Sanitary Dermatology Outpatient Clinic, Secretaria Estadual de Saúde do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Fundação Alfredo da Matta, Instituição ligada à Secretaria de Estado de Saúde do Governo do Estado do Amazonas, Manaus, AM, Brazil.
An Bras Dermatol. 2022 Sep-Oct;97(5):551-565. doi: 10.1016/j.abd.2022.01.004. Epub 2022 Jul 20.
Genital ulcers (GUs) represent a diagnostic challenge and can be secondary to neoplastic and inflammatory processes of different causes. Among those of infectious etiology, there are sexually transmitted infections (STIs), a very frequent reason for seeking the health service. The most common agents are herpes simplex virus and Treponema pallidum and, more rarely, Haemophilus ducreyi, Klebsiella granulomatis and Chlamydia trachomatis. A careful dermatological examination offers important diagnostic elements; however, atypical manifestations are very common. Distinctive characteristics of ulcers to look out for include their margin, edge, bottom, and base. Regional lymph node chain alterations should be evaluated regarding their number, size, mobility, consistency, inflammation, and pain on palpation. Diagnostic tests have variable sensitivity and specificity, and molecular tests are currently considered the reference exams. The rapid immunochromatographic tests represented a significant advance, as they can be performed with blood obtained from the digital pulp, offer results in up to 30 minutes, and do not require a laboratory structure. The treatment of persons affected by GU/STIs must be immediate, as it aims to prevent complications, as well as reduce transmission. It is not always considered that people with GUs/STIs have varying degrees of depression, anxiety, and self-reproach, with an impact on relationships. Establishing a bond and trusting the professional is essential for adherence to treatment and preventive measures that must be discussed individually.
生殖器溃疡(GU)是一种诊断上的挑战,可能是由不同原因的肿瘤和炎症过程引起的。在那些感染病因中,有性传播感染(STI),这是寻求医疗服务的一个非常常见的原因。最常见的病原体是单纯疱疹病毒和梅毒螺旋体,较少见的病原体是杜克雷嗜血杆菌、颗粒性淋病奈瑟菌和沙眼衣原体。仔细的皮肤科检查提供了重要的诊断元素;然而,不典型的表现非常常见。需要注意的溃疡的特征包括其边缘、边缘、底部和基底。应该评估区域淋巴结链改变的数量、大小、移动性、一致性、炎症和触诊时的疼痛。诊断测试的敏感性和特异性不同,目前认为分子测试是参考检查。快速免疫层析测试是一个重大的进展,因为它们可以用从指尖获得的血液进行检测,在 30 分钟内提供结果,并且不需要实验室结构。受 GU/STI 影响的人的治疗必须是立即的,因为它旨在预防并发症,并减少传播。人们并不总是认为患有 GU/STI 的人有不同程度的抑郁、焦虑和自责,这会对人际关系产生影响。建立联系并信任专业人员对于治疗和预防措施的依从性至关重要,这些措施必须单独讨论。