Genital skin lesions and dermatitis ♂♀ Thank you and launch into photo Matiu Bush Nurse Practitioner Candidate Melbourne Sexual Health Centre

Clinical Photography Take photos! Any digital camera with a macro function Patient consent form Policy and procedure Secure location on hard drive to store images

Causes Nodular scabies Herpes Type 2 Varicella virus Candida Could we reduce unnecessary clinic visits for results in low risk individuals Introduce what we have done for females Low risk assessment, phone for results Primary Syphilis Lichen sclerosis

Causes STI NON STI Herpes type 1 and 2 (95% of genital ulcers) Syphilis (>1% of genital ulcers) LGV (<1% of genital ulcers) NON STI Bacterial Viral Fungal Dermatoses Trauma Drug reactions

Symptom history How long has it been there? Is it new or reoccurring? Any other associated symptoms? Is it getting worse or resolving? What hygiene products do you use? Any new medications? Any new sexual contacts? Any self treatment?

Symptom history How long has it been there? Is it new or reoccurring? Any other associated symptoms? Is it getting worse or resolving? What hygiene products do you use? Any new medications? Any new sexual contacts? Any self treatment? Acute or chronic HSV past infection Prodrome, other rashes on body Too late for treatment Over washing, chemical irritant Drug reaction Exclusion criteria, inclusion criteria Case record review of the 9 positive results STI related, partner symptomatic Hydrocortisone, tea tree oil etc- has it made it worse?

Genital exam Clear Instructions Privacy Consent Examination etiquette Good lighting Limit nudity Genital exam Chaperone County of birth of the 9 Age of HIV + and HIV – Include countries of sexual contact State they were “regular partners” in these countries Condom use and partner change Good examination couch Clinical photography

HSV History Multiple vesicular lesions Painful lesions Itchiness and tingling sensation Developed over a period of days after sexual contact Lymphadenopathy Systemic signs such as fever, myalgia Previous lesions that have become ulcerative Recurrent lesions in same area Partner with HSV infection National surveillance data Everyone here is aware of the need to maximise efficiency Demand on finite resources International studies show benifits

HSV Vesicles Dry lesion Moist ulcer

Diagnostics HSV swab- it will give you the type PCR – DNA Use cotton swap and rub over lesion with vigour Syphilis swab- for those who are at risk of syphilis

Clinical Diagnosis Start treatment before results are back Back up clinical diagnosis with positive swab results Review if symptoms persist Symptom management Genital Skin Care Salt baths Paracetamol/codeine as required Potassium permanganate Xylocaine 2%jelly topically Promote hydration to avoid urinary retention Supportive voiding measures

What’s next Follow up results Discuss the effects of HSV in relation to sexual activity Information Promote self efficacy and positive body image