The diagnosis of genital ulcer disease (GUD) can be challenging, especially if resources are limited. Htun et al used a syndromic protocol to manage these patients. The authors are from the South African Institute for Medical Research in Johannesburg.
Patient selection: sexually-active patient with complaint of genital sore
Parameters:
(1) small blister OR small ulcer with history of recent blisters
(2) single ulcer and painful, matted lymph nodes
(3) other lesion(s)
If all are absent, then provide counseling.
If small blister OR small ulcer with history of blisters present, then treat for Herpes simplex and counsel.
If single ulcer and painful, matted lymph nodes present, then treat for syphilis, chancroid and LGV.
If other lesion present and NOT single ulcer with matted lymph nodes, then treat for syphilis and chancroid
Counseling package for all patients:
(1) Counsel and educate about sexually-transmitted diseases (STD).
(2) Promote and/or provide condoms.
Treatment package:
(1) Look for other STDs, especially HIV.
(2) Aspirate any fluctuant lymph nodes.
(3) Notify sexual partner(s) and treat if appropriate.
(4) Submit blood sample for syphilis testing.
(5) Schedule for follow-up visit in 1 week.
