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Transcript
Genital skin lesions and dermatitis ♂♀ Matiu Bush Nurse Practitioner Candidate Melbourne Sexual Health Centre Clinical Photography • • • • • Take photos! Any digital camera with a macro function Patient consent form Policy and procedure Secure location on hard drive to store images Causes Herpes Type 2 Nodular scabies Varicella virus Candida Primary Syphilis Lichen sclerosis Causes STI • Herpes type 1 and 2 (95% of genital ulcers) • Syphilis (>1% of genital ulcers) • LGV (<1% of genital ulcers) NON STI • • • • • • Bacterial Viral Fungal Dermatoses Trauma Drug reactions Symptom history • • • • • • • • How long has it been there? Is it new or reoccurring? Any other associated symptoms? Is it getting worse or resolving? What hygiene products do you use? Any new medications? Any new sexual contacts? Any self treatment? Symptom history • • • • • • • • How long has it been there? Acute or chronic HSV past infection Is it new or reoccurring? Prodrome, other Any other associated symptoms? rashes on body Is it getting worse or resolving?Too late for treatment washing, What hygiene products do you Over use? chemical irritant Any new medications? Drug reaction related, partner Any new sexual contacts? STI symptomatic Any self treatment? Hydrocortisone, tea tree oil etc- has it made it worse? Clear Instructions Privacy Consent Limit nudity Examination etiquette Good lighting Genital exam Chaperone Good examination couch Clinical photography HSV History • • • • • • • • • Multiple vesicular lesions Painful lesions Itchiness and tingling sensation Developed over a period of days after sexual contact Lymphadenopathy Systemic signs such as fever, myalgia Previous lesions that have become ulcerative Recurrent lesions in same area Partner with HSV infection Vesicles HSV Dry lesion Moist ulcer Diagnostics • HSV swab- it will give you the type • PCR – DNA • Use cotton swap and rub over lesion with vigour • Syphilis swab- for those who are at risk of syphilis Clinical Diagnosis • Start treatment before results are back • Back up clinical diagnosis with positive swab results • Review if symptoms persist Symptom management •Genital Skin Care •Salt baths •Paracetamol/codeine as required •Potassium permanganate •Xylocaine 2%jelly topically •Promote hydration to avoid urinary retention •Supportive voiding measures What’s next • Follow up results • Discuss the effects of HSV in relation to sexual activity • Information • Promote self efficacy and positive body image
