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INTRODUCTION

KEY POINTS

  • Genital lesions may have a unique appearance in patients with skin of color, and both the frequency and the appearance may vary between men and women.

  • Some African Americans and Hispanics have higher rates of primary and secondary syphilis in comparison to other racial groups.

    In the United States, reported cases of chancroid generally occur in urban epidemics and are most common in men with darker skin of color.

  • In tinea cruris, patients with darker skin of color may present with striking hyperpigmentation rather than erythema, and genital skin may not have scales.

  • Psoriasis occurs less commonly in Americans with darker skin of color (0.1%) than in Caucasian Americans (1%), and lesions in individuals with darker skin of color may possess an atypical morphology and thus may require biopsy confirmation.

  • A high mortality rate from genital squamous cell carcinoma has been reported in the past among those with darker skin of color, both in the United States and in Africa.

  • Genital dermatoses may occur only on the genitalia or may occur anywhere on the body, and lesions may have a different appearance when found on genital skin compared with other anatomic sites.

Genital lesions may have a unique appearance in individuals with skin of color. There also may be variation in both statistical frequency and clinical characteristics of selected lesions between men and women. Genital dermatoses include a wide variety of diagnoses, and lesions may occur only on the genitalia or also may occur elsewhere on the body. When lesions appear on genital skin, they may have a unique morphology. The thin, moist skin typically found in the genital region is at least partially responsible for the different characteristics of lesions in this region.1 For example, the dry scale that may be a prominent manifestation of lesions elsewhere may not be present in the genital region. Furthermore, genital lesions and the concern over the possibility of a sexually transmitted infection (STI) may cause significant anxiety for the patient. Genital lesions may result from a variety of etiologies, including non-STI infectious agents, inflammatory cutaneous disorders, multisystem diseases, benign and malignant neoplasms, and exogenous factors.

It is often difficult to distinguish between one genital disorder and similar entities based solely on morphology. In various published studies, physicians have had an accuracy of only 33% to 80% in diagnosing genital lesions based solely on appearance.2 The physician should not hesitate to perform additional diagnostic testing, including serologic studies, bacterial and viral cultures, cytologic studies, colposcopic examinations, incisional and excisional biopsies, and other appropriate studies. Additionally, a full-body skin check and a detailed review of systems may be necessary when evaluating a patient with genital lesions.

INFECTIOUS DISEASES

Sexually Transmitted Infections

Syphilis

Epidemiology, Etiology, and Pathogenesis Syphilis is caused by the spirochete Treponema pallidum, with an incubation period of 9 to ...

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