Genital ulcer disease

Differential Diagnosis

Sexually-Transmitted Infections

Organism	Disease	%	Incubation	Treatment
Painless
Treponema pallidum pallidum	primary syphilis	1%	3-90 days	penicillin 2.4 MU IM once
Chlamydia trachomatis serovars L1-L3	lymphogranuloma venereum	<1%	3-30 days	doxycycline 100 mg PO bid for 21 days
Painful
Herpes simplex virus	genital herpes	95%	2-7 days (1º)	acyclovir or valacyclovir for 5 to 10 days
Haemophilus ducreyi	chancroid	<1%	5-14 days	ciprofloxacin 500 mg PO once
Klebsiella granulomatis	donovanosis (granuloma inguinale)	<1%	1-180 days	azithromycin 1 g PO weekly for 21 days (and healed)

Other Infectious Causes

• Fungal
  • Candida
  • Deep fungal infection
• Viral
  • Cytomegalovirus
  • Varicella-zoster virus
  • Epstein-Barr virus
• Bacterial
  • Staphylococcus species
  • Streptococcus species
  • Salmonella species
  • Pseudomonas species
  • Mycobacterium species
• Scabies

Non-Infectious Causes

• Bullous dermatoses
  • Non-autoimmune
    • Contact dermatitis
    • Erythema multiforme (usually secondary to HSV)
    • Toxic epidermolysis
  • Autoimmune
    • Pemphigus
    • Pemphigoid
• Non-bullous dermatoses
  • Nonspecific vulvitis/balanitis
  • Aphthous ulcer
  • Lichen planus
  • Lichen sclerosus
  • Behçet disease
  • Pyoderma gangrenosum
  • Fixed drug eruption
  • Systemic lupus erythematosus
  • Crohn disease
  • Vasculitis
• Malignancy
  • Squamous cell carcinoma
  • Vulvar intraepithelial neoplasia
  • Extramammary Paget disease
  • Basal cell carcinoma
  • Lymphoma
  • Leukemia
  • Langerhans cell histiocytosis
• Trauma
• Idiopathic (12-51%)

Further Reading

• Management and treatment of specific syndromes – Genital Ulcer Disease (GUD). Canadian Guidelines on Sexually Transmitted Infections. 2016.