简单病例
Case 31
38-year-old man comes as an unscheduled patient because of a genital lesion
History
How long have you had this lesion?
About 1 week.
The time course of a lesion can give clues to the diagnosis.
How did the lesion start?
There was a tiny sore which just kept getting bigger and bigger.
The clinical progression of a lesion also gives clues to the etiology.
Do you have a regular partner?
No, I don't have a girl friend.
The sexual history is crucial when dealing with genital lesions.
How many different women have you slept with in the past 4 weeks?
I think there were 2.
Multiple partners is a helpful clue to sexual activity
When did you have sexual intercourse last?
Hmm maybe for 2 weeks. Yes, I think that's right.
The sexual history helps figure out the incubation time.
Who was the woman?
It was an African lady.
Sometimes a sexual partner from abroad may carry sexually transmitted diseases that are not usually seen in a practice.
Do you always use a condom?
No, not always.
Failure to use a condom increases the risk of sexually transmitted disease.
Is the sore painful?
Yes, it really hurts.
Knowing if a genital ulcer is painful or not helps with the differential diagnosis.
Lesion
Choose the right efflorescences:
An erosion is superficial; this lesion is deep.
A pustule is a pus-filled space; that is not seen here.
We see a dirty ulcer with yellow areas and undermined edges.
Urticaria is transient and not ulcerated.
诊断
Choose the right diagnosis:
A fixed drug eruption can occur on the penis, but it is bruise-colored, rarely blistered, and never ulcerated.
Chancroid is also known as soft chancre because the genital ulcer is painful, dirty and undermined.
Herpetic ulcers are smaller, more superficial, often grouped and usually painful. In immunosuppressed patients, they can be deeper and more chronic.
A squamous cell carcinoma does not grow this rapidly. A chronic or slow-to-heal penile ulcer should always be biopsied to exclude a carcinoma.
Therapy
Choose the right therapy(ies):
This is appropriate treatment (just as for gonorrhea).
Infections are generally not treated by surgery.
This is the standard treatment.
This is the treatment for early syphilis.
