UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Approach to the patient with genital ulcers

Authors
Sonia N Chimienti, MD
Donna Felsenstein, MD
Section Editor
Noreen A Hynes, MD, MPH, DTM&H
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Genital ulcers may be due to an infectious or a noninfectious etiology, although most are caused by sexually transmitted infections. The prevalence of specific pathogens differs by geographic location. Determining the etiology of a genital ulcer is complicated by the fact that more than one infection may coexist. In addition, the presence of genital ulcers is a risk factor for the transmission of HIV. The challenge for the clinician is to determine the cause of the genital ulcers in order to institute appropriate therapy and to decrease the risk of transmission to others.

The approach to the patient with genital ulcers is discussed below. More detailed information regarding the individual diseases can be found in the relevant topic reviews:

(See "Syphilis: Screening and diagnostic testing".)

(See "Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients".)

(See "Syphilis: Treatment and monitoring".)

                         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2016. | This topic last updated: Jun 30, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Schmid GP. Approach to the patient with genital ulcer disease. Med Clin North Am 1990; 74:1559.
  2. Rosen T, Brown TJ. Genital ulcers. Evaluation and treatment. Dermatol Clin 1998; 16:673.
  3. Bruisten SM. Genital ulcers in women. Curr Womens Health Rep 2003; 3:288.
  4. Taylor S, Drake SM, Dedicoat M, Wood MJ. Genital ulcers associated with acute Epstein-Barr virus infection. Sex Transm Infect 1998; 74:296.
  5. Martín JM, Godoy R, Calduch L, et al. Lipschütz acute vulval ulcers associated with primary cytomegalovirus infection. Pediatr Dermatol 2008; 25:113.
  6. Hudson LB, Perlman SE. Necrotizing genital ulcerations in a premenarcheal female with mononucleosis. Obstet Gynecol 1998; 92:642.
  7. Toledo-Pastrana T, Ferrándiz L, Pichardo AR, et al. Tuberculosis: an unusual cause of genital ulcer. Sex Transm Dis 2012; 39:643.
  8. Sehgal VN, Pandhi D, Khurana A. Nonspecific genital ulcers. Clin Dermatol 2014; 32:259.
  9. Farhi D, Wendling J, Molinari E, et al. Non-sexually related acute genital ulcers in 13 pubertal girls: a clinical and microbiological study. Arch Dermatol 2009; 145:38.
  10. Finch JJ, Wald J, Ferenczi K, et al. Disseminated Lyme disease presenting with nonsexual acute genital ulcers. JAMA Dermatol 2014; 150:1202.
  11. Beyrer C, Jitwatcharanan K, Natpratan C, et al. Molecular methods for the diagnosis of genital ulcer disease in a sexually transmitted disease clinic population in northern Thailand: predominance of herpes simplex virus infection. J Infect Dis 1998; 178:243.
  12. Mertz KJ, Trees D, Levine WC, et al. Etiology of genital ulcers and prevalence of human immunodeficiency virus coinfection in 10 US cities. The Genital Ulcer Disease Surveillance Group. J Infect Dis 1998; 178:1795.
  13. Morse SA, Trees DL, Htun Y, et al. Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection. J Infect Dis 1997; 175:583.
  14. DiCarlo RP, Martin DH. The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis 1997; 25:292.
  15. Ndinya-Achola JO, Kihara AN, Fisher LD, et al. Presumptive specific clinical diagnosis of genital ulcer disease (GUD) in a primary health care setting in Nairobi. Int J STD AIDS 1996; 7:201.
  16. French P. Syphilis. BMJ 2007; 334:143.
  17. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
  18. Centers for Disease Control. 2013 sexully transmitted disease surveillance. http://www.cdc.gov/std/stats13/other.htm (Accessed on September 30, 2015).
  19. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2014. Atlanta: U.S. Department of Health and Human Services; 2015 http://www.cdc.gov/std/stats14/surv-2014-print.pdf (Accessed on November 23, 2015).
  20. Chen CY, Ballard RC, Beck-Sague CM, et al. Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection. Sex Transm Dis 2000; 27:21.
  21. 2007 National Guidelines for the management of chancroid. Clinical Effectiveness Group (British Association for Sexual Health and HIV, BASSH). www.bashh.org/guidelines (Accessed on October 12, 2011).
  22. Lewis DA, Müller E, Steele L, et al. Prevalence and associations of genital ulcer and urethral pathogens in men presenting with genital ulcer syndrome to primary health care clinics in South Africa. Sex Transm Dis 2012; 39:880.
  23. Phiri S, Zadrozny S, Weiss HA, et al. Etiology of genital ulcer disease and association with HIV infection in Malawi. Sex Transm Dis 2013; 40:923.
  24. Makasa M, Buve A, Sandøy IF. Etiologic pattern of genital ulcers in Lusaka, Zambia: has chancroid been eliminated? Sex Transm Dis 2012; 39:787.
  25. Lai W, Chen CY, Morse SA, et al. Increasing relative prevalence of HSV-2 infection among men with genital ulcers from a mining community in South Africa. Sex Transm Infect 2003; 79:202.
  26. Paz-Bailey G, Rahman M, Chen C, et al. Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clin Infect Dis 2005; 41:1304.
  27. Riedner G, Todd J, Rusizoka M, et al. Possible reasons for an increase in the proportion of genital ulcers due to herpes simplex virus from a cohort of female bar workers in Tanzania. Sex Transm Infect 2007; 83:91.
  28. Gomes Naveca F, Sabidó M, Amaral Pires de Almeida T, et al. Etiology of genital ulcer disease in a sexually transmitted infection reference center in Manaus, Brazilian Amazon. PLoS One 2013; 8:e63953.
  29. Tomas ME, Getman D, Donskey CJ, Hecker MT. Overdiagnosis of Urinary Tract Infection and Underdiagnosis of Sexually Transmitted Infection in Adult Women Presenting to an Emergency Department. J Clin Microbiol 2015; 53:2686.
  30. Rompalo AM, Lawlor J, Seaman P, et al. Modification of syphilitic genital ulcer manifestations by coexistent HIV infection. Sex Transm Dis 2001; 28:448.
  31. LeGoff J, Péré H, Bélec L. Diagnosis of genital herpes simplex virus infection in the clinical laboratory. Virol J 2014; 11:83.
  32. Mackay IM, Harnett G, Jeoffreys N, et al. Detection and discrimination of herpes simplex viruses, Haemophilus ducreyi, Treponema pallidum, and Calymmatobacterium (Klebsiella) granulomatis from genital ulcers. Clin Infect Dis 2006; 42:1431.
  33. Orle KA, Gates CA, Martin DH, et al. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers. J Clin Microbiol 1996; 34:49.
  34. O'Farrell N. Donovanosis. Sex Transm Infect 2002; 78:452.
  35. Larsen SA, Steiner BM, Rudolph AH. Laboratory diagnosis and interpretation of tests for syphilis. Clin Microbiol Rev 1995; 8:1.
  36. Mertz KJ, Weiss JB, Webb RM, et al. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis 1998; 178:1060.
  37. Celum C, Wald A, Lingappa JR, et al. Acyclovir and transmission of HIV-1 from persons infected with HIV-1 and HSV-2. N Engl J Med 2010; 362:427.
  38. Rietmeijer CA, Alfonsi GA, Douglas JM, et al. Trends in clinic visits and diagnosed Chlamydia trachomatis and Neisseria gonorrhoeae infections after the introduction of a copayment in a sexually transmitted infection clinic. Sex Transm Dis 2005; 32:243.