Genital ulcerations

Genital ulcers are shallow sores that affect the mucous membrane of the genital area both in men and women.
Most often, they are caused by sexually transmitted infections: genital herpes, syphilis or chancroid.
Genital sores can also be caused by other conditions that do not belong to the group of sexually transmitted diseases: candidiasis, scabies, bacterial infections, genital trauma or Behcet’s disease.

Genital herpes

Genital ulcers are mostly, in 70% of cases, caused by Herpes simplex virus type 1 or type 2 . Herpetic sores can occur for the first time, as a primary infection on the genitals characterised by redness, clustered blisters, small sores. Beside sores that recede in 5 to 14 days, other symptoms may be present like pain, itching and swollen lymph glands.

Recurrent genital herpes represents the re-appearance of genital sores, which develop by the activation of the virus that is harboured in sacral ganglions. Redness, clustered blisters and painful sores are present.
Treatment of genital herpes consists of the intake of an antiviral medication — acyclovir.
Genital herpes can be verified by detecting antibodies to herpes virus type 1 and type 2.

Syphilis

During the first (primary) stage of syphilis, one may notice ulcers — sores on the genitals formed at the site of penetration of a bacterium Treponeme pallidum.
Ulcers in syphilis account for about 10 to 20% of all genital ulcers. The ulcers usually develop around the 21st day after infection. Hard chacres or ulcers in syphilis are round, with sharp edges and solid bottom. The surrounding area is not red, and it is painless.
Together with ulcers, swelling of regional lymph nodes also appears.
Diagnostics are made when the presence of anti treponemal and anticardiolipin antibodies is verified, which are formed 3 weeks after the development of ulcer.
The treatment consists of antibiotic therapy.

Chancroid

Chancroid is caused by Haemophilus ducreyi bacterium, when numerous sores appear in the genital region, 3 to 7 days after infection.
The base of the ulcer has a purulent exudate and bleeds easily. The surrounding skin is inflamed, red, and with purulent inflammation of the lymph nodes.
They become soft, the inflammation spreads to the skin and the purulent content leaks to the surface.

Genital candidiasis

Genital candidiasis can be the causative agent of the inflammation with small blisters which burst and leave sores in the genital region. The sores are very shallow, eroded areas that are moist and the surrounding skin is bright red. There is an intense sensation of itching. The diagnosis can be confirmed by isolation of Candida albicans, and it is treated locally with antibiotics.

Bacterial ulcers

Bacteria such as Staphylococcus aureus, Streptococcus pyogenes and other gram-negative microorganisms can be causative agents of genital infections and ulcers. Redness, discharge and shallow ulcers are present.
Diagnosis is confirmed by isolation of bacteria and antibiotic therapy is prescribed.

Behcet’s disease

Behcet’s disease is a systemic disease characterised by very painful genital ulcers with necrotic base. The disease has other systemic manifestations, and sores are treated locally with corticosteroids.

Other dermatological conditions can also cause genital ulcers: Lichen sclerosus et atrophicus, genital psoriasis, because the underlying disease leads to thinning of the mucosa, followed by ulcer formation.

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