This document discusses the approach to diagnosing and treating genital skin lesions. It covers common infections, neoplasms, and inflammatory conditions that can present as genital skin lesions. These include sexually transmitted infections (STIs) like herpes, molluscum contagiosum, and warts. Taking an appropriate sexual history is important for establishing a diagnosis. STIs are common and guidelines should be followed for systematic evaluation and treatment, including history, exam, investigations, and contact tracing. The document provides examples of clinical presentations and microscopic images to illustrate common STIs like gonorrhea and syphilis. Prevention through safe sexual practices is emphasized.

1. APPROACH TO GENITAL
SKIN LESIONS
DR. PUBALAN MUNIANDY FRCP[E]

2. GENITAL SKIN LESIONS
INFECTIONS NEOPLASMS
HEREDITARY INFLAMMATORY
Hailey - Hailey
Disease
Benign
Pearly Penile
Papules
Malignant
1. Vulvar/anal
SCC
2. VIN/PIN
3. Extram-
mammary
Paget’s
1. Psoriasis
2. Contact Dermatitis
3. Lichen Sclerosus/
BXO
4. Behcet’s
5. Hidradenitis
Suppurativa
Non- STI
Sexually
transmitted
Infections
(STI)
Viral
Warts
Herpes
Molluscum
Contagiosuum
Fungal
Tinea
Candida
Bacteria
Boils
Furuncles
Impetigo
Erythrasma
Infestation
Pubic lice
Scabies

5. ERYTHRASMA

8. WHEN YOU SEE A SKIN PROBLEM
 YOU MUST ESTABLISH A DIAGNOSIS
 CRUCIAL TO TAKE A SEXUAL HISTORY WHEN REQUIRED
 THIS COMES WITH EXPERIENCE

9. TAKING A SEXUAL HISTORY
 MUST BE APPROPRIATE
 CONFIDENTIALITY IS CRUCIAL
 YOU MUST BE AWARE OF SEXUAL PRACTICES
 PATIENTS DO MORE THAN YOU THINK
 MUST NOT HAVE A FIXED

10. SEXUALLY TRANSMITTED
INFECTIONS
 ARE COMMON
 RISING INCIDENCES IN ALMOST ALL STIs
 COMMON STIs
 CHLAMYDIA/HERPES/GENITAL WARTS
 CONSIDERABLE MORBIDITY
 LEARN TO APPROACH STIs IN A SYSTEMATIC MANNER
 HISTORY/ PHYSICAL EXAMINATION/ INVESTIGATIONS/TREATMENT/CONTACTS
 ADHERE TO LOCAL GUIDELINES – LOCAL PROTOCOLS

11. CLINICAL PRESENTATIONS
 GENITAL ULCERS
 GENITAL DISCHARGE
 GROWTHS ON THE GENITAL AREA
 PRURITUS

27. Gonorrhea - gram stain of urethral
discharge

29. The multiple potential paths of
Gonococcus

33. Swollen and tender PIP joint, 3rd digit of right hand

34. SYPHILIS
 ILLUSTRATES A DISEASE IN PERSPECTIVE
 TREPONEMA PALLIDUM
 INCUBATION PERIOD 9-90 DAYS
 PRIMARY/SECONDARY/LATENT/TERTIARY SYPHILIS
 MOST NOWADAYS ARE SEROLOGICAL SYPHILIS

35. 9 – 90 days 6 weeks – 6 months First 2 years 2 years to a lifetime
PRIMARY
SYPHILIS
EARLY
LATENT
SYPHILIS
SECONDARY
SYPHILIS
LATE LATENT SYPHILIS
GUMMA
CARDIO
VASCULAR
SYPHILIS
NEURO
SYPHILIS
SPONTANEOUS
CURE
E
X
P
O
S
U
R
E
THE COURSE OF UNTREATED SYPHILIS

41. Gonococcal cervicitis

50. NOW FOR THE REST

64. Total Body Condom
PREVENTION IS THE
KEY