❑ Herpes simplex
❑ Trauma
❑ Syphilis
❑ Fixed drug eruption
❑ Behçet syndrome
❑ Candida balanitis
❑ Granuloma inguinale
❑ Chancroid
❑ Lymphogranuloma venereum
❑ Bowen disease
❑ Carcinoma of the penis
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.
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.
Read excerpts from these other book chapters related to Genital sores:
Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.
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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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