Diagnosis of Granuloma inguinale
Diagnostic Test list for Granuloma inguinale:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Granuloma inguinale
includes:
Granuloma inguinale Diagnosis: Book Excerpts
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VULVAL OR VAGINAL ULCERATIONS:
Ask the Following Question:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is the lesion or are surrounding lymph nodes tender? The presence of tenderness of the lesion or the surrounding lymph nodes would suggest chancroid, lymphogranuloma venereum, herpes genitalis, and carcinoma. On the other hand, if the lesions or the surrounding lymph nodes are nontender, chancre, yaws, condyloma latum, and lupus should be suspected.
DIAGNOSTIC WORKUP
The workup includes a CBC, sedimentation rate, urinalysis, and VDRL test. A smear and culture of material from the ulceration should be done. A dark field examination may also be necessary. The Frei test may diagnose lymphogranuloma venereum, but a serologic test for this disorder may also be ordered. Biopsy may be ultimately necessary. It is wise to enlist the help of a urologist or gynecologist in difficult cases.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Genital Skin Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Herpes simplex virus (HSV-1 and HSV-2) is the most common cause of genital lesions in the U.S.
–Presents with prodromal tingling and genital discomfort before lesions
–Lesions are always painful and appear as grouped vesicles on an erythematous base -
Condyloma acuminatum (“warts,” HPV)
–Etiologic agent is human papilloma virus
–Lesions usually painless and pearly with a smooth surface but may be filiform, fungating, and lobulated
Tinea cruris
–Inguinal erythema with itch or tenderness
–Always spares the scrotum
Candida intertrigo
–Inguinal erythema with itch or tenderness
–Often very red with satellite lesions
–Frequently involves the labia or scrotum Syphilis
–Primary stage: Painless solitary ulcer (chancre) on labia, penis, or oral mucosa that heals in 2–3 weeks
–Secondary stage: Condyloma lata (moist hypertrophic papules on genital and oral regions)
–Tertiary stage: Cardiac, neurologic, and other systemic effects
-
Molluscum contagiosum
–Multiple, very small, painless, flesh-colored nodules with umbilicated centers
-
Chancroid
–Etiologic agent is Haemophilus ducreyi
–Painful, solitary, and erythematous lesions
–May present with dyspareunia and/or dysuria
Erythrasma
Lymphogranuloma venereum
Granuloma inguinale
Behçet syndrome
–Oral and genital ulcers, retinitis, uveitis
Lichen planus
Scabies
Zoon's plasma cell balanitis
Less common etiologies (“zebras”) include inverse psoriasis, seborrheic dermatitis, genital squamous cell carcinoma, extramammary Paget's disease, plaque psoriasis, and fixed drug eruptions
Workup and Diagnosis
-
History and physical examination including a sexual history and a complete skin exam
–Separate lesions into painless and painful categories; however, note that an initially painless lesion may become painful following a secondary infection
-
Viral culture is gold standard for HSV detection
-
Tzanck test may be used to detect HSV and will reveal multinucleated giant cells and intranuclear inclusions
-
RPR or VDRL serum tests screen for syphilis, but become
positive only 6–8 weeks after primary infection
–These tests have high false-positive rates
–Serum FTA is more specific for syphilis
–Early diagnosis of primary disease requires dark-field
microscopic evaluation of infected tissue or IgM assay
-
Culture or Gram stain to detect chancroid
-
Condyloma accuminata can be diagnosed by applying acetic acid to lesions, which will turn acetowhite
-
Molluscum contagiosum is diagnosed by appearance
-
Wood's lamp may be used to detect erythrasma
-
Shave biopsy is diagnostic for psoriasis, Zoon's, and neoplasms
-
Lesions in older patients that are changing in size, appearance, or texture should always be biopsied to rule out carcinoma
-
All patients with a suspected STD require a full workup for HIV, syphilis, hepatitis B and C, and pregnancy
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Genital lesions in the male:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Genital warts:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Dark-field examination of scrapings from wart cells shows marked vascularization of epidermal cells, which helps to differentiate genital warts from condylomata lata associated with second-stage syphilis. Applying 5% acetic acid (white vinegar) to the warts turns them white. Warts usually are diagnosed early by visual inspection; biopsy is indicated only when neoplasia is strongly suspected.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital lesions in the male:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, the number of sexual partners, and the pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Genital Ulcer:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Herpes simplex
❑ Trauma
❑ Syphilis
❑ Fixed drug eruption
❑ Behçet syndrome
❑ Candida balanitis
❑ Granuloma inguinale
❑ Chancroid
❑ Lymphogranuloma venereum
❑ Bowen disease
❑ Carcinoma of the penis
Diagnostic Approach
A sexually transmitted infection is by far the most likely cause; therefore, a careful sexual history must be taken. Because the patient is often embarrassed or ashamed, cooperation with accurate information can best be gained by first clearly explaining the purpose of the questions. Therapy is usually initiated based upon a clinical diagnosis. Although classic presentations are useful guides, the appearance of ulcers can be atypical (particularly in HIV), overlap, and multiple agents may be acquired simultaneously.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Genital lesions in the male:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Genital lesions, male:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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