Genital ulcer disease

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Synonyms and keywords: GUD

Overview

Genital ulcer disease (GUD) can be defined as diseases characterized by genital, anal, or perianal lesions that are ulcerative or pustular. GUD is typically caused by sexually transmitted infections (STI) but also by other non-STI conditions.

Sexually transmitted diseases characterized as GUD include:

• Chancroid
• Genital herpes
• Donovanosis (granuloma inguinale)
• Lymphogranuloma venereum (LGV)
• Syphilis

Other conditions that are not sexually transmitted infections that may be associated with genital, anal, and perianal lesions include:

• Genital candidiasis
• Trauma
• Carcinoma
• Aphthae
• Fixed drug eruption
• Psoriasis
• Behçet's disease

Differentiating Genital Ulcer Diseases

Sexually transmitted diseases characterized as GUD may present with similar manifestations and lesion characteristics. A diagnosis based only on the patient’s medical history and physical examination frequently is inaccurate. Patients who have genital, anal, or perianal ulcers should be evaluated with laboratory tests to make a definitive diagnosis.

Clinical Characteristic	Sexually Transmitted Disease
	Chancroid	Genital Herpes	Donovanosis	LGV	Syphilis
Cause	Haemophilus ducreyi	Herpes Simplex Virus (HSV-1 & HSV-2)	Klebsiella granulomatis	Chlamydia trachomatis serovars L1, L2, or L3	Treponema pallidum
Lesion Type	Papule evolving to ulcer	Vesicle evolving to ulcer	Ulcer progressing to granuloma	Self-limited papule or ulcer	Papule evolving to ulcer
Lesion Border	Crater with irregular, sharp margins	Circular, sharp margins on erythematous base	Friable base with sharp, raised, rolled margin	Shallow, smooth border	Crater with raised edges, smooth margins
Lesion Distribution	Single or multiple	Multiple, in group/crop	Single or multiple	Single or herpetiform	Multiple
Lesion Texture	Soft	Umbilicated	Granulomatous	Firm bump	Indurated
Lesion Tenderness	Present	Present	Absent	Absent	Absent
Lesion Exudate	Grey/yellow purulent exudate	Non-exudative	Non-exudative but bleeds easily	Non-exudative	Non-exudative; non-fluctuant
Lymphadenopathy	Present and tender in approx. half of patients (typically unilateral)	Present and tender	Absent from primary infection; pseudobuboes may occur	Present and tender	Present and non-tender (uni- or bilateral)