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Dual GUD Concurrent Treatment — SCE Infectious Diseases MCQ

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EasySTIsDual GUD Concurrent TreatmentSCE Infectious Diseases

A 28-year-old man presents with a new genital ulcer. Testing reveals concurrent primary syphilis (dark-field positive) AND primary genital herpes (HSV-2 PCR positive). What is the clinical significance of dual GUD?

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Correct answer: E — Concurrent GUD from multiple pathogens is well-documented (3–10% of GUD cases); each pathogen must be treated with its standard regimen simultaneously; genital ulceration from any cause increases HIV acquisition risk 2–5 fold

Mixed GUD (dual or even triple pathology) occurs in 3–10% of genital ulcer cases. Each pathogen requires its own treatment: Benzathine Penicillin G for syphilis, Valaciclovir for HSV. Importantly, genital ulceration from ANY cause disrupts the mucosal barrier, increasing HIV acquisition risk 2–5 fold — HIV testing should be offered if not already known positive. This case reinforces the BASHH principle of testing for ALL GUD causes simultaneously rather than stopping after identifying one pathogen.

Reference: BASHH 2019 – GUD guidelines; WHO 2024 – STI