ago, ulcus appeared on the penis, the
patient felt pain on his ulcus. and now the ulcus is hemorrage. The patient
also had oedema at the penis and scrotum. Next 5 days tumors like a corn
seed to murbles appears at the dextra and sinistra femoralis, suprapubic
and scrotum. hematuria (+), pyuria (+), Dyspareneu (+), pretibial udem (+),
swelling of scrotum and penis (+), lhympadenopati (+) at inguinal sinistra
and dextra nausea (+), sexual intercourse to others disclaim.
Vital sign:
BP: 150/80 mmHg, Pulse: 96x/minute, reguler, Breathing: 28x/minute,
Temperature: 36,8 0 C
Dermato-venerology :
Location
:
Regio Femoralis Dextra et Sinistra
Efflorescence
:
Papul, Nodul
Location
:
Regio Suprapubic
Efflorescence
:
Papul, Nodul
Location
:
Regio Penis
Efflorescence
:
Ulcus, Nodul, Tumor, OUE Erithema
Location
:
Regio Scrotum
Efflorescnece
:
Papul, Nodul

DIAGNOSIS
- Genitalia Ulcer
MANAGEMENT
- Topical : Fuson Cream 30gr + Ictiol 10gr Twice
a day (Morning, afternoon)
NaCl 0,9% Compress twice a day
- Systemic : IVFD RL 20 TPM
gentamicin: 80 mg/12 hours/IV
ketorolac: 1 amp/8 hours/IV
Vit C : 3g/12 hours/IV
Nonflamin 3x1
PROGNOSIS
- Dubia

GENITALIA ULCER
Genital Ulcers are rare as an initial manifestation.
They are usually a secondary or tertiary
manifestation however, genital ulcer tend to
appear as the disease a progresses.
In males, the scrotum is the most common site, but
affected areas may included the prepuce glands
penis and the shaft of the penis, walking can cause
severe pain due to the resulting friction.
Characteristic punched out, well defined ulcer;
variable number and size; dried crust or grayishwhite exudate covering the base of the ulcer; gray
necrotic lession formation with accompanying pain;
Progress reccurrence less common than oral ulcer;
Deep and large ulcer often cause scarring.

ETIOLOGIES

Syphilis
Herpes
Chancroid
Lymphogranuloma venereum
Donovanosis

Sites of Genital ulcer in 155

male patients
SITE

NUMBER
OF
PATIENT

PERCENTA
GE

SCROTUM

107

69,0

PENIS

103

66,5

GROIN

23

14,8

DIFFERENTIAL DIAGNOSIS
Penis
Carcinoma

Lession : Ulcus
at the penis

Squamous Cell
Carcinoma

Lession : ulcus at
the penis

TREATMENT
counseling
Symtomatic therapy
Depend on causality

PROGNOSIS

Depend on early diagnostic but severe to

the people who have immunodeficiency.
Proper medication
counseling