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Sores on the genitals (genital ulcers)

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HealthWiki > A Book for Midwives > Chapter 18: Sexually transmitted infections > Sores on the genitals (genital ulcers)


Most sores on the genitals are sexually transmitted. (There can be other causes of sores on the genitals — like boils or injuries.)

Sores on the genitals should be kept clean. Wash them with soap and water. Dry them carefully. Wash any cloth that you dry them with before you use it again.

WARNING!    When a person has a sore on the genitals, it is easy to get other infections through those sores — especially HIV. The best way to prevent passing the infection to another person is to avoid sex until the sores heal.

Contents

Syphilis

Syphilis is a serious STI that affects the whole body. It can last for many years, getting worse and worse. Syphilis can be cured if it is treated early.

illustration of the below: a small sore outside the vagina.
Signs of syphilis
  1. The first sign is a sore that may look like a pimple, a blister, or an open sore. It appears 2 to 5 weeks after sexual contact with a person who has syphilis. This sore is full of germs, which are easily passed on to another person.
    a dark spot near the end of the penis.
    syphilis sore on a man's penis

    The sore does not hurt, and if it is inside the vagina, a woman may not know she has it. But she can still infect anyone she has sex with. The sore lasts for only a few days or weeks and then goes away. But the infection is still there and continues to spread throughout the body.


  2. Weeks or months later, the infected person may get a sore throat, mild fever, mouth sores, swollen joints, or a rash — especially on the hands, feet, belly, and sides. During this time the person can pass the disease to others by simple physical contact like kissing or touching, because the syphilis germs are on the skin.

  3. All of these signs usually go away by themselves, but the disease continues. If a person with syphilis does not get treatment early, the syphilis germs can cause heart disease, paralysis, mental illness (craziness), and death.

Syphilis and pregnancy

a woman speaking to a pregnant woman sitting with a man.
You'll need a
blood test to
be sure you
do not have
syphilis.

If a woman has syphilis when she is pregnant, her baby can be born too early, deformed, or dead. If possible, every pregnant woman should get a blood test to check for syphilis — especially if she has ever had sores on her genitals.

To treat syphilis
  • inject 2.4 million Units benzathine benzylpenicillin
in the muscle, 1 time only
or
if the person is allergic to penicillin:
  • give 500 mg erythromycin
by mouth, 4 times a day for 14 days
(Erythromycin is not always effective against syphilis. You may need to treat the woman with tetracycline after she finishes breastfeeding.)
If the person has had syphilis for 2 years or more, get medical help. She needs different medicines.

WARNING!   It is very hard to tell the difference between syphilis and chancroid. If you are not sure whether the woman has syphilis or chancroid, or if she might have both, you should give her benzathine penicillin and erythromycin.

Chanchroid

Chancroid is an STI that causes sores on the genitals. It is easily confused with syphilis.

Signs of chancroid
  • one or more soft, painful sores on the genitals or anus that bleed easily
  • enlarged, painful glands (buboes) in the groin
  • slight fever


To treat chancroid
  • give 500 mg erythromycin
by mouth, 4 times a day for 7 days
or
  • inject 250 mg ceftriaxone
in the muscle, 1 time only

Genital herpes

Genital herpes is a virus that causes painful blisters which burst and turn into sores on the skin. Herpes is spread when the sore on one person touches another person’s skin — usually during sexual intercourse. Genital herpes usually affects the genitals or anus. Rarely, the sores may spread to the mouth during oral sex.

Note: Some sores on the mouth — called cold sores — are caused by another type of herpes. These sores may be passed from the mouth to the genitals during oral sex.
Signs of herpes
blisters outside the vagina.
blisters from genital herpes
  • tingling, itching, or pain on the genitals
  • small blisters that burst and form painful open sores on the genitals

Once a person has the virus, he or she can get sores many times. The first time a person has herpes sores, they can last 3 weeks or more. The person may also have fever, headaches, body aches, chills, and swollen lymph nodes near the genitals. The next infections are usually not as bad as the first one.

To stop the spread of herpes, people should not have sex when they have a sore. Condoms may prevent the spread of herpes, if the condom is covering the sore. Condoms for women may work even better because they cover more of the genitals.

Treatment

There is no cure for herpes but there are some ways to make the sores feel a little better:

  • Put ice on the sore as soon as you feel it. This may stop the sore from getting worse.
  • Soak a cloth in cooled black tea or tea made of cloves. Hold the wet cloth on the sores.
  • Sit in a pan or bath of clean cool water.
  • Make a paste by mixing baking soda or cornstarch with water and put it on the sore area.
  • Apply witch hazel or a local plant that makes the skin dry.

The pain and sores of a first outbreak can be lessened with medicines.

For a first herpes outbreak
  • give 400 mg acyclovir
by mouth, 3 times a day for 7 to 10 days
For continuing herpes outbreaks
  • give 400 mg acyclovir
by mouth, 3 times a day for 5 days
For a woman with more than 6 herpes outbreaks a year
  • give 400 mg acyclovir
by mouth, 2 times every day for 1 year. Then stop and see if the medicine is still needed.
For a pregnant woman who has had herpes outbreaks in the past
  • give 400 mg acyclovir
by mouth, 2 times every day during the last month of pregnancy
To help with pain
  • give 500 to 1000 mg paracetamol
by mouth, every 4 hours


A person with a lot of stress or other health problems is likely to get sores more often. So if possible, people with herpes should get plenty of rest and eat healthy food.

WARNING!   Herpes is very dangerous for the eyes and can cause blindness. After touching a herpes sore, always wash your hands with soap and water.

Herpes and pregnancy

It is possible for herpes to be passed from mother to baby. This usually happens during delivery if the mother has herpes sores on the vagina at the time of birth. A first-time infection during pregnancy is even more likely to pass to the baby. For this reason, a woman in labor with an active herpes sore should give birth in a hospital, usually by caesarean surgery. The risk of passing herpes during delivery can be reduced or prevented by treating a first-time herpes outbreak immediately with acyclovir, whenever during pregnancy it occurs. A woman who already has had herpes can use acyclovir daily during the last month of pregnancy.

HPV (genital warts)

HPV is a virus that can cause warts to grow on the genitals or anus. It is also possible to have warts and not know it, especially if they are growing inside the vagina. The warts are not dangerous, but they can be uncomfortable.

Signs of HPV
  • Itching.
  • Small, dry, white or brown bumps on the genitals or anus. The bumps have a rough surface and do not hurt.

To test for HPV: touch the warts with a mixture of plain vinegar and water. The warts will turn a whitish color if they are caused by HPV.

WARNING!   Large, flat, wet growths that look like warts are not usually HPV. They may be caused by syphilis. Anyone with these growths should be tested for syphilis. Do not use the following treatment.

Treatment
  1. To protect the healthy skin, put petroleum gel (Vaseline) or another greasy ointment on the skin around each wart.
  2. With a small stick, put a little trichloroacetic acid (TCA) 80% to 90% solution or bichloroacetic acid (BCA) on the wart. Leave the acid on until the wart turns white. Be careful not to spill the acid on the healthy skin. Wash the acid off after 30 minutes or if the burning feeling is very painful.

    The acid should burn the wart off and leave a painful sore where the wart used to be.

    Usually, you must repeat the treatment once a week for a few weeks before the wart goes away completely. Keep the sore clean and dry until it heals. The woman should also not have sex until the sore heals.

The types of HPV that cause cancer in a woman’s cervix are not the same types of HPV that cause warts. Learn how to test a woman’s cervix for HPV.

A vaccine called Gardasil is now available which protects against the most dangerous types of HPV, as well as the HPV viruses that cause most genital warts. The vaccine is a series of 3 injections that can be given to young women between the ages of 9 and 26. It should not be given during pregnancy, and cannot be used to treat a woman who already has HPV.


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