Skin genital lesions


As the name implies, are genital skin lesions located in the genital areas.

  1. Infectious diseases (viral) simple herpes and condylomata acuminata.
    Bacterial such as syphilis and gonorrhea or fungal infection as 
    athlete’s foot  or vaginal candidiasis.
  2. There are other non-infectious ones, such as lichen sclerosus atrophy.
  3. Other injuries related to systemic diseases such as Behcet’s disease.

The presence of lesions on the external genitalia is one of the most worrisome events in the life of the human being and a frequent consultation not only with the dermatologist but also with urologists, gynecologists or primary care doctors.

Lesions in external genitalia in both sexes, can bring physical, psychological, social and above all, “fear of contagion.”

Infectious diseases, especially sexually transmitted diseases (STDs), are the first cause of lesions on the genitals, however, there are other non-infectious diseases that develop in these areas as the only manifestation or as part of a disease.

Infectious diseases include STDs.

There are more than 30 bacteria, viruses and parasites that cause sexually transmitted infections.

First recognized STDs:

  • Chlamydiasis and lymphogranuloma venereum (Chlamydia trachomatis infection).
  • Gonorrhea
  • SyphilisMost recently recognized ETS:
  • candidiasis or thrush (infection by Candida albicans).
  • Mycoplasma genitalium (non-gonococcal urethritis).
  • Retroviruses such as HIV, HTLV or XMRV.
  • Ureaplasma.
  • Condyloma acuminata (genital warts), caused by the human papillomavirus.

Infections occasionally transmitted sexually:

Many diseases of non-sexual transmission can also be transmitted sexually, considering the level of intimacy of the couple:

  • Campylobacteriosis.
  • Cytomegalovirus
  • Cryptosporidiosis
  • Gardnerella vaginalis (also Haemophilus).
  • Hepatitis B, hepatitis C.
  • Enteric infections (intestinal parasites include giardiasis).
  • Fungal infection.
  • Listeriosis.
  • Meningococcemia.

Infections transmitted mainly through sexual contact:

  • Chancroid.
  • Donovanosis or inguinal granuloma,
  • Pediculosis (crabs).
  • Herpesvirus.
  • Gonococcal infection of the genitourinary tract.
  • Congenital syphilis, early syphilis and late syphilis.
  • Trichomoniasis.
  • Genital mycoplasmas.
  • Molluscum contagiosum.
  • Human papilloma virus (HPV).
  • Salmonellosis.
  • mycobacteriosis.
  • Scabies.
  • Vaginitis.
  • Bacterial vaginosis.

Non-infectious pathologies that cause genital involvement

Within the non-infectious inflammatory causes, contact dermatitis may be the first.
Among others are:

  • Psoriasis.
  • Pharmacodermias (Erythema Fijo medicamentoso, Stevens Johnson).
  • Lichen plane.
  • Seborrheic dermatitis.
  • Behcet’s disease (characterized by oral thrush and at least 2 of the following:
  1. Recurrent genital ulcers.
  2. Synovitis.
  3. Posterior uveitis.
  4. Pustular cutaneous vasculitis.
  5. Meningoencephalitis.

In the non-inflammatory we can name:

  • Vitiligo.
  • Lichen sclerosus and Atrophic.
  • Benign melanosis

Tumor Pathology

  • Human papilloma virus (HPV) is very common.
    A recent study showed that almost 27% of women between 14 and 59 years old had positive cases of one or more strains of HPV, and it is possible that rates in men are similar.
    Other studies have shown that more than 80% of women will have been infected with genital HPV by the time they reach 50 years of age. HPV
    Currently there are more than 160 different types of HPV, more than 40 of them capable of infecting the anogenital tract. These can be subdivided into three different categories based on their association with the development of intraepithelial cancer:
  • Low risk.
  • Intermediate risk.
  • High risk

Low-risk types are viral strains that rarely lead to cervical cancer, such as HPV types 6 and 11. Infection by these genotypes, however, accounts for 90% of genital warts lesions.
Types 16 and 18 are strongly associated with cervical cancer, vulvar, vaginal and anal dysplasia, and evidence of infection with these genotypes can be found in up to 70% of squamous cell carcinomas (SCC) of the cervix.

Therefore, the high risk oncogenic types 16 and 18 are considered  of intermediate risk: 29, 31, 33, 45, 51, 52, 56, 58 and 59, are often found in association with squamous neoplasms.
Patients with CA, in addition, may be infected with several strains of HPV, and the exact nature of the infection may be an indicator of a critical prognosis of cervical cancer. This does not play an important role, however, in the diagnosis or treatment of genital warts.

Gardasil (HPV4)

In 2006, the FDA approved the use of the first vaccine designed to prevent infection by specifically targeted types of HPV.
Gardasil ® (HPV4) is a recombinant tetravalent vaccine that protects against infection with HPV-6, -11, -16 and -18 by activating the formation of neutralizing antibodies.
The vaccine has also been shown to prevent potentially precancerous dysplastic lesions of the cervix, such as grades CIN I / II / III, as well as precursor lesions of the anus, vulva, vagina and penis.
Gardasil injections are administered in three separate doses, at the start of the study, 1 and 6 months. Vaccination is most effective in the virgin HPV population, and is therefore recommended initially for young women between the ages of 9 and 25 who had not yet been exposed.
The vaccine is thought to be 99% effective in preventing the formation of genital warts in this population.
Current evidence suggests, however, that Gardasil may be of additional benefit to women up to the age of 45, provided that they have not yet contracted at least one of the HPV target types of the vaccine. This is probably due to the ability of Gardasil to reduce the incidence of recurrent or persistent HPV infection, which is associated with an increased risk of malignant progression.

In addition, the Advisory Committee on Vaccination Practices offers the following guidelines for the HPV vaccine in men:
The recommended age for vaccination of men against HPV is from 11 to 12 years old. The vaccine is recommended as a precautionary measure for men aged 13 to 21 who have not been vaccinated previously. Men of 22-26 years can be vaccinated.

Cervarix (HPV2)

In 2009, the FDA approved the use of a second recombinant vaccine against HPV (HPV2) in women between the ages of 10 and 25 years.
Cervarix is ​​similar to HPV4 in terms of dosing and administration schedules, however, it is a bivalent vaccine directed only against high-risk HPV types 16 and 18. These two oncogenic types are more commonly associated with cervical cancer, CIN grade I / II / III and adenocarcinoma in situ. Cervarix does not protect against the types commonly associated with genital warts.
Cervarix has been shown to be 93% effective in preventing HPV related to grade II or III CIN and adenocarcinoma in situ.

A new variant of the Gardasil vaccine, and Gardasil 9, which takes its name from the 9 strains of HPV on which it acts. It has a greater spectrum of acion than the gardasil and a lower age range than the cervarix. what makes it the best option in the prevention of human papillomavirus

Accumulated Condylomas

Giant Accumulated Condilomas


Chondromatosis of childhood

HERPES SIMPLEX

HSV-1 reacts more efficiently to the trigeminal ganglia (affecting the face and oropharynx and ocular mucosa), while HSV-2 has a more efficient reactivation in the lumbosacral ganglia (affecting the hips, buttocks, genitals and lower extremities).

HSV-1 infection is acquired by early childhood, and serological evidence of infection with HSV-1 approaches 80% in the general adult population. Only about 30% of these people have clinically apparent outbreaks.
In the United States, approximately 1 in every 4-5 adults (21-25%) is seropositive for HSV-2.

.
The most common complication of primary genital HSV-2 infection is bacterial superinfection. In women, systemic complications such as urinary retention and aseptic meningitis can occur. The associated pain, paresthesia and discomfort, as well as the psychosocial impact of herpes simplex outbreaks cause significant morbidity to people who are affected.
Severe complications associated with herpes simplex occur especially in women who are pregnant and in people with immunosuppression who may develop a disseminated infection and encephalitis.

  • Herpes Simplex
  • Gonococcia

  • Trichomonas balanitis

  • Pediculosis Pubis. (Ladillas)

  • Primary syphilis. Chancre.

  • Chancroid or Chancroid.

  • Scabies nodule

  • Contagious Mollusks

  • Contact Dermatitis.

  • Herpes Zoster Genital (sacroischiatica)

  • Angiokeratomas

  • Psoriasis

  • Lichen Sclerosus and Atrophic

  • Lichen sclerosus vulvaris (VLS) is a chronic skin condition, in men, women and children, occurs in any area of ​​the body, but most commonly affects the genital region of adult women (commonly in postmenopausal age). Although there is currently no cure, modern treatments can effectively manage VLS once diagnosed. Untreated VLS can cause significant physical, emotional and sexual discomfort, can progress to squamous cell carcinoma.
  • Vitiligo.

  • Fixed drug erythema

  • Bartolinits.Genital.

Bartholin’s glands are typically palpable. Each gland secretes mucus in a 2.5 cm duct. These two ducts emerge in the vestibule on each side of the vaginal orifice, inferior to the hymen. Its function is to maintain the moisture of the vestibular surface of the vaginal mucosa.
Acute inflammation and painful unilateral labial? Dyspareunia? Pain when walking and sitting? Sudden relief of pain followed by discharge (very suggestive of spontaneous rupture)? Fever, sometimes.

  • Malignant Melanoma

 

  • Epidermoid carcinoma

 

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