Skip to Main Content

INTRODUCTION

KEY POINTS

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

  • Genital lesions are difficult to diagnose based solely on morphology.

  • Genital dermatoses may occur only on the genitals or may occur anywhere on the body, and lesions may have a different appearance when found on genital skin than when seen elsewhere on the body.

  • Most recently, overall rates of primary and secondary syphilis were higher among darker skin of color Americans and Hispanics than among Caucasian Americans, although rates decreased among darker skin of color American females.

  • Most women are unaware of the primary chancre. Cervical, anal, and oral lesions are possible, although extragenital chancres are apparently less common in darker skin of color individuals.

  • Darker skin of color American patients, especially women, are reportedly more likely to develop condylomata lata in secondary syphilis than Caucasian Americans.

  • The annular syphilid (round facial lesions located near orifices) is nearly unique to darker skin of color individuals.

  • Vulvar contact dermatitis may present with edema, vesicles or bullae, erythema, and weeping. Patients with darker skin of color may show hyperpigmentation instead of erythema.

  • The physician may need to perform additional studies, including biopsies, when evaluating genital lesions.

Similar to those seen in men, genital lesions seen in women may have a unique appearance in skin of color individuals (see Chapter 58, Genital Lesions in Men). There may also be variation in both the statistical frequency and clinical characteristics of selected lesions between men and women.

INFECTIOUS DISEASES

Sexually Transmitted Infections

Syphilis

Epidemiology, Etiology, and Pathogenesis Syphilis primarily affects young adults of both sexes. After rates of syphilis dropped to the lowest reported rate of 2.1 cases per 100,000 population in 2000, the primary and secondary syphilis rate increased to 2.7 between 2001 and 2004.1 From 2000 to 2004, overall rates of primary and secondary syphilis were higher among darker skin of color Americans than among Caucasian Americans, although rates decreased among darker skin of color American females.1 Syphilis is caused by the bacterial spirochete Treponema pallidum and is transmitted via sexual contact, likely by inoculation into tiny abrasions from sexual trauma.2 After spreading to the regional lymph nodes, treponemes spread via a hematogenous route to other parts of the body.

Clinical Findings The primary lesion of syphilis is a solitary, painless ulcer (chancre) that develops in the genital area approximately 9 to 90 days after sexual contact with an infected individual [Figure 59-1].3 The labia major and the perineal skin just adjacent to the vaginal orifice are the most frequent sites affected. Most women are unaware of the primary chancre.4 Cervical, anal, and oral lesions are possible, although extragenital chancres are apparently less common in darker skin of color individuals.3 Between 1 to ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.