Skin rash - generalised

Overview

Several STIs may be associated with generalised dermatological problems.

Possible causes

Clinical presentation

SymptomsComments/Considerations
Rash - chlamydia Hypertrophic rash on soles, circinate balanitis, psoriatic rash (associated with chlamydia as part of reactive arthritis and eye signs).

Erythema over grossly swollen inguinal lymph nodes (bubo = lymphogranuloma venereum (LGV).
Rash - gonorrhoea

Macular rash that may include necrotic pustules

Rash - syphilis
  • Jarisch-Herxheimer reaction (fever, headache, lymphadenopathy and rash) associated with penicillin in primary and secondary syphilis, but not due to hypersensitivity
  • Maculopapular rash involving palms and soles: secondary syphilis
  • Condylomata lata (secondary syphilis) must be differentiated from human papillomavirus (HPV)
  • Patchy alopecia: secondary syphilis.
Oral lesions Mucous patches (secondary syphilis) and transient vesicles/erosions (chlamydia)

Diagnosis

Diagnosis in males
InfectionSite/SpecimenTest
Chlamydia FPU

Eye swab if symptomatic

NAAT

Gonorrhoea FPU

Eye swab if symptomatic

NAAT

If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment.

Syphilis Blood Syphilis serology
Lymphogranuloma venereum (LGV) Rectal swab NAAT.
Write on request form “NAAT. If chlamydia positive please send for LGV testing.”
FPU – First pass urine
NAAT – Nucleic Acid Amplification Test
 
 
Diagnosis in females
TestSite/SpecimenConsideration
Chlamydia

Endocervical swab
OR

Self-collected vaginal swab
OR
FPU

Eye swab if symptomatic.

NAAT

Gonorrhoea

Endocervical swab
OR

Self-collected vaginal swab
OR
FPU

Eye swab if symptomatic.

NAAT

If NAAT test result is positive, take swab at relevant site(s) for culture, before treatment.

Syphilis Blood Syphilis serology
Lymphogranuloma venereum (LGV) Rectal swab

NAAT.

Write on request form “NAAT. If chlamydia positive please send for LGV testing.”

FPU - First pass urine
NAAT - Nucleic Acid Amplication Test
 

Investigations

Always check for ano-genital infection if chlamydia or gonorrhoea is found in conjunctival swabs.

Specimen collection 

Clinician collected |
Self-collection

Special considerations

Management

Principal Treatment Options
SituationRecommendedAlternative
Chlamydia  Azithromycin 1g PO, stat

Doxycycline 100mg PO, BD 7 days

Gonorrhoea Seek specialist advice for disseminated gonorrhoea. 
Syphilis#

Benzathine penicillin 1.8g IMI, stat

Procaine penicillin 1.5g IMI, daily for 10 days

Lymphogranuloma venereum (LGV)

Doxycycline 100mg PO, BD for 21 days 

Alternative regimens are not recommended due to lack of efficacy data. If alternative regimen required, seek specialist advice.

Treatment advice

  • # Seek specialist advice for all patients who are pregnant, hypersensitive to penicillin or who are HIV positive
  • Treat the underlying infection which will usually lead to resolution of symptoms and signs of skin disease.
  • Provide symptomatic relief of itch with topical emollients and antihistamines if needed. Moderate skin irritation may require low strength topical steroid ointment.
  • Ocular involvement requires review by an ophthalmologist.

Other immediate management

  • Advise no sexual contact for 7 days after treatment is administered.
  • Advise no sex with partners from the last 6 months until the partners are tested and treated if necessary.

 

Contact Tracing

Contact tracing for chlamydia, gonorrhoea and lymphogranuloma venereum (LGV) is a high priority and should be performed in all patients with confirmed infection.

See Australasian Contract Tracing Manual for more information.

Follow up

If STI confirmed, follow up provides an opportunity to:

  • Confirm patient adherence with treatment and assess for symptom resolution.
  • Confirm contact tracing has been undertaken or offer more contact tracing support.
  • Provide further sexual health education and prevention counselling.

For test of cure (TOC) and retesting advice see:

Auditable outcomes

Refer to the relevant STI:

 

References

British Association for Sexual Health and HIV (BASHH) 2014. Available from: http://www.bashh.org/BASHH/Guidelines/Guidelines/BASHH/Guidelines/Guidelines.aspx

Last Updated: Thursday, 31 March 2016