Patients may seek a sexually transmitted disease (STD) evaluation
for essentially anything they perceive as abnormal and that is located “below
the belt.” Although the presence of an STD should always
be considered and ruled out, many patients who seek care for a suspected
STD have nonsexually transmitted genital conditions. For this reason,
clinicians should have a basic understanding of the spectrum of
both normal skin findings and common dermatologic conditions that
arise in the genitalia so they can prescribe appropriate therapy,
refer the patient to a dermatologist for additional evaluation and
management when necessary, or provide reassurance.
This chapter discusses the nonsexually transmitted dermatologic
conditions most commonly encountered in the STD clinic setting,
as well as normal variants. The discussion of pathologic lesions
that follows is organized by morphology and color of lesion. A review
of definitions employed to describe skin lesions is found in Table
30–1. A section on ectoparasites concludes the chapter.
For a more comprehensive review of genital dermatology, the reader
is referred to the text references listed below.
Table 30–1. Terminology Used to Describe Skin Lesions. |Favorite Table|Download (.pdf)
Table 30–1. Terminology Used to Describe Skin Lesions.
|Macule||Area of color change <1.5 cm and smooth|
|Patch||Area of color change >1.5 cm and smooth|
|Papule||Palpable lesion <1 cm|
|Plaque||Palpable lesion >1 cm|
|Nodule ||Papule or plaque with deeper extension into the skin|
|Scale||Abnormal shedding or accumulation of cornified cells|
|Vesicle||Blister <1 cm |
|Bulla||Blister >1 cm|
|Erosion||Shallow skin defect|
|Ulcer||Deep skin defect|
|Crust||Amorphous accumulation of dried serum, pus, or blood|
Edwards L. Genital Dermatology Atlas. Lippincott
Williams & Wilkins, 2004.
Fisher BK, Margesson LJ. Genital Skin Disorders: Diagnosis and
Treatment. Mosby, 1998.
Habif TB. Clinical Dermatology, 4th ed. Mosby, 2004.
Wolff K, Johnson RA, Summond D. Fitzpatrick’s Color
Atlas & Synopsis of Clinical Dermatology, 5th
ed. McGraw-Hill, 2005.
A thorough history is an essential component in the evaluation
of an individual presenting with genital lesions or rash. Useful
questions to ask include the following:
- (1) How long has the lesion
or rash been present? The duration of a genital lesion is important
for directing evaluation. For example, a genital ulcer or atypical
lesion that has been slowly growing over the course of months to
years implies the need for immediate biopsy, whereas an ulcer of shorter
duration (that does not appear atypical) may warrant a workup for
common infectious etiologies, and perhaps empiric therapy, with
biopsy reserved for situations in which the workup is negative and
the lesion fails to resolve.
- (2) Does the lesion look the
same now as it did when it first appeared? If not, how is it different? Understanding
the evolution of a lesion or rash may assist the clinician in narrowing
the differential diagnosis. For example, a patient may have self-treated ...