Genital Ulcers: Differential Diagnosis and Management
1Georgetown University Medical Center, MedStar Georgetown University Hospital, Washington, DC, USA.
American Family Physician
|March 13, 2020
Summary
Genital ulcers, often caused by herpes simplex virus, require careful diagnosis and management. Testing includes PCR for herpes, syphilis serology, and cultures for Haemophilus ducreyi, alongside considering noninfectious causes.
Area of Science:
- Infectious Diseases
- Dermatology
- Public Health
Background:
- Genital ulcers present a diagnostic challenge, with infectious and noninfectious etiologies.
- Herpes simplex virus is the most frequent cause of genital ulcers in the U.S.
- Management strategies are guided by the 2015 CDC sexually transmitted disease guidelines.
Purpose of the Study:
- To outline the diagnostic approaches for genital ulcers.
- To review management strategies for genital ulcer disease.
- To highlight key etiological agents and diagnostic tests.
Main Methods:
- Diagnosis relies on physical examination and observation of lesions.
- Specific laboratory tests include PCR for herpes simplex virus, syphilis serology, darkfield microscopy, direct fluorescent antibody tests for Treponema pallidum, and cultures for Haemophilus ducreyi.
- Consideration of noninfectious causes like sexual trauma, psoriasis, Behçet syndrome, and drug eruptions is crucial.
Main Results:
- Herpes simplex virus is the most common cause.
- Syphilis and chancroid are mandatory reportable diseases.
- In some cases, no pathogen is identified, necessitating evaluation for noninfectious etiologies.
Conclusions:
- Effective management of genital ulcers involves accurate diagnosis through clinical presentation and specific laboratory testing.
- Public health initiatives emphasize mandatory reporting of syphilis and chancroid.
- Screening recommendations vary, with U.S. Preventive Services Task Force advising against routine herpes simplex virus screening in asymptomatic individuals.
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