Dr. med. Dirk Manski

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Differential Diagnosis of Genital Ulcers

References: (CDC Guidelines, 2021)


The primary lesion (genital or oral ulcus) of syphilis 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. Often, a painless inguinal lymphadenopathy can be observed.

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.


Painful deep purulent ulcers (2–20 mm) develop from a papel or pustula. In addition purulent lymphadenopathy develops.

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:

Granuloma inguinale presents with progressive painless highly vascular genital ulcers without inguinal lymphadenopathy. The genital ulcers are destructive and can affect the genital organs, the groin and the perineal region.


Primary or secondary tuberculosis of the penis is uncommon.

Penile Cancer:

Penile cancer may present as painless, slowly progredient genital ulcer or induration.

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Center for Disease Control and Prevention: “Sexually Transmitted Infections (STI) Treatment Guidelines,” 2021. [Online]. Available: https://www.cdc.gov/std/treatment-guidelines/STI-Guidelines-2021.pdf