| |
<
DXable from serum? |
DXable from cytology? |
DXable from biopsy? |
DXable from other means? |
| acute vulvar aphthus ulcer in young females (tend to appear as with oral type) |
no |
Tzank neg. & flora looks unremarkable |
not needed |
tend not to be febrile or ill &, as with oral, can recurr |
| herpes , ulcer |
yes: serology & PCR |
Tzank prep or DIF smear |
yes |
we can do DIF for HSV I & II [S09-11046] |
syphilis
(painless ulcer...chancre) |
yes: RPR & FTA-abs |
no |
yes, may be difficult; expect plasma cell rich perivasculitis |
yes but dark field wet prep not worth the effort |
| chancroid, ulcer (Haemophilus ducreyi) |
yes: PCR |
Gram stain: gn cocco-bacilli |
bubo groin node; expect ulcer to be rich in polys |
|
| LGV (lymphogranuloma venereum...due to some serovars L1, L2, & L3 of
Chlamydia trachomatis & primary lesion is painless herpetiform ulcer) |
yes: serology & PCR of smears or active tissue placed in M4 or M5 Mayo Clinic transport media |
usually not |
(1) secondary stage groin node bubo = can bracket into "likely".
(2) tertiary stage proctitis. |
|
granuloma inguinale (ulcer)
(Calymmatobacterium granulomatosis)
(only 100 reported cases per year in USA) |
|
Gram stain: gn pleomorphic bacillus |
Granulomatous; by smearing fresh cut surface of BX of ulcer edge, crush prep of biopsy portion, or swab smear of surface onto glass
slide and stain with Wright's or Giemsa...see the small straight or curved
pleomorphic bacilli with rounded ends and polar granules..."safety pin". When many are in a macrophage, the composite cell is a Donovan
body. |
no node enlargement due to C. gran. but may get due to super-infection of other bacteria |
| Neisseria gonorrhea (exudate) |
|
Gram stain: gn intracellular diplococcus |
swab PCR; culture |
|
| Chlamydia |
|
|
swab or tissue or saline washings PCR as with LGV |
|
| herpes (HSV I & II) |
yes... HERE |
|
yes and/or swab PCR |
Tzank & DFA smears & culture |
| HPV, trichomonas, bacterial vaginosis |
|
|
liquid-based Pap smear sample |
|
| HIV genital ulcer |
yes |
|
|
|
| Behcet's (not an STD) |
|
|
|
|
| cancer (not an STD) |
|
|
|
|
| mono (EBV) ulcer3 (not an STD) |
yes |
|
swab PCR; culture; biopsy might show balooning of epithelial cells |
|
| CMV ulcer 3(not an STD) |
yes |
|
swab PCR; culture; biopsy might show balooning of epithelial cells |
|
| other non-STD viral |
|
|
biopsy might show balooning of epithelial cells |
|
| nutritional deficiency mucosal breakdown |
|
|
biopsy might show balooning of epithelial cells |
|
| Brucellosis ulcer 3(not an STD) |
|
|
|
|
| other primary infectious organism associated ulcers3 (typhoid, etc.) (not an STD) |
|
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|
| Aphthosis: Lipschutz ulcer of teens & young women3; acute vulvar ulcer or ulcus vulvae acutum (not an STD) or apthous ulcer in older age groups. |
no |
nonspecific |
nonspecific but shallow acute ulcer & unimpressive as to any marginal epithelial hypertrophic hyperplasia |
Lipschutz said to be usually febrile |
| caustic causes3 (not an STD) |
|
|
|
|
| dermatoses causes3 (fixed drug, EM, Stevens-Johnson syndrome, pemphigoid, inflammatory bowel disease, aphtosis) (not an STD) |
|
|
yes; maybe even skin DIF battery [S09-11046] |
|
| Lichen sclerosus et atrophicus (LS&A) |
no |
no |
yes...biopsy |
yes: expert dermatologist can accurately diagnose on physical exam |
