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INTRODUCTION

Infections in the pelvic organs and surrounding structures comprise a heterogenous group of diseases. They primarily affect sexually active women and men. Many of the pathogens implicated are sexually transmitted, so an important facet of management is partner notification and treatment, as well as patient education regarding safe sexual practices. Among sexual transmitted infections, major syndromes that will be discussed are genital ulcer disease, vaginitis, cervicitis, pelvic inflammatory disease, urethritis, and prostatitis.

GENITAL ULCER DISEASE

Definition

Genital ulcer disease manifests as a breach in the skin or mucosa of the genitalia, usually caused by a sexually transmitted infection. Of these infections, herpes simplex virus type 2 (HSV-2) is the most common etiology in most geographic areas, followed by syphilis and chancroid. The most important noninfectious cause is Behçet’s disease.

Pathophysiology

The mechanisms by which ulcers are produced by pathogens are incompletely understood, and there are different mechanisms of injury depending on the pathogen. In chancroid, a cytotoxin secreted by Haemophilus ducreyi may be important in epithelial cell injury.

Clinical Manifestations

Although the various lesions may have a characteristic appearance, it is important to note that local epidemiology is an important consideration because lesions may appear in an atypical fashion. The appearance of the ulcer, whether it is painful, and the nature of the associated lymphadenopathy may be clues in the etiology of the ulcer. Figure 74–1 shows several vesicles on the shaft of the penis of a patient with genital herpes. The vesicular lesions are typically painful. The vesicles can then progress to form shallow ulcers. Figure 74–2 shows the chancre of primary syphilis. It is a painless lesion with a shallow base and a firm, rolled edge. Table 74–1 describes the important clinical features of genital ulcer lesions, their diagnostic procedures, and treatment.

FIGURE 74–1

Genital herpes caused by herpes simplex virus-2. Note group of vesicles on shaft of penis. (Reproduced with permission from Wolff K, Johnson R, Saavedra A (eds). Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, 7th ed. New York: McGraw-Hill, 2013 Copyright © 2013 by The McGraw-Hill Companies, Inc.)

FIGURE 74–2

Chancre of primary syphilis caused by Treponema pallidum. Note shallow ulcer with clean base and rolled edge. (Reproduced with permission from Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw-Hill, 2012. Copyright © 2012 by The McGraw-Hill Companies, Inc.)

TABLE 74–1Genital Ulcers: Clinical Features, Diagnosis, and Treatment

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