Genital ulcer

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: John Fani Srour, M.D.

Overview

A Genital ulcer is an ulcer located on the genital area, caused by a sexually transmitted disease such as genital herpes, syphilis, chancroid, or thrush. Some other signs of having genital ulcers include enlarged lymph nodes in the groin area, or vesicular lesions, which are small, elevated sores or blisters. The syndrome may be further classified into penile ulceration and vulval ulceration for males and females respectively.

Causes^[1]^[2]

Common Causes

Balanitis
Behcet’s disease
Cancer
- Basal cell carcinoma
- Squamous cell carcinoma
Chancroid (Haemophilus ducreyi) (the third most common cause in the USA)
Excoriations
Herpes Genitalis HSV-2 and less common HSV-1 (the most common cause in USA)
HIV-specific ulcers (acute HIV infection or late HIV)
Human papilloma virus
Lichen planus
Neisseria gonorrhoeae
Pyoderma
Syphilis (primary syphilis) (the second most common cause in USA)
Vulvovaginitis

Other Causes (rare)

Athabaskan severe combined immunodeficiency
Cicatricial pemphigoid^[3]
Cytomegalovirus infection
EBV infection
Erythema multiforme
Fixed drug eruption^[4]
Foscarnet^[5]
Genital trauma
Granuloma inguinale (Klebsiella granulomatis)
Langerhans cell histiocytosis
Lymphogranuloma venereum (LGV, Chlamydia trachomatis serovars L1-3)
Pemphigus vulgaris
Reiter’s syndrome
Scabies
Stevens-Johnson syndrome
Strachan’s syndrome: orogenital ulceration, sensory neuropathy, amblyopia^[6]
Yeast infection

Complete Differential Diagnosis of the Causes of Genital Ulcers:

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	Balanitis, Behcet’s disease, Cancer, Basal cell carcinoma, Squamous cell carcinoma, Chancroid, Chlamydia trachomatis, Herpes Genitalis, Lichen planus, Pyoderma, Syphilis, Cicatricial pemphigoid, Erythema multiforme, Excoriations, Fixed drug eruption, Granuloma inguinale, Langerhans cell histiocytosis, Lymphogranuloma venereum, Pemphigus vulgaris, Reiter’s syndrome, Scabies, Stevens-Johnson syndrome, Strachan’s syndrome
Drug Side Effect	Foscarnet
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Excoriations
Infectious Disease	Chancroid, Chlamydia trachomatis, Herpes Genitalis, Human papilloma virus, Neisseria gonorrhoeae, Syphilis (primary syphilis), Vulvovaginitis, Cytomegalovirus infection, Granuloma inguinale, Lymphogranuloma venereum, Scabies, Yeast infection, HIV, Klebsiella granulomatis, EBV infection
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	skin cancer, basal cell carcinoma, squamous cell carcinoma, Langerhans cell histiocytosis
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Behcet’s disease, Athabaskan severe combined immunodeficiency, Cicatricial pemphigoid, Erythema multiforme, Fixed drug eruption, Pemphigus vulgaris, Reiter’s syndrome, Stevens-Johnson syndrome
Sexual	No underlying causes
Trauma	Genital trauma, Excoriations
Urologic	Balanitis, Cancer, Chancroid, Genital trauma, Granuloma inguinale, Lymphogranuloma venereum, Yeast infection
Miscellaneous	No underlying causes

Medical Therapy

Pathogen-Based Therapy

References

↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
↑ Martín JM, Pinazo I, Molina I; et al. (2009). “Cicatricial pemphigoid of the Brunsting-Perry type”. Int. J. Dermatol. 48 (3): 293–4. doi:10.1111/j.1365-4632.2009.03975.x. PMID 19261020. Unknown parameter |month= ignored (help)
↑ Fischer G (2007). “Vulvar fixed drug eruption. A report of 13 cases”. J Reprod Med. 52 (2): 81–6. PMID 17393766. Unknown parameter |month= ignored (help)
↑ Luelmo J, Sala M, Sasal M, Cervantes M (1996). “[Genital ulcers from foscarnet: three cases]”. Med Clin (Barc) (in Spanish; Castilian). 107 (8): 318. PMID 8965499. Unknown parameter |month= ignored (help)
↑ Cockerell OC, Ormerod IE (1993). “Strachan’s syndrome: variation on a theme”. J. Neurol. 240 (5): 315–8. PMID 8326339. Unknown parameter |month= ignored (help)

External Links

Template:WikiDoc Sources

[1] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[2] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[pmid19261020-3] Martín JM, Pinazo I, Molina I; et al. (2009). “Cicatricial pemphigoid of the Brunsting-Perry type”. Int. J. Dermatol. 48 (3): 293–4. doi:10.1111/j.1365-4632.2009.03975.x. PMID 19261020. Unknown parameter |month= ignored (help)

[pmid17393766-4] Fischer G (2007). “Vulvar fixed drug eruption. A report of 13 cases”. J Reprod Med. 52 (2): 81–6. PMID 17393766. Unknown parameter |month= ignored (help)

[pmid8965499-5] Luelmo J, Sala M, Sasal M, Cervantes M (1996). “[Genital ulcers from foscarnet: three cases]”. Med Clin (Barc) (in Spanish; Castilian). 107 (8): 318. PMID 8965499. Unknown parameter |month= ignored (help)

[pmid8326339-6] Cockerell OC, Ormerod IE (1993). “Strachan’s syndrome: variation on a theme”. J. Neurol. 240 (5): 315–8. PMID 8326339. Unknown parameter |month= ignored (help)

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