STUDY - Technical - New Dacian's Medicine
Genital
lesions, male (Classical / Allopathic Medicine)
Among the diverse
lesions that may affect the male genitalia are warts, papules,
ulcers, scales, and pustules. These common lesions may be
painful or painless, singular or multiple. They may be limited
to the genitalia or may also occur elsewhere in the body.
Genital lesions may result from infection, neoplasms, parasites, allergies, or the effects of drugs. These lesions can profoundly affect the patient's self-image. In fact, the patient may hesitate to seek medical attention because he fears cancer or a sexually transmitted disease (STD).
Genital lesions that arise from an STD could mean that the patient is at risk for human immunodeficiency virus (HIV). Genital ulcers make HIV transmission between sexual partners more likely. Unfortunately, if the patient is treating himself, he may alter the lesions, making differential diagnosis especially difficult. (See Recognizing common male genital lesions.)
HISTORY:
Ask the patient when he noticed the first lesion.
Ask the patient if he has recently traveled.
Ask the patient if has recently started on a new medication.
Ask the patient if he has had similar lesions before. If so, did he get medical treatment for them?
Ask the patient if he has been treating the lesion himself. If so, did the treatment make the lesion better or worse?
Ask the patient if the lesion itches. If it does, ask him if the itching is constant or if it bothers him only at night. Also, ask him if the lesion is painful.
Obtain a complete sexual history, noting the frequency of relations and the number of sexual partners.
Recognizing common male genital lesions
Many lesions can affect the male genitalia. Some of the more common ones and their causes are discussed here.
Chancroid causes a painful ulcer that's usually less than 2 cm in diameter and bleeds easily. The lesion may be deep and covered by gray or yellow exudate at its base.
Fixed drug eruptions cause bright red to purplish lesions on the glans penis.
Genital herpes begins as a swollen, slightly pruritic wheal and later becomes a group of small vesicles or blisters on the foreskin, glans penis, or penile shaft.
Genital warts are marked by clusters of flesh-colored papillary growths that range in size from barely visible to several inches in diameter.
Penile cancer causes a painless ulcerative lesion on the glans penis or foreskin, possibly accompanied by a foul-smelling discharge.
Tinea cruris (commonly known as jock itch) produces itchy patches of well-defined, slightly raised, scaly lesions that usually affect the inner thighs and groin.
PHYSICAL ASSESSMENT:
Observe the fit of the patient's clothing, noting if his pants fit properly.
Examine the skin surface in the genital area, noting the location, size, color, and pattern of the lesions. Note any lesions on other parts of the body.
Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection such as erythema.
Take the patient's vital signs.
SPECIAL CONSIDERATIONS:
Many disorders produce penile lesions that resemble those of syphilis. Expect to screen every patient with penile lesions for an STD.
PEDIATRIC POINTERS:
In infants, contact dermatitis (diaper rash) may produce minor irritation or bright red, weepy, excoriated lesions. The use of disposable diapers and careful cleaning of the penis and scrotum can help reduce diaper rash.
In children, impetigo may cause pustules with thick, yellow, weepy crusts.
Children with an STD must be evaluated for signs of sexual abuse.
Adolescents ages 15 to 19 have a high incidence of STDs and related genital lesions. Syphilis, however, may also be congenital.
AGING ISSUES:
All patients - including the elderly - who are sexually active with multiple partners are at high risk for developing an STD. However, because many elderly patients have decreased immunity, poor hygiene, poor symptom reporting, and several concurrent conditions, they may present with different symptoms.
Seborrheic dermatitis lasts longer and is more extensive in bedridden patients and those with Parkinson's disease.
PATIENT COUNSELING:
Teach the patient how to use prescribed ointments or creams. Advise him to use a heat lamp to dry moist lesions or to take a sitz bath to relieve crusting or itching. Instruct him to report changes in the lesions. If appropriate, counsel the patient on safer sex practices.
Genital lesions may result from infection, neoplasms, parasites, allergies, or the effects of drugs. These lesions can profoundly affect the patient's self-image. In fact, the patient may hesitate to seek medical attention because he fears cancer or a sexually transmitted disease (STD).
Genital lesions that arise from an STD could mean that the patient is at risk for human immunodeficiency virus (HIV). Genital ulcers make HIV transmission between sexual partners more likely. Unfortunately, if the patient is treating himself, he may alter the lesions, making differential diagnosis especially difficult. (See Recognizing common male genital lesions.)
HISTORY:
Ask the patient when he noticed the first lesion.
Ask the patient if he has recently traveled.
Ask the patient if has recently started on a new medication.
Ask the patient if he has had similar lesions before. If so, did he get medical treatment for them?
Ask the patient if he has been treating the lesion himself. If so, did the treatment make the lesion better or worse?
Ask the patient if the lesion itches. If it does, ask him if the itching is constant or if it bothers him only at night. Also, ask him if the lesion is painful.
Obtain a complete sexual history, noting the frequency of relations and the number of sexual partners.
Recognizing common male genital lesions
Many lesions can affect the male genitalia. Some of the more common ones and their causes are discussed here.
Chancroid causes a painful ulcer that's usually less than 2 cm in diameter and bleeds easily. The lesion may be deep and covered by gray or yellow exudate at its base.
Fixed drug eruptions cause bright red to purplish lesions on the glans penis.
Genital herpes begins as a swollen, slightly pruritic wheal and later becomes a group of small vesicles or blisters on the foreskin, glans penis, or penile shaft.
Genital warts are marked by clusters of flesh-colored papillary growths that range in size from barely visible to several inches in diameter.
Penile cancer causes a painless ulcerative lesion on the glans penis or foreskin, possibly accompanied by a foul-smelling discharge.
Tinea cruris (commonly known as jock itch) produces itchy patches of well-defined, slightly raised, scaly lesions that usually affect the inner thighs and groin.
PHYSICAL ASSESSMENT:
Observe the fit of the patient's clothing, noting if his pants fit properly.
Examine the skin surface in the genital area, noting the location, size, color, and pattern of the lesions. Note any lesions on other parts of the body.
Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection such as erythema.
Take the patient's vital signs.
SPECIAL CONSIDERATIONS:
Many disorders produce penile lesions that resemble those of syphilis. Expect to screen every patient with penile lesions for an STD.
PEDIATRIC POINTERS:
In infants, contact dermatitis (diaper rash) may produce minor irritation or bright red, weepy, excoriated lesions. The use of disposable diapers and careful cleaning of the penis and scrotum can help reduce diaper rash.
In children, impetigo may cause pustules with thick, yellow, weepy crusts.
Children with an STD must be evaluated for signs of sexual abuse.
Adolescents ages 15 to 19 have a high incidence of STDs and related genital lesions. Syphilis, however, may also be congenital.
AGING ISSUES:
All patients - including the elderly - who are sexually active with multiple partners are at high risk for developing an STD. However, because many elderly patients have decreased immunity, poor hygiene, poor symptom reporting, and several concurrent conditions, they may present with different symptoms.
Seborrheic dermatitis lasts longer and is more extensive in bedridden patients and those with Parkinson's disease.
PATIENT COUNSELING:
Teach the patient how to use prescribed ointments or creams. Advise him to use a heat lamp to dry moist lesions or to take a sitz bath to relieve crusting or itching. Instruct him to report changes in the lesions. If appropriate, counsel the patient on safer sex practices.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)