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genital ulcer
Etiology:
1) sexually transmitted diseases
a) genital herpes simplex (HSV type 1, HSV type 2)
1] multiple 1-2 mm, tender vesicles or erosions
2] tender lymphadenopathy
3] HSV type 2 most common cause of painful genital ulcer
b) chancroid (Haemophilus ducreyi)
1] ragged, purulent, painful ulcers
2] tender inguinal lymphadenopathy
c) granuloma inguinale (Donovanosis)
d) lymphogranuloma venereum (Chlamydia trachomatis)
1] single 0.2-1.0 cm ulcer
2] sometimes painful
3] tender unilateral lymphadenopathy
4] may suppurate
e) syphilis (Treponema pallidum)
1] single, painless 0.5-1.0 cm indurated genital ulcer
2] non-tender bilateral genital inguinal lymphadenopathy
2) fixed drug eruptions (NSAIDs, phenobarbital, antibiotics)
a) single or multiple blisters or erosions
b) 1-2 cm in size
c) frequently on glans penis
3) chemical irritant
- sodium hypochlorite [2]
Laboratory:
1) serology, & either darkfield examination or direct immunofluorescence test for T. pallidum
2) culture or antigen test for herpes simplex virus (HSV)
3) culture for H. ducreyi
4) HIV testing indicated if caused by T. pallidum or H. ducreyi.
- consider if caused by HSV
Management: see specific etiology
Specific
vulvar ulcer
General
cutaneous ulcer
References
- Medical Knowledge Self Assessment Program (MKSAP) 14, 16.
American College of Physicians, Philadelphia 2006, 2012
- Gallais Serezal I, Hillion B.
Atypical Ulcerations of the Penis.
PMID: 25651249
N Engl J Med 2015; 372:555. February 5, 2015.
http://www.nejm.org/doi/full/10.1056/NEJMicm1305054