Anogenital lumps
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Anogenital lumps (papules, nodules, vesicles)
- Sexually transmitted infections (STIs): human papillomavirus (HPV), Molluscum contagiosum virus, herpes simplex virus (HSV), syphilis.
- Other conditions: haemorrhoids, folliculitis, impetigo, intra-epithelial neoplasia or carcinoma.
- Normal anatomical variations (e.g. skin tag, sebaceous glands, penile or vulval papillae, Fordyce spots).
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Symptoms |
Considerations |
|---|---|
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Vesicles |
Herpes simplex viruses (HSV) types 1 and 2 are the most common causes, generally evident by clusters of small painful vesicles. Other causes include varicella zoster, bullous impetigo (Staphylococcus aureus), immunobullous diseases such as pemphigus. |
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Papules and nodules |
Anogenital warts caused by human papillomavirus (HPV) can vary greatly in size, number and appearance. |
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Infection |
Site/Specimen |
Test |
|---|---|---|
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Diagnosis is usually based on visual appearance. If there are atypical lesions (e.g. variable pigmentation, raised plaque-like lesions, ulceration, bleeding) or failure to respond to standard treatments consider biopsy to exclude high-grade squamous intraepithelial lesions and cancer. Cervical warts should be referred for specialist assessment. | ||
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Molluscum contagiosum |
Clinical diagnosis | |
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Swab of base of ulcer or deroofed vesicle |
NAAT | |
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Swab of base of ulcer |
NAAT | |
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Dry swab or punch biopsy of lesions |
Histology has low-to-moderate sensitivity but highly specific; requires experienced histopathologist as classic Donovan bodies may be sparse | |
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Chancroid |
If chancroid suspected, seek specialist advice | |
NAAT – Nucleic acid amplification test
Specimen collection guidance
Please see relevant treatment sections
Genital warts (human papilloma virus (HPV))
Herpes
Syphilis
Donovanosis
M. contagiosum: Deroof lesions with needle and express contents. Cryotherapy.
Other immediate management
- If a specific STI is considered likely, refer to the specific guideline for information on advice to patient of any requirement to abstain from sexual contact.
- When diagnosis is in doubt consider recommending abstinence until results of diagnostic tests are available, especially where significant behavioural risk factors are present.
- Contact tracing.
- Contact tracing is a high priority for syphilis, and should be performed in all patients with confirmed infection.
- If the contact of syphilis is confirmed (i.e. the named contact names the index case) then treatment should be offered even if the serology is negative.
- Contact tracing for herpes and genital warts is not recommended.
See Australasian Contract Tracing Manual for more information.
If STI confirmed, follow-up provides an opportunity to:
- Confirm patient adherence with treatment and assess for symptom resolution.
- Confirm contact tracing procedures have been undertaken or offer more contact tracing support.
- Educate about condom use, contraception, HIV PrEP/PEP, safe injecting practices, consent, CST and vaccinations for HAV, HBV and HPV as indicated.
Consider alternative diagnoses, biopsy or referral for any lesions not responding as expected to treatment.
For test of cure and retesting advice see:
- 100% of patients complaining of a genital lump have a genital examination.
