Cause

HPV Virus (Types 6, 11 as well as 16, 18)

transmission

Sexually transmitted disease (usually)

Clinical Picture

Typical cauliflower-like masses, sub-white, pink, single or in clusters

Diagnosis

Visually through clinical examination

Incubation period

Unknown, 1-6 months up to several years

Diagnosis

Visually, through clinical examination

Differential Diagnosis

pearls, papillomas, squamous condylomas, molluscum contagiosum, epidermal cysts

Treatment

Destruction of lesions with diathermy coagulation, cryotherapy, Laser or use of imiquimod

Comment on transmission

Avoid unprotected sexual contact for up to 12 months

Comments

No criteria to confirm cure

Cause

Caused by HSV 2 and HSV 1

Transmission

Direct contact with active lesion or biological fluid containing the virus (Sexually-transmitted disease)

Clinical Picture

Precursor symptoms (burning sensation - itching), Bubbles on red blotchy-oedematous base which develop into an erosive lesion

Diagnosis

Visually, through clinical examination

Incubation period

3-7 days

Differential Diagnosis

Syphilis, injuries, ulcers, pharmacogenic rash, mucus membrane pemphigoid

Treatment

Anti-herpes medication: quite effective if administered in good time (within the first 48-72 hours)

Comments

Spontaneous remission within 1-2 weeks; Frequent   recurrences; Recurrent herpes: milder symptoms

Cause

Viral infection – small pox type viruses (MCV -1, MCV - 2). MCV-2 most prevalent among  AIDS patients

Transmission

Infection through contact (sexual or other)

Clinical Picture

White-yellow, dome-shaped bumps

Diagnosis

Visually, with clinical examination

Incubation period

15 days - 6 months

Differential Diagnosis

Folliculitis, condyloma acuminatum, warts, milia

Treatment

Destruction of lesion (crushing, cryopexy, diathermy)

Comments

Spontaneous self-limiting within 6-9 months, although successive exposure due to self-inoculation may be a problem

Cause

Self-immune disease – there is hereditary predisposition

Transmission

Non-transmitted

Clinical Picture

Erythematous, erosive lesions; itching, lichenisation

Diagnosis

Visually, with clinical examination. Persistent in taking history. (sensitive to detergents, cosmetics, latex, treatment products!!)

Incubation period

-

Differential Diagnosis

From almost everything else

Treatment

Avoidance of triggering cause– corticosteroids

Comments

Seborrheic - atopical (history)

Cause

Unknown aetiology (immunomediated, Τ - lymphocytes.)

Transmission

Non-transmitted

Clinical Picture

Labia majora, labia minora, penile body, prepuce, balanus; Red-blue / red-violet blotches, occasionally ring-like, shining or erosive lesions (mainly in women), Hypertrophic/ hyperkeratotic (rarely...)

Diagnosis

Visually, with clinical examination; Biopsy

Incubation period

--

Differential Diagnosis

Lichen sclerosus, psoriasis, scabies, eczema

Treatment

Corticosteroid and immunomodifiers; Spontaneous remission.

Comments

Genitalia affected in 50% of women and 35% of men with Lichen planus

Cause

Unknown aetiology (idiopathic, inflammatory)

Transmission

Non-transmitted

Clinical Picture

Hypochromasia, sclerosis – atrophy, erosive lesions - itching (women), Paraphimosis - phimosis – stenosis of external urethra orifice (men), Painful erections

Diagnosis

Visually, with clinical examination. Biopsy

Incubation period

-

Differential Diagnosis

Erosive Lichen planus, Queyrat Erythroplasia, Cicatricial pemphigoid, Eczema (vaginal)

Treatment

Local corticosteroids combined with cicatrizants and Vitamin E per os.  

Comments

Women / men — — 10/1, increases with age, mainly among non-circumcised individuals, but not only.  

Cause

Unknown aetiology (not among circumcised individuals!)

Transmission

Non-transmitted

Clinical Picture

Erythematous (" red pepper" ) wet, well circumscribed plaques. Mild erosion (?) Usually asymptomatic

Diagnosis

Visually, with clinical examination, Histological examination (necessary): zonary, plasmatocyte infiltration below the epithelium

Incubation period

-

Differential Diagnosis

Lichen, Cicatricial pemphigoid, extramammary Paget’ s disease (EMPD)

Treatment

Mild corticosteroids, immunomodifiers, meticulous local hygiene

Comments

Overwhelmingly more frequent among men ( > 30 years of age)

Cause

Pharmaceutical aetiology (pharmacogenic)

Transmission

Non-transmitted

Clinical Picture

Single or several lesions, round or oval, grey-black or blue-grey in colour  

Diagnosis

Visually, with clinical examination. History is of the essence

Incubation period

-

Differential Diagnosis

Malignant melanoma

Treatment

Avoidance of the medication that caused it (in pharmacogenic rash cases.)

Comments

-

Cause

Self-immune, relatively rare dermatopathy

Transmission

Non-transmitted<

Clinical Picture

Often appears in semi– mucous membranes; Very rarely only in the genitalia. Erosive – ulcerative lesions on the balanus, the labia and the entrance to the vagina.   

Diagnosis

Visually, with clinical examination, Tzanck (+) Cytological examination, histological examination.

Incubation period

--

Differential Diagnosis

All cases with erosive lesions

Treatment

Systemic corticosteroids and immunosuppressant treatment

Comments

Cautious prognosis

Cause

Usually Candida albicans (fungus))

Transmission

Usually – but not always – sexually transmitted.

Clinical Picture

Erythema, whitish-thick secretion (not urethral), erosive lesions, oedema

Diagnosis

Visually, with clinical examination.

Incubation period

1-3 days

Differential Diagnosis

Seborrheic eczema, Contact dermititis, Cicatricial pemphigoid

Treatment

Local antifungal treatment sufficient

Comments

Higher incidence among diabetics, immunosuppressed patients or following antibiotic treatment

Cause

Scabies mite / pubic lice

Transmission

Through contact (sexual or other)

Clinical Picture

Scabies: typical scabies rash in the male genitalia (blotches, tunnels), Lice: finding the lice- nits in the pubic region

Diagnosis

Visually, with clinical examination.

Incubation period

Scabies: 2-4 weeks

Differential Diagnosis

Local treatment sufficient

Treatment

Local anti-fungal treatment sufficient

Comments

Intense itching not responsive to anti-histamine medication

Cause

Treponema pallidum (Spirochoeta pallida) (NOT cultivated)

Transmission

Sexually but also vertically transmitted disease

Clinical Picture

Usually single painless lesion, round or oval, with smooth borders, clear floor and the appearance of ‘ muscular flesh’ seated on a hard base

Diagnosis

Try to find the Treponema pallidum, dark field microscopy, direct immunofluoresence, trying to find antibodies, non-specific serological reactions   (RPR, VDRL), specific serological reactions (FTA abs, TPHA)

Incubation period

21 days

Differential Diagnosis

herpes, injuries, ulcers, pharmacogenic rash

Treatment

Parenteric administration of penicillin

Comments

Ipsilateral painless lymphadenitis (sentinel lymph node). The ulcer recedes without treatment after 4-6 weeks. ‘ Any lesion of the genitals is SY, until proven otherwise’ .  

Cause

Hypertrophic growth from the semi-mucous membreane of the balanus

Transmission

Non-transmitted

Clinical Picture

Semi-spherical or conical blotches, about 1mm in diameter and height, arranged in 1-3 rows in the balanus corona region, partially or fully surrounding it.    

Diagnosis

Visually, with clinical examination. The blotches are whitish-pink, red-pink or normal mucosa colour; Elastic in texture and asymptomatic.

Incubation period

--

Differential Diagnosis

Condyloma acuminatum

Treatment

Not necessary

Comments

Normal condition noted in the balanus corona region after puberty

Cause

HPV 16, 18

Transmission

Sexually transmitted disease

Clinical Picture

Flat brown-grey or red-violet papillas with a smooth surface; 2-4 mm.

Diagnosis

Visually, with clinical examination. Biopsy: Bowen Disease histological findings

Incubation period

--

Differential Diagnosis

Condyloma acuminatum, Warts, Naevi

Treatment

Lesion destroyed with Cryopexy, Diathermy coagulation, Laser CO2

Comments

This is an endothelial neoplasia

Cause

Associated with HPV 16 (as well as other HPV viruses)

Transmission

Unknown whether included in STD.

Clinical Picture

Erythematous – shining plaques, erosive lesions

Diagnosis

Visually, with clinical examination; biopsy

Incubation period

--

Differential Diagnosis

Lichen sclerosus, Lichen Planus, Zoon’ s Balanitis

Treatment

Local excision, imiquimod, 5FU, photodynamic

Comments

This is an endothelial neoplasia (Acanthocytes in situ)

Cause

The commonest malignant tumour of the genitals

Transmission

Non-transmitted

Clinical Picture

Erosive – ulcerative, wart-like lesions

Diagnosis

Histological examination necessary

Incubation period

--

Differential Diagnosis

Lichen, Condyloma acuminatum

Treatment

Excision to healthy borders

Comments

It often co-exists with phimosis. Associated with smooth Lichen sclerosus and HPV infection; correlated to tar, petroleum products, etc

Cause

Unknown

Transmission

Not transmitted

Clinical Picture

Rarely located in the genitals - Non-melanoma types: 25%

Diagnosis

Biopsy is compulsory if there is a suspicious lesion

Incubation period

--

Differential Diagnosis

Naevi, seborrheic warts, ‘ benign’ lesions (for non-melanoma type)  

Treatment

Excision to healthy borders

Comments

Exceptionally negative prognosis

Comments

Skin lesion located in the coronary sulcus; soft in texture and asymptomatic; It was excised.

Histological Diagnosis

Fibroepithelial polyp; Benign aetiology.

Comments

Reddish nodule projecting from the outer urethra orifice; It causes mild haematuria. It was excised.  

Histological Diagnosis

Urethra ectropion.

Comments

Confluent nodule-cystic lesions and small blisters located in the perigenital region. Biopsy was performed.   The lesions subsided when treated with antibiotics locally and per os.

Histological Diagnosis

Reverse acne

Comments

Multiple scrotal nodules, hard and painless.

Histological Diagnosis

Seborrheic scrotal cysts

Comments

Elderly patient with neglected phimosis presenting intense inflammation.   Circumcision was performed. The balanus presented deep, painless ulcer. Biopsy of lesion specimens showed no malignancy.

Diagnosis

Inflammatory ulcer.

Comments

Multiple follicular lesions located on the balanus and the prepuce, caused by excessive use of corticosteroids. Local antibiotics were administered; Lesions disappeared completely.

Comments

Red nodule, soft in texture with a constricted base; Painless; Micro-haemorrhaging when pressed. It was excised and biopsy was performed.  

Histological Diagnosis

Pyogenic granuloma. Recurrence of lesion; patients underwent diathermy coagulation and cryotherapy.