See also Genital herpes.
Anogenital ulcers are breaches of the epithelium occurring on the genitals, perianally or in the anal canal.
Once aetiology of anogenital ulcer is confirmed, registered nurses employed within a PFSHS can provide test results, medication information and health education to patient as delegated by a medical officer or clinical director.
Provision of therapy
Antiviral therapy for genital herpes is to be supplied through PFSHS imprest, hospital pharmacy, co-located community health pharmacy or outside prescription. Services may have LHD protocols in place to allow a registered nurse to supply antiviral therapy.
Ongoing care and management of patients diagnosed with genital herpes is referred to a general practitioner where possible.
DiagnosisSee Australia STI Management Guidelines.Anogenital ulcers can be caused by STIs including genital herpes and syphilis, and by malignancy, trauma and dermatological conditions.
Donovanosis (granuloma inguinale)
If the anogenital ulcer is typical of herpes simplex infection, refer to Australian STI Management Guidelines.If the anogenital ulcer is not typical of herpes or the patient is a man who has sex with men include swab for T. pallidum NAAT and syphilis serology. Refer to syphilis guidelines as above.
Treat sexual partner(s) as appropriate for the identified or suspected STI (genital herpes, syphilis, lymphogranuloma venereum, chancroid, donovanosis). For other suspected STIs see the Australian STI Management Guidelines.If herpes simplex infection is confirmed, educate the patient about the importance of avoiding transmission to women in the third trimester of pregnancy.
If syphilis is confirmed, treatment is required for sexual partners in the three months before the patient developed symptoms.
Generally partner notification is not required for herpes.Contact tracing is a high priority for syphilis, lymphogranuloma venereum, chancroid and donovanosis and should be performed for all patients with confirmed infection.
If herpes simplex infection is confirmed, advise the patient of the diagnosis and refer to a general practitioner if appropriate for ongoing care. If syphilis is confirmed, a review is required one to two weeks later to ensure that the ulcer has resolved. Arrange follow-up serology at three months.
All patient consultations including examinations and tests collected are to be documented on the patient’s medical record.
- References and further reading