Care Service for Patients with Genital and Anal Ulcers

Abstract

Genital and anal ulcers can be divided by causes into two groups: non-infectious and infectious causes. Genital and anal ulcers caused by infective organisms are usually sexually transmitted infections, with genital herpes, primary syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale are common. History taking and physical examination can help determine the provisional diagnosis. Essential data include the history of pain, systemic symptoms, nature of recurrence, patient's sexual behavior, and previous sexually transmitted infections. Physical examinations should include examining the lesions' numbers and characteristics and palpating the lymph nodes. Laboratory investigation should be performed on all patients with genital and anal ulcers, particularly the testing for genital herpes and syphilis. Critical laboratory investigations such as Tzanck smear, dark-field microscopy, and gram stain can help diagnose genital herpes, syphilis, and chancroid. Biopsies should be performed on patients who have not been definitively diagnosed or are unresponsive to treatment. Treatment for genital and anal ulcers differs and depends on the cause of the ulcers. Sexually transmitted infections can be treated with antibacterial or antiviral drugs. Counseling should be done on all patients with genital and anal ulcers caused by sexually transmitted infections. All patients should receive advice to screen for other sexually transmitted infections and ways to prevent transmission to their sexual partners.