Ulcerative STIs

Question 1

Genital ulcer disease is grouped into?

Answer 1

Infectious

Noninfectious

Question 2

Where are genital ulcers typically located?

Answer 2

vagina, penis, and anorectal or perineal areas

Question 3

What are the risk factors of genital ulcers?

Answer 3

Unprotected sexual contact, 
multiple sex partners, 
alcohol 
Illicit drug use
MSM
Lack of male circumcision

Question 4

What are the causes of GUD in Malawi?

Answer 4

HSV-2, 67%; 
Haemophilus ducreyi, 15%; 
T. pallidum, 6%; 
Lymphogranuloma venereum, 6%; 
Mixed infections, 14%, 
no etiology, 20%.

Question 5

What are the clinical features of HSV?

Answer 5

• Prodromal symptoms (tingling before vesicular eruptions),

- Location: found inside the foreskin, labia, vagina, rectum

Question 6

Describe the clinical features of chancroid?

Answer 6

• usually nonindurated, painful lesions
• characterized by a serpiginous border surrounding a friable base covered with a necrotic and often purulent exudate.
• A painful, unilateral inguinal adenitis is present in one-half of cases
  > these can develop into buboes, an inflammatory swelling of lymphatic glands in the groin

Question 7

Describe the clinical features of syphilis?

Answer 7

• May start with a painless, well defined ulcer, a chancre.

- In late stage syphilitic gumma may also ulcerate

Question 8

Describe the relationship between genital ulcers and HIV infection?

Answer 8

1. GUD is estimated to enhance HIV acquisition by 4–23-fold
   - Ulcers provide a portal of entry for HIV
   - The inflammation associated GUD can result in the presence of a large number of CD4 and other immune cells which are targeted by HIV.
2. Higher risk of transmission of HIV during concurrent infection with GUD
   - Increased viral shedding in the genital mucosa

Question 9

Describe the relationship between between HSV and HIV?

Answer 9

1. HIV Positivity high in ulcerative HSV 67 %,
   - Alone in 54%, with other ulcer etiologies 13 %
2. Increase HIV positivity among relapse (78 %)
   - Higher risk of HIV acquisition in the event or recurrent disease
   - Relapse in the setting of HIV immunosuppression

Question 10

What diagnostic fact is important to note about syphilis?

Answer 10

26 % positive rapid test for syphilis without genital ulcer

Question 11

Describe the impact of syphilis and HIV coinfection in pregnancy?

Answer 11

Increased risk of poor fetal outcome

• Still births
• Low Birth Weight

Question 12

Describe the Syphilis/HIV Co-infection on ART Therapy?

Answer 12

Reduced Immune recovery

Increased viral replication

Question 13

Describe the management of ulcerative STIs?

Answer 13

Malawi uses syndromic management

- Treating all possible aetiologies without specific microbiological isolation