25 yrs old , married since last 10 months, p0a0, came wd these type of vulval and thigh lesions.kindly help in diagnosing d case... N



Dr. Priyanka, Good case, In my 24 years experience, I am getting these cases more and common with recurrence. Here visual shows multiple tenanscent lesions on left side labia majors with edematous Inflammation more favour to RECURRENT HERPES GENITALIS . These are the healed lesions, common in both partners . Once occur, with its antigen activity it will last for 12 years in both partners and transmits its strains from one to another partner through sexual contact and lasts for years together. TREATMENT: Already suggested good treatment from our friends. But here keep in mind is, Both partners to be treat, when virus activates better to avoid sexual contact or wearing condom for 2 weeks period, to prevent the duration of viral activity and transmission. During activity virus.. Tab Acyclovir 400 mg bd for 7 days with good appropriate antibiotic is cephalexin 750 mg bd for 3 days. If any curdy discharge with infection Fluconazole 400 mg stat. Maintain Local hygiene, Prevent itching by using antihistamines. Here no role of topical creams. So salt water washing or wash with vagiclean lotion. Maintains the nutrition and Counselling the both partners about viral transmission.

Thank you sir

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Priyanka, As both husband and wife suffer with genital ulcers,this is sexually transmitted disease. Evaluate for the cause. DIFFERENTIAL DIAGNOSIS OF GENITAL ULCERS : INFECTIOUS.(most common ) 1.Genital herpes simplex virus. 2.Syphilis. 3.Chancroid. 4.Lymphogranuloma venereum. 5.Granuloma inguinale/Donovanosis. 6.Fungal infection. 7.Secondary bacterial infection. NON INFECTIOUS (Less common ) 1.Behcet syndrome. 2.Fixed drug eruption. 3.Psoriasis. 4.Sexual trauma. 5.Wegener granulomatosis. Diagnosing the specific cause of genital ulcers is based on history, physical examination and laboratory findings. RISK FACTORS FOR GENITAL ULCERS: 1.Lack of male circumcission. 2.Multiple sex partners,lifetime or current. 3.Unprotected sexual contact. DIFFERENTIAL DIAGNOSIS OF GENITAL ULCERS. 1.HERPES SIMPLEX VIRUS INFECTION. Multiple, vesicular lesions that rupture and become Painful, shallow ulcers. ∆ : Identification of herpes simplex virus on culture or polymerase chain reaction of ulcer scraping PR vesicle fluid aspirate. Treatment : treatment of HSV infection should be initiated before test results ate available because early treatment reduces transmission and duration of ulcers.Advice the patient to refrain from sexual activity during treatment. Tab Acyclovir 400mg /oral /three times daily for 10 days in first episode and for 5days in recurrent episodes. 2.SYPHILIS : Single,Painless, well demarcated ulcer /chancre with a clean base and indurated border.Can be associated with tender inguinal lymphadenopathy. ∆ : Treponema pallidum identified on dark field microscopy or direct fluorescent antibody testing of a chancre or lymph node aspirate. VDRL positive, TPHA positive. Primary syphilis is treated with intramuscular penicillin G benzathine,2.4 million units in a single dose.Patients allergic to penicillin should undergo desensitization. 3.CHANCROID : Non -indurated ,painful ulcer with serpiginous border and friable base.covered with necrotic often purulent exudate. This is associated with tender,suppurative ,unilateral inguinal lymphadenopathy. ∆ : Gram stain of exudate suggestive of hemophilus ducreyi-gram negative, slender rod or coccobacillus in a" school of fish " pattern.Definite test is identification of hemophilus ducreyi on culture. Presumptive diagnosis of hemophilus ducreyi is done based on painful genital ulcer,regional lymphadenopathy, no evidence of T.pallidum infection and negative HSV tests. TREATMENT : Intramuscular ceftriaxone /azithromycin /ciptofloxavcin or erythromycin. Sex partners should be treated. 4.LYMPHOGRANULOMA VENEREUM : Small,shallow,Painless, genital ulcer with no induration. Associated with unilateral, tender,inguinal or femoral lymphadenopathy. Can be associated with rectal papule,rectal bleeding, rectal pain,discharge. ∆ : Definitive diagnosis by identification of chlamydia trachomatis from clinical specimen or culture. (OR) Immunoflorescence demonstrating inclusion bodies in leukocytes of an inguinal lymph node.or bubo. (OR ) Microimmunoflorescence positive for lymphogranuloma venereum strain of chlamydia trachomatis. TREATMENT : Treated with tab doxycycline 100mg twice daily for 21 days. 5.GRANULOMA INGUINALE/DONOVANOSIS Persistent, painless ,beefy red,highly vascular papules or ulcers. These ulcers can be hypertrophic, necrotic or sclerotic.No lymphadenopathy. ∆ : Definite diagnosis by demonstration of DONOVAN BODIES on wright stain.or positive result with giemsa stain or biopsy of granulation tissue. TREATMENT :Donovanosis requires continous antibiotics like doxycycline 100mg twice daily until resolution of symptoms. 6.NON INFECTIOUS BEHCET SYNDROME. Genital ulcers associated with aphthous ulcers. ∆ : Diagnostic criteria Recurrent genital ulcers. Eye lesions - Uveitis. Cutaneous lesions -erythema nodosum. Positive pathergy test (2 mm erythema appears 24-48 hours after skin prick test.) Biopsy shows diffuse arteritis with venulitis. 7 FIXED DRUG ERUPTIONS Varied ulcerations that resolve with withdrawal of offending agent.

Thank you ma'am

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Herpes genitalis super added fungal infections to be taken care of

Looking like bacterial infection of vulva, send vaginal swab for culture and sensitivity, blood for cbp, rbs. Give ceftriaxone (monocef) ink 500 mg Im single dose. Put her on clavam 625mg bd for 5 days. Surfaaz sn ointment 3 times local application Abstinence 2 wks

immediately if you have any of the above symptoms. Take an over-the-counter (OTC) pain killer. ... Use heat therapy to ease cramps. ... Take an Epsom salt bath to help relax your muscles and ease cramping. ... Snack on almonds, which are high in magnesium. ... Take dong quai supplements to help ease cramps. Medication. No drug can get rid of the herpes virus. However, a doctor may prescribe an antiviral medication, such as acyclovir, to prevent the virus from multiplying. Meanwhile, over-the-counter herpes treatments, which are often creams, can help manage tingling, itching, and pain. Rx antiviral cream or ointment can relieve the burning, itching, or tingling. An antiviral medicine that is oral (pills) or intravenous (shot) can shorten an outbreak of herpes. Prescription antiviral medicines approved for the treatment of both types of herpes simplex include: Acyclovir.

Herpes genitalia

HERPES Genitalia ask for CBC ESR Blood SUGAR HIV VDRL treatment Tab Acuvir 800 five times daily ointment Acuvir apply locally twice Tab Algesia sp one bd

Herpes genitalis Treat with acyclovir

herpes genitalis. do Vaginal culture and sensitivity test. Tab. Acyclovir 400mg TDS. Tab. Cefixime-O BD,


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