I have a genital ulcer for the past few days. What could it be?

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There are many differential diagnoses of genital ulcer-like herpes genitalis, primary chancre, beaches, chancroid, gonorrhea, STI, etc. Have you done VRDL, TPHA, and FTA-Abs tests? If the tests come reactive or positive, take a tablet of Doxycycline 100 mg twice daily after food for two to four weeks. It depends on the stage of syphilis. Apply Fucidin cream twice daily for seven days. Take tablet Emanzen D twice daily for three days (if painful). Do you have any constitutional symptoms like sore throat, malaise, headache, weight loss, fever, rashes, or muscle pain? Do you have any lymphadenopathy or mucosal lesions other than this? Do you have alopecia, split papules at the angle of the mouth, or mucous patches on the lips? Do you have a tingling or burning sensation?

It seems to be genital herpes as syphilis ulcer presents as a penile snail track ulcer. Have you done HSV 2 IgG, and IgM tests? Do you have any test reports?

Please revert back.

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Before starting the treatment, get blood investigations and urine culture done and confirm the infection's cause.

In herpes tablets, Acyclovir 400 mg thrice daily for five days, or Valacyclovir 500 mg tablet twice daily for three days is given. It depends on whether the infection is primary or recurrent.

You can start applying topical creams without investigation. Apply Sodium Fusidate cream or Fucidin cream twice daily in the morning and evening for seven days, and Mupirocin ointment at night for 10 days.

You can also take the tablet Pregaba M (Pregabalin and Mecobalamin), one tablet twice daily for 15 days, or a Neurobion forte tablet twice daily for 15 days. Apply Acyclovir 1 percent gel three times daily for 10 days (if available), and Melipox spray to soothe lesions.

Are you sexually active?

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I have seen the picture (attachment removed to protect patient's identity). This is balanitis (inflammation or swelling) of the penis. The cause of balanitis could be a bacterial, viral, or fungal infection and STI.

It appears like herpes with secondary bacterial infection due to scratching or rubbing of the lesion. But if antiviral treatment is not responding, there are more chances of bacterial or fungal infection. Usually, antiviral treatment show results in seven days.

Genital hygiene plays a vital role in this case. Maintain proper genital hygiene. Wash genitals daily with lukewarm water and mild cleansers like Episoft cleanser or no soap cleanser or Cetaphil cleanser.

Avoid scratching or rubbing of lesions. Keep the area dry and clean. Avoid occlusion and friction. Wear loose, comfortable thin cotton inners. And avoid tight clothes and inners.

Stay in a well-ventilated cool environment and avoid a humid environment. Use barrier. Avoid multiple partners. Refrain from sex until complete healing of lesions. Avoid stress as it may cause aggravation in herpes.

Apply Fucidin cream twice daily for seven days and use Candid cream at night for seven days. Do all tests and follow up with reports. There will be an improvement if the exact cause is found and treated accordingly to prevent a recurrence.

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There is improvement seen in the lesions.

But balanitis is present. To reduce inflammation and swelling, apply 1 percent Hydrocortisone cream twice daily in very little quantities for 10 days. Apply candid cream or Miconazole gel at night for 15 days. Continue Fucidin cream twice daily for 7 days. Are any symptoms at present? Done all tests? Previous treatment has taken? Which treatment was taken in these 6 days?

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Do not use Betnovate. Balanitis can occur due to improper hygiene, scratching or rubbing, allergic reaction to irritant soap, and infection like yeast infection, chlamydia, and fungal infection. These are the possible causes that need to be ruled out so recurrence can be prevented. Avoid possible irritants. Practice good hygiene, safe sex and use barrier. A swab test is done to check for infection (a swab from the glans is taken). Also, a biopsy can tell the exact cause (a sample from a lesion or inflamed skin is taken). Urine test and blood test-STI panel test are done. Treatment for balanitis is antibiotic cream or anti-fungal cream and steroid ointment. Avoid scented soap or lotions. Always clean the glans after retracting the foreskin. Wash with warm water. Use a neutral cleanser like Episoft cleanser or no soap cleanser to clean genitals, as hygiene plays a very important role in this case. Clean and dry the area. Always wash your private parts after sexual intercourse. Avoid self-medication as it may worsen the condition.

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Yes, You can Apply to Kenacomb for 10 days. Triamcinolone is also low potency steroid like 1 % Hydrocortisone. If inflammation reduces in these 10 days, no need to apply Hydrocortisone. If inflammation stays, then use 1 % hydrocortisone cream twice daily for 10 days. Herpetic lesions appear in groups in blisters from inflammatory papules, erosions, ulcers, and crust form mostly associated with a tingling sensation. These appear to be fungal infections Balanitis with a secondary bacterial infection. Also, anti-fungal medication improved the lesion. Also if a herpetic lesion, it usually improves in 7 to 10 days with crust formation without treatment, but may recur, to reduce the frequency of recurrence of herpes oral antivirals are given.

Any symptoms like a tingling sensation, pain, or tenderness?

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If the genital ulcer is non-herpetic (dark blue kit is available for non-herpetic ulcers). Take tablet Doxycycline 100 mg twice daily after food for 15 days and tablet Azithromycin 1 gm for one day. Yes, you should get VDRL and all the above tests like swab test, biopsy, urine culture, and sensitivity report done. Start treatment after doing all tests and follow up with reports.

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Get the following tests done.

1. Urine routine.
2. Urine culture and sensitivity test for chlamydia and gonorrhea etc.
3. Blood test-serology (non-treponemal test).
4. Treponemal test (FTA-Abs,TPHA) for syphilis.
5. A swab test, biopsy-sample from a lesion, or inflamed skin are taken (to check for infection like LGV, or chancroid).
6. HSV 1 and HSV 2 (IgG or IgM) for herpes.

Treatment for syphilis is Benzathine penicillin 2.4 million unit IM (1.2 million in each gluteal region). Take tablet Doxycycline 100 mg BD (twice daily after food) for 14 days with Azithromycin 1gm (500 mg twice) only once. It should be taken for the duration and dosage prescribed after confirmation of the investigation.

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IgG test positive suggests positive infection in the past. IgG is high suggesting good immunity against herpes. HSV IgM if positive (suggest real indication of acute infection). IgM negative suggests there is no active infection at present. Take tablet Acyclovir 800 mg thrice daily (6 hourly) if signs of active infection are present. Apply Acyclovir gel or cream on lesions three to five times a day. Herpes active lesions will have painful blisters in groups with redness at the base. Syphilis and chancroid will have ulcers. Gonorrhea and chlamydia present pus from the urethra with discharge, and pain while urinating.

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IgG positive suggests past infection (no active infection of herpes and syphilis now). Reports suggest past infection of HSV 1 (so lesions could be recurrent episodes of HSV 1 (sometimes HSV 1 can present with genital lesions also). Reports suggest past infection of syphilis as antibodies to syphilis antigen are present in the FTA test. The infection is gone.No present infection of syphilis. But clustering and recurrent episodes of HSV are common. It may cause intermittent episodes of genital sores though the frequency of recurrences decreases with time. The good part is it will go away with treatment but can recur. Herpes is a disease of nerves it will burn and itch initially but does not scratch the crust when they form. Change underwear every day. Maintain proper genital hygiene. Clean the area with lukewarm water twice daily. Avoid washing the area with any anti-septic soap or lotions. Wear loose cotton inners wears. Avoid intercourse. Use barriers.

I hope this has helped you.

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For chlamydia and syphilis, take a tablet of Doxycycline 100 mg two times daily for 14 days. If urine culture reports confirm chlamydia infection. For gonorrhea take Cipro XR (Ciprofloxacin extended release) 500 mg single dose or Levofloxacin 500 mg single dose. At present take Ciprofloxacin 500 mg twice daily for 5 days. Take tablet Azithromycin 500 mg once daily for 3 days and tablet Doxycycline 100 mg twice a day for 10 days. Testing for HIV should be done. Sore on genitals syphilis infection bears possibility. Get urine culture and sensitivity reports done. Also, repeated outbreaks of HSV are common but are usually shorter and less severe. Although the organism stays in the body for the rest of its life, the number of outbreaks tends to decrease over a period of years. Changes in the status of the immune system or due to stress, uncontrolled sugar levels, cytotoxic drugs, or thyroid, increase chances of HSV recurrence. Need to avoid risk factors and take precautions at the time of active infection. Possible risk factors could also be physical stress, mental, and emotional stress, recent illness, surgery, and prolonged sun exposure. These can trigger cold sores. HSV 1 is contagious during the active blisters stage.

1. Apply Mupirocin 2 % cream twice daily with 1 percent Clotrimazole cream.
2. Take a tablet of Levocetirizine 5 mg at night for 10 days (to relieve itching or burning).
3. Protected sexual intercourse is advised.
4. Take tablet Acyclovir 400 mg three times daily after a meal for 7 days.
5. Take tablet Rantac (Ranitidine 150 mg) twice daily before meal for 7 days.
6. Can Use Fucidin cream twice daily instead of Mupirocin.

I hope this has helped you.

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IgG antibody presence suggests that there was an infection in the past and now immunity has developed antibodies in order to fight those antigens. The values given in FTA-IgG mean that on quantifying the antibodies they were positive in the 1:40 titer and not in the 1:80 titer. Yes, it could be a herpes outbreak due to risk factors like stress.

1. Take tablet Acyclovir 400 mg thrice daily after meals for 7 days. If it is a recurrent episode it may subside in 3 to 5 days.
2. Apply Fucidin cream twice daily for 7 days.
3. Avoid sex.

STI can cause ulcers. In chlamydia there is burning urination, erythema of urinary meatus, and painful ulcer so rule out all possible infections to prevent recurrence.

Hello doctor,

I suggest you the following things.

1. Take tablet Valacyclovir 500 mg twice daily after meals for 3 days.
2. Fucidin cream twice daily in the morning and evening for 7 days.
3. Mupirocin ointment at night for 10 days.
4. Avoid Scratching or rubbing lesions.

I hope this has helped you.