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Herpes Simplex and other Genital Ulcer Diseases

The three most common causes of sexually transmitted lesions are genital herpes, early syphilis, and chancroid. Genital herpes and syphilis are endemic. Chancroid, although common in Africa, Asia, and Latin America, is only present in certain US cities.

Genital Ulcer Disease

Cause

Percent

Herpes 60-70
Syphilis 10-20
Chancroid 0-20
Other or unknown 10-20

Genital Herpes

Serologic studies indicate that 20% of young adults have been infected with herpes simplex virus type 2.

Natural History

Acute genital herpes infections are followed by long periods of latency then reactivation.

The disease usually has a prodrome of itching or burning, associated with a localized erythematous patch. 1-3 mm vesicles then appear. Spontaneous rupture of the vesicles results in painful, superficial ulcerations or erosions.

The lesions are usually multiple and are commonly found on the glans, prepuce, and penile shaft in men and on the vulva and cervix in women.

The initial ulceration resolves within 10-14 days.

The three most common causes of sexually transmitted lesions are genital herpes, early syphilis, and chancroid. Genital herpes and genital ulcer disease are endemic. Chancroid, although common in Africa, Asia, and Latin America, is only present in certain US cities.

Constitutional symptoms such as fever, malaise, and painful regional lymphadenopathy often accompany primary infection.

Reoccurrences occur in more than 80% of patients, and they are less severe than the primary episode.

Laboratory Diagnosis

Antigen detection is a rapid technique that is more sensitive than culture. Viral culture requires 48-96 hours and has an accuracy rate of 85-90%.

Sensitivity is greatest when specimens are collected from fresh vesicles; dry, healing ulcers have a very poor yield. The sample may be collected from a vesicle that has been unroofed with a needle.

Treatment. Acyclovir is used for

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