Genital Ulcer: Differential Diagnosis
References: (CDC Guidelines, 2006)
Syphilis:
The primary lesion (genital or oral ulcus) occurs with an incubation period of 10-90 days. The ulcus (also called chancre) is a firm painless ulceration, 5–15 mm and sharply demarcated [fig. chancre in primary syphilis]. Often, a painless inguinal lymphadenopathy can be observed.
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fig. Chancre (genital ulcer) in primary syphilis: firm painless ulceration, which is sharply demarcated. Figure from Dr. Gavin Hart and Dr. N. J. Fiumara. Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Herpes genitalis:
Grouped papels or vesicles on an erythematous base are pathognomonic for genital herpes. After rupturing, they form an ulcer and heal within 1–4 weeks [fig. genital sores in herpes genitalis].
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fig. genital sores in herpes genitalis: grouped vesicles on an erythematous base at the sulcus of the penis. Figure from Dr. N.J. Flumara and Dr. Gavin Hart, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Chancroid:
Painful deep purulent ulcers (2–20 mm) develop from a papel or pustula. In addition purulent lymphadenopathy [fi. ulcus molle (chancroid)].
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Ulcus molle (Chancroid). Fig. from J. Pledger, Public Health Image Library, Center for Disease Control and Prevention, USA, www.cdc.gov. |
Lymphogranuloma venereum:
After an incubation period of 5–21 days, a genital papule or pustule develops and leads to a singular ulcer (2–10 mm). The genital ulcers heal spontaneously.
A tender and painful lymphadenopathy is a typically symptom of lymphogranuloma venereum. At the time of presentation, the genital ulcer may have already healed. Lymphnodes may become purulent and cause inguinal ulcerations (Bubo). Further symptoms are fever and chills.
Granuloma inguinale:
Tuberculosis:
as a singular genital manifestation very seldom.
Penile Cancer:
painless, slowly progredient: genital ulcer and induration.
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References
- Center for Disease Control and Prevention.:
- Sexually transmitted diseases treatment guidelines 2006.
in: MMWR
2006; 55 (No. RR-11): 1–93.
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