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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