Genital Ulcers

Infectious genital ulcers are associated with herpes simplex virus (HSV), syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale. HSV is by far the most common, affecting 50 million people in the United States. HSV-1 and HSV-2 are chronic, neurotropic viral infections that enter through epithelium and come to rest in the dorsal root ganglia. Therefore, infection leads to lifetime presence of the virus, but the clinical manifestation of this condition

Table 16-7 Recommendations for the Screening of Sexually Transmitted Infections (STIs)


Who to Screen?

Recommending Body


All sexually active women under age 24.

Women over 24 at increased risk. All pregnant women under 24 and those over 24 at increased risk.

Insufficient evidence for or against screening men.



All sexually active women at increased risk. Insufficient evidence for screening women not at increased risk. Insufficient evidence for or against screening men at increased risk.



Strongly recommended for pregnant women and all patients at increased risk.



All individuals as a routine part of health care in all settings after informing the patient. Pregnant women as standard prenatal testing.



Recommendation against screening for asymptomatic individuals.


Hepatitis B

Strongly recommended for pregnant women at their first prenatal visit.


Modified from US Preventive Services Task Force (USPSTF). Guide to Clinical Preventive Services, 2009.; and Branson B et al. Revised recommendations for HIV testing of adults, adolescents and pregnant women in health-care settings. MMWR 2006;55(RR-14):1-17.

is variable. A small percentage of those with serologic evidence of HSV-2 (10%-25%) have had symptoms of clinical herpes infection. In addition, patients with HSV infection can shed the virus in the absence of symptoms, creating a prime opportunity for spread.

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