Cutaneous Manifestations of Sexually Transmitted Infections: A Clinical Guide for Dermatologists

Dermatologists play a pivotal role in the early recognition and management of sexually transmitted infections (STIs), as many of these diseases present with cutaneous or mucocutaneous findings. Since 2020, the global resurgence of bacterial STIs such as syphilis and gonorrhea has highlighted the critical need for heightened vigilance in clinical settings. Syphilis rates, in particular, have risen sharply in many regions, with congenital syphilis also reemerging as a significant public health concern. The stakes are high—not only for individual patient outcomes but also for broader public health efforts to curb transmission and prevent complications. Dermatologists, often the first specialists to evaluate patients with unexplained rashes or genital lesions, are uniquely positioned to contribute to early diagnosis, timely treatment, and effective public health interventions. Why Dermatologists Are on the Front Line of STI Diagnosis Genital and mucocutaneous lesions are frequently among the earliest and most visible signs of many STIs, making dermatologists a critical first point of contact for affected individuals. Patients may initially seek dermatologic care for symptoms they perceive as skin-related, such as genital ulcers, diffuse rashes, or localized nodules, without recognizing their systemic or infectious etiology. Additionally, dermatologists are trained to perform detailed skin and mucosal examinations, which are essential for identifying subtle or atypical presentations of STIs. This expertise places dermatologists at the forefront of early recognition and diagnosis, particularly in cases where primary care or sexual health services are not utilized. The epidemiology of bacterial STIs has shifted significantly since 2015, with notable increases in syphilis, gonorrhea, and chlamydia rates across many regions. Factors contributing to this trend include reduced condom use, the impact of COVID-19 on public health infrastructure, and changing sexual behaviors. Mo