Save Yourself From Private Part Ulcer


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Genital ulcer is a defect  of  the epithelia or mucosal (skin) surface on the genitals — i.e. the penis, the vagina and their surroundings. It may be caused by sexually transmitted diseases such as genital herpes, syphilis, chancroid, etc.

Though commonly caused by sexually transmitted diseases, genital ulcer is not strictly a sexually transmitted disease, as it may also occur in other disease conditions like genital tuberculosis, candidiasis, scabies, genital cancers, etc. It could also be associated with lymph node enlargement around the groin.

Let’s look closely at some common causes of genital ulcer in this enviroment, starting with those that are sexually transmitted.

Genital herpes: Herpes simplex virus infection is one of the most common sexually transmitted infections causing genital ulceration among men and women during their sexually active years. It usually presents with multiple painful, shallow, irregular edge sores or blisters around the pelvis, vagina or the anus. It may also present with painful lymph node enlargement on the same side of the infection. Those experiencing the infection for the first time could present with fever, malaise, etc.

Syphylis: It usually presents with a single, long-standing painless ulcer, usually called early or primary syphylis.

Donovanosis: presents as beefy, smelly, painless red ulcer, and it usually begins as a nodule or nodules, which slowly erode and enlarge.

Chancroid: presents with single or multiple painful swelling, with secondary infection and purulent sloughing. It may come with large, painful ingural lymph node, which could burst and produce very big ulcer in the groin.

Lymphogramlonia venurum is rare, and usually presents as small, painless, transcient genital ulcer.

Non-Sexually transmitted causes of genital ulcer includes pyogenic infection of the genital region, and tumour in the genital area, which may develop into secondary bacteria infection.

Sometimes, drug eruption can lead to genital ulcer. Some individuals react to certain drugs and present with genital ulcer in the aftermath. Examples of such drugs are cotrimoxazole, antimalaria single dose (Sulphadoxine & Pyrymethamine), and penicillins like Ampicillin and Tetracycline, just to mention a few.

Scabies with secondary bacterial infection expecially in congested and dirty residential communities like boarding hostels for teenagers, people who live in slums, refuge camp, etc. There could be recurrent re-infection in such set-up, especially when personal effects are shared.

Vulvo-vaginal or penile candidiasis could also present with genital ulcer, especially when there is secondary bacterial infection.

Behçet’s disease is associated with mouth ulcer, though it is not very common in this environment.

In older persons, genital ulcer could be a pointer to cancer of the penis or of  the vagina. Other rare skin disorders could also present as genital ulcer.

To diagnose genital ulcer, a detailed history is compulsory. Also necessary is laboratory investigation that will help to secure a definitive diagnosis of the cause of the genital ulcer.

Detailed scx history must include protected or not-protected scx, number of partners, scxual preferences — anal sex, male-to-male, use of scx to ys, vib rators, etc; which may cause secondary bacterial infection or trauma to the genitalia, especially in women.

The period of the ulcer and the current medical history of the patient are also important. The ulcer will be examined to enable the doctor know if there is associated pain or if it is painless. Also, check for rolled-up edges or induration, thickness of the ulcer base and presence of inginal lymp node enlargement.

Swab from the ulcer will be taken and sent to the laboratory; scrapping from the ulcer also may be taken and sent to the laboratory. Patient will also be counselled to undergo some tests for infections like syphilis, HIV1 & II, Hepatitis B. Other investigations, where necessary, are based on the history of the patient and may include blood sugar test, among others, to rule out cancer of the genitalia.

The history and the results of the laboratory investigations will guide the doctor to know the definitive management.

I remember the case of a 47-year-old man a few years back, who presented with six-month history of penile ulcer. The trigger was the jean trousers zip, which traumatised the penis because he was not wearing any underwear. For six months, the penile wound refused to heal. Unkown to him, he was diabetic; but the penile ulcer healed easily when the blood sugar was controlled.

So, it’s better to assess a patient with genital ulcer very well before commencing treatment.

Treatment of genital ulcer depends on the underlying cause. Do not apply any antibiotic, cream  or powder to the ulcer or take oral medications until the diagnosis has been made. For sexually transmitted cause of genital ulcer, both partners must be investigated and treated appropriately.

The patient must avoid sex until the ulcer is healed. Meanwhile, most genital ulcers can be prevented by practising safe sex and promoting use of condom.

Teenage and pre-marital sex should be discouraged. Again, we must reduce crowded existence, improve personal hygiene in community settings like student hostels in order to avoid common infections like scabies.

All cases of genital ulcer must be assessed by a doctor; who may refer the patient to infectious disease specialist if necessary.

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