Genital ulceration
- In any painful breach of the genital skin, consider genital herpes
- Most first presentations of herpes are recurrences of prior asymptomatic infection, rather than being recently acquired
- A negative swab for PCR does not exclude a diagnosis of herpes, especially if the lesions are more than a few days old
- Herpes does not prevent normal vaginal delivery
- Kenacomb® ointment should be avoided on the genitals; it may prolong herpetic ulceration and may cause contact dermatitis
- Refer to Herpes treatment guidelines
Genital lumps
- Do not confuse normal anatomical variants for genital warts. Such normal findings include pearly penile papules, Tyson's glands, vestibular papillae and sebaceous glands (Fordyce spots)
- Warts typically have a verrucous surface and tend to be centrally distributed in the anogenital region
- Molluscum contagiosum lesions are smooth, round and centrally umbilicated. They tend to be distributed more peripherally than warts, on buttocks, thighs and pubic area
- Warts do not cause cancer
- Topical treatments work best on non-keratinised warts
- Refer to Anogenital warts & HPV treatment guidelines and Molluscum contagiosum treatment guidelines
Urethritis (in men)
- Treat empirically, don’t wait for results
- Consider herpes or adenoviral urethritis when dysuria is severe
- Refer to Herpes treatment guidelines and Urethritis in men treatment guidelines
Vaginitis and vaginal discharge
- Candidiasis and trichomonas are almost always associated with vulvar itching and/or irritation
- Exclude a retained tampon or other foreign body in cases of malodorous discharge
- Think of herpes in cases of vulvitis with inguinal lymphadenitis. Candidiasis is unlikely to be associated with regional lymph node inflammation
- Refer to Vaginal discharge treatment guidelines and Trichomonas treatment guidelines