Genital Ulceration in Men

History

• Ask about onset/duration/timing etc; also whether there is a solitary ulcer or multiple
  • Ask about location – including whether there is any evidence of anal disease; oral disease (Behcet’s disease)
  • Ask about a trigger e.g. trauma, unprotected sex
• Key question is whether there is pain
  • Painful multiple ulcers is almost always herpes simplex infection
  • A single, painless, undurated ulcer (chancre) is characteristic of syphilis
• Ask about travel history and sexual history
  • Other rarer and tropical infections include
    • VZV
    • Chancroid- tropical disease (Africa, Asia and South and Central America) caused by Haemophilus ducreyi (gram neg bacillus). Generally causes painful genital ulcers which typically have a sharply defined, ragged, undermined border; associated with unilateral and painful inguinal lymph node enlargement (unilocular and can be suppurative ‘bubo’).  Diagnosed by M&C of scrapings from ulcer or pus from bubo.  Treated with Azithromycin 1g oral once only
    • Lymphogranuloma venereum (LGV) caused by Chlamydia Trachomatis. Typically 3 stages:
      • Small, painless, pustule which later ulcerates
      • Painful inguinal lymphadenopathy
      • Proctocolitis
      • Treated with Doxycycline BD for 21 days
    • Granuloma Inguinale (klebsiella granulomatis)
• Other causes include
  • Behcets syndrome – also oral involvement; ocular disease (anterior uveitis)
  • Drug eruption

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