Genital Ulcer

Genital Ulcer: Excerpt from Field Guide to Bedside Diagnosis

Differential Overview

❑ Herpes simplex

❑ Trauma

❑ Syphilis

❑ Fixed drug eruption

❑ Behçet syndrome

❑ Candida balanitis

❑ Granuloma inguinale

❑ Chancroid

❑ Lymphogranuloma venereum

❑ Bowen disease

❑ Carcinoma of the penis

Diagnostic Approach

A sexually transmitted infection is by far the most likely cause; therefore, a careful sexual history must be taken. Because the patient is often embarrassed or ashamed, cooperation with accurate information can best be gained by first clearly explaining the purpose of the questions. Therapy is usually initiated based upon a clinical diagnosis. Although classic presentations are useful guides, the appearance of ulcers can be atypical (particularly in HIV), overlap, and multiple agents may be acquired simultaneously.

Clinical Findings

Herpes simplex  Typically, HSV produces a cluster of flaccid vesicles and/or shallow ulcers on an erythematous base. They are painful with a burning, dysesthetic quality.

Trauma  The most common causes are zipper tears and human bites.

Syphilis  A single, painless ulcer with a clean base and an indurated, rolled border is associated with a rubbery, nontender, regional lymph node.

Fixed drug eruption  It can present as red patches, plaques, and/or ulcers on the glans. Tetracycline is the most common cause.

Behçet syndrome  Scrotal or penile ulcers are well-demarcated and deep, and heal with scarring. Suspect Behçet when uveitis is combined with genital ulcers.

Candida balanitis  Multiple painful, shallow ulcers on a bright red base rapidly coalesce. The prepuce becomes edematous and constricted (phimosis). There are often small satellite lesions. Suspect Candida in persons with diabetes.

Granuloma inguinale  It begins as a papule that erodes into a velvety, red, painless granuloma. Spreading to the perianal area, it may become secondarily infected.

Chancroid  A vesicle/pustule rapidly breaks down into a saucer-shaped ulcer with a red margin. The ulcer is painful and ragged, with undermined edges covered with a grayish exudate. Unilateral lymphadenopathy develops, becoming quite painful.

Lymphogranuloma venereum  The chancre feels like a button.

Bowen disease  The lesion is a bright red, sharply defined, velvety plaque. Regional lymph nodes may be firm with cancer. A history of arsenic contact may be elicited.

Carcinoma of the penis  Suspect cancer if the lesion does not heal and appears as a small, raised ulcer with irregular friable edges.

Pictures

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

More About Sexual Conditions

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

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