Genital Lesions
Genital lesions are a frequent presentation to the emergency department (ED).
The clinician’s priorities are accurate visual recognition, identification of lesions that require urgent investigation or public‑health action, appropriate sampling, symptom control, clear documentation, and arranging the correct onward care (sexual‑health clinic, primary care, dermatology or urgent treatment pathways).
In the UK, use national summaries (NICE ESNM66) and GOV.UK / UKHSA syphilis and HPV guidance to shape local practice; BASHH guidelines contain detailed treatment algorithms and drug regimens.
Initial ED approach
- Take a focused history including onset, progression, character of symptoms (pain, itch, discharge, bleeding), recent sexual contacts, number of partners, contraception and pregnancy status, vaccination status, immunosuppression and other STI risk factors.
- Perform a targeted visual assessment and describe size, shape, colour, distribution, surface characteristics (papillated vs flat vs umbilicated), moisture, and number of lesions.
- Photograph lesions only with informed consent and according to local and safeguarding policy; document consent.
- Screen for systemic features such as rash, fever and lymphadenopathy.
- Offer or arrange STI screening as clinically indicated and per local pathways.
- Apply safeguarding rules immediately if the patient is a child or if findings raise concern for sexual assault, following RCEM and local child‑protection pathways.
Key red flags that require urgent action
- Lesions suggestive of condylomata lata (secondary syphilis): perform immediate syphilis serology and arrange urgent...