Abstract
James is a 22-year-old man who attends you as a Sexual Health physician. He tells you that he had noticed a sore on his penis for about 5 days, and that this sore is increasing in size. You know that he has sex with men because he had asked you to undertake an HIV antibody test a year before for visa purposes, and he told you then that he was a sexually active gay man. You arranged for hepatitis A and B vaccination at that time, and a Health Adviser provided advice on risk reduction for the sexually transmitted infections.
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Notes
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Indurated = hard; sometimes likened to cartilage or a button under the skin. Note that induration is not an invariable finding.
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The published sensitivity of dark field microscopy varies between 79 and 97%. Both the sensitivity and specificity are dependent on the experience of the microscopist. Because of interference from commensal spirochaetes that are found in the normal flora of the genital and rectal mucosa, DGM is considered to be less reliable in examining rectal and non-penile genital lesions. DGM is not suitable for examining oral lesions because of the many commensal treponemes that occur in the mouth. DGM can be applied to the moist mucous lesions (condylomata lata or mucous patches) of secondary syphilis but as serological tests are virtually 100% sensitive at this stage there is little need for it.
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© 2009 Springer-Verlag London
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McMillan, A. (2009). A Gay Man with a Genital Ulcer. In: Sexually Transmissible Infections in Clinical Practice. Springer, London. https://doi.org/10.1007/978-1-84882-557-4_18
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DOI: https://doi.org/10.1007/978-1-84882-557-4_18
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