Ulcers

Exam Cram

• Herpes: painful vesicle

• Syphillis (primary/chancre): painless, single

• Bechet's Disease: accompanied with joint pain & DVT

• Lower limb ulcers can be arterial, venous or neuropathic

Oral Ulcers (5)

Summary of Differentials

Herpes Simplex: Painful, clusters of vesicles, immunocompromised

Behcet's Associated with systemic symptoms: arthralgia, uveitis, venothromboembolism

Crohn's Associated with abdominal pain and perianal disease

Nicorandil Common cause of mouth ulcers

Aphthous Erosion of lining- dehydration, lack of sleep/ nutrition, potentially stress

Genital Ulcers Common (5)

Herpes Simplex

Pathogen: HSV 2 > 1 (previously HSV 2 but oral sex has cross contaminanted these bugs!)

Presentation: Painful, itchy cluster of vesicles, often without lymphadenopathy

Management: Acyclovir

Syphilis chancre

Pathogen: Syphilis

Presentation: Painless, indurated, single ulcer without lymphadenopathy

Management: Penicillin, (doxycycline if pen allergy)

Chancroid

Pathogen: Haemophilus ducreyi

Presentation: 1-2 large painful ulcers at location of abrasions during sex with lymphadenopathy, 

Travel history to Latin America/ Africa

Management: Ceftriaxone or azithromycin. 

Granuloma inguinale

Pathogen: Klebsiella granuolmatis 

Presentation: large single painless ulcer- highly vascular and prone to bleeding, 

Without lymphadenopathy

Management: Doxycycline, erythromycin

Lymphogranuloma venereum (LGV)

Pathogen: Chlamydia

Presentation: Shallow, painless ulcers; painful lymphadenopathy; travel history to tropical regions

Management: Doxycycline, (azithromycin if pregnant)

Ulcers in lower limbs

• Venous

• Arterial

• Neuropathic

Diabetic ulcers can cause venous, arterial or neuropathic ulcers

Skin Cancers

Pyoderma Gangrenosum

Anal Ulcers

• can be caused by nicorandil

References

1. Granuloma Inguinale (donovanosis) - STI treatment guidelines (2021) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/std/treatment-guidelines/donovanosis.htm (Accessed: 27 September 2024).

2. https://teachmesurgery.com/vascular/presentations/ulcers/

Written in 2024.