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

2. 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

3. 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

4. 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

5. 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?

6. 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?

7. 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

8. 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

9. HSV
Vesicles
Dry lesion
Moist ulcer

10. 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

11. 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

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