A genital ulcer is an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents (fungal infections, secondary bacterial infections, or sexually transmitted diseases such as genital herpes, syphilis or chancroid). However, this is not always the case, as a genital ulcer may have noninfectious causes as well. Overview
A genital ulcer may be located on the vulva, penis, perianal region, or anus. Globally, the incidence of genital ulcers is estimated to be approximately 20 million cases annually. The most likely cause of a genital ulcer varies depending on the characteristics of a population and location. The most common cause of genital ulcers in the United States is herpes simplex infections, with syphilis the second most common cause, and chancroid the third. These common causes of genital ulcer disease (HSV-1, HSV-2 and treponema pallidum) can all be efficiently transmitted through oral sex.Important signs associated with genital ulcers that may assist in the diagnosis of the cause of the genital ulcer may include the presence of tender or non-tender enlarged lymph nodes in the groin area, a painful or non-painful genital ulcer, or the presence of vesicular lesions, which are small, painful, elevated blisters.The most common causes of a genital ulcer include infectious agents, with sexually transmitted diseases being the most common, but which can also include fungal infections and secondary bacterial infections.
While infectious agents are the most common cause, a genital ulcer may also be the result of non-infectious causes such as Behcets syndrome, lupus, or psoriasis.Since it is difficult to determine a cause of a genital ulcer from history, examination, and population characteristics alone, further testing is often needed. The most common diagnostic tools used are targeted towards the most common etiologies of genital ulcers: syphilis (syphilis serology, PCR testing, or dark-field examination), herpes simplex virus (PCR, culture, or type specific HSV antibodies), and haemophilus ducreyi (culture on special media currently not widely available in most hospital systems) if the individual is in a known endemic region. Further diagnostic tools such as a biopsy or culture are often utilized if ulcers appear unusual or do not respond as expected to therapy.Since genital ulcers are often infectious in origin, there is an increased risk of acquiring HIV in a HIV negative patient through viral introduction through the open sore Conversely, there is an increased risk of HIV transmission through increased shedding of viral HIV in the presence of a genital ulcer in a patient with a history of HIV. The CDC recommends testing for HIV in any individual presenting for a genital ulcer who does not already have a history of HIV.