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Despite all the advancements in modern medicine and sexual education, Sexually Transmitted Infections (STIs) remain a public health concern. In most cases, primary care physicians are at the diagnostic forefront. But, they have a difficult task considering that STIs are often asymptomatic.

As a result, most patients are unaware of the infections because they lack “obvious” symptoms. However, the first signs of STIs can appear on the skin. Doctors with training in general dermatology can recognise them and take appropriate action.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in General Dermatology.

In this article, we take a look at cutaneous symptoms of common sexually transmitted infections:

Syphilis

The discovery of penicillin made syphilis a less common health issue in the general population. However, the bacterial infection lost none of its harmful potentials.

Primary syphilis may cause genital ulcers. The symptoms of secondary and tertiary syphilis can resemble other dermatologic conditions.

Secondary syphilis can be widespread or local. It presents as papular, macular, and polymorphous. The cutaneous changes occurring on soles or palms are a solid prediction signal for syphilis infection.

Cutaneous symptoms are less common in tertiary syphilis. Still, the appearance of gummas (tumour-like growths) and nodular eruptions are possible.

Chlamydia and gonorrhea

Skin changes resembling Herpes Simplex Virus (HSV) may appear after chlamydia or gonorrhea infection. These include grouped pustules or hemorrhagic vesicles (with gonorrhea) that present on the extremities but may affect the eyes and pharynx.

Some chlamydia strains can also cause conjunctivitis. Mothers can infect newborn babies at birth with neonatal chlamydia conjunctivitis. The symptoms of such infections usually include:

• Watery eyes,
• Redness,
• Discharge, and
• Swelling or one or both eyes.

Human Papillomavirus (HPV)

HPV is a common sexually transmitted infection. But, it rarely produces cutaneous symptoms. When it does, these are usually genital warts and tumors. Rarely, such changes can also appear in the throat and mouth.

HPV is the leading cause of cervical cancer. Therefore, primary care doctors should advise screening of all HPV-associated symptoms. Vaccination is the best preventive measure against HPV infections.

HIV

There are many described cutaneous symptoms associated with HIV infection. Some are virus-caused others are a consequence of the immune system decline. The latter group may occur as a consequence of various infectious, non-infectious, and neoplastic diseases.

In the early stages of the disease (before immunosuppression sets in) HIV patients may experience temporary morbilliform rashes or papular eruptions. These usually occur on the trunk, arms, and legs.

Signs of Kaposi sarcoma may appear in this stage too. Later on, chronic HSV, molluscum contagiosum, and cytomegalovirus infections are also common.

Genital ulcers

As we said, primary syphilis and Herpes Simplex Virus can cause genital ulcers. However, there are other causes too, and ulcers can appear simultaneously in other body parts, such as hands, breasts, and the oral cavity. Therefore, it is necessary to look into all potential origins before we can rule out STIs.

Recognising cutaneous changes as symptoms of STIs is often not a simple task. With proper training, however, physicians can accurately identify most causes and increase their patients’ life quality and overall healthcare satisfaction.

– Dr Rosmy De Barros

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References:

1. De Vries HJ. Skin as an indicator for sexually transmitted infections. Clin Dermatol. 2014; 32(2):196-208. doi:10.1016/j.clindermatol.2013.08.003
2. Moon J, Yu DA, Yoon HS, Cho S, Park HS. Syphilitic Gumma: A Rare Form of Cutaneous Tertiary Syphilis. Ann Dermatol. 2018 Dec; 30(6):749-751. Doi: 10.5021/ad.2018.30.6.749. Epub 2018 Oct 26. PMID: 33911527; PMCID: PMC7992438.
3. Khattab RA, Abdelfattah MM. Study of the prevalence and association of ocular chlamydial conjunctivitis in women with genital infection by Chlamydia trachomatis, Mycoplasma genitalium, and Candida albicans attending an outpatient clinic. Int. J Ophthalmol. 2016 Aug 18; 9(8):1176-86. Doi: 10.18240/ijo.2016.08.15. PMID: 27588273; PMCID: PMC4990584.
4. Falcaro M, Castañon A, Ndlela B, et al. The effects of the national HPV vaccination program in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. Lancet. 2021; 398(10316):2084-2092. doi:10.1016/S0140-6736(21)02178-4
5. Pires CAA, Noronha MAN, Monteiro JCMS, Costa ALCD, Abreu Júnior JMC. Kaposi’s sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital. An Bras Dermatol. 2018 Jul-Aug;93(4):524-528. doi: 10.1590/abd1806-4841.20186978. PMID: 30066758; PMCID: PMC6063130.