Genital ulcers can be caused by various venereal and non-venereal conditions. Syphilis is a sexually transmitted infection caused by Treponema pallidum bacteria. It progresses through primary, secondary, latent, and tertiary stages if left untreated. Primary syphilis presents as a chancre ulcer, while secondary syphilis has various rash types. Benzathine penicillin is the treatment of choice. Chancroid is caused by Haemophilus ducreyi and presents as a painful genital ulcer with undermined edges and purulent base. Diagnosis is made by identifying the bacteria. Azithromycin or ceftriaxone are common treatments. Herpes genital

1. GENITAL ULCERS

2. GENITAL ULCERS
Genital ulcers are defied as breach in the
continuity of genital mucosa and/or skin.

3. Etiological classification of GUDs
VENERAL
Herpes simplex
Syphilis
Chancroid
Lymphogranuloma venereum
Granuloma inguinale
NON VENERAL
Trauma
Adverse drug reactions
Crohn’s disease
Neoplasms
Premalignant conditions
Behcet’s disease
Reiter’s disease

4. Syphilis
Syphilis is a sexually transmitted infection caused by a spirochaete
bacterium, Treponema pallidum.

5. Classification of Syphilis
Acquired Syphilis
Early Syphilis (Infectious phase)
Primary Syphilis
Secondary syphilis
Early latent Syphilis
Late Syphilis (Non infectious phase)
Late latent Syphilis
Tertiary Syphilis
- Benign Tertiary
- Cardiovascular Syphilis
- Neurosyphilis

6. Congenital Syphilis
Early congenital syphilis
Late congenital syphilis
Stigmata of congenital syphilis

7. Incubation period- The primary Syphilitic lesions appear within 9 to 90 days as an
ulcer at the site of inoculation
Tertiary (1/3) and Remission (2/3)
Late latent (More than 2 years)
Early latent ++ relapsing
Secondary (mucocutaneous lesions/organ involvement) in 2-12weeks
Primary (chancre in 10-19 days)
Exposure of Treponema pallidum

8. Primary Syphilis
Presented as an ulcer or chancre usually situated on genitalia. The lesion starts
as a dusky red, painless, non itchy macule of about 0.5-1 cm in size.

9. The regional lymph nodes become enlarged within 7-10 days, initially unilateral,
but soon other sides also become involved. In case of ano-genital chancre there
is bilateral enlargement in a majority of cases at the time of infection.
Characteristically the lymph nodes appear small, discrete, non-tender, firm and
rubbery in consistency and they do not suppurate.
Diagnosis of primary Syphilis
Based on demonstration of the trepo-nemes from the chancre and
serological tests for Syphilis.
The organisms in the lesion are demonstrated by performing a dark field
microscope examination of the exudates.

10. Differential diagnosis
Chancroid
Donovanosis
LGV
Herpes genitalis

11. Secondary Syphilis
•Begins 2-12 weeks after the appearance of primary chancre
•The rashes may be confined to only one anatomical area as palms, soles,
genitals.
•The eruptions of syphilis can be macular, popular, pustular or a combination of
these.

12. Serological tests for Syphilis and their Application
Non treponemal test
VDRL
RPR
Treponemal test
TPHA
EIA

13. Treatment
•Benzathine penicillin G 2.4 million units (im) single dose.
•For children: Benzathine penicillin G 50,000 units/kg IM up to the adult dose of
2.4 million units in a single dose.

14. CHANCROID

15. Introduction
Chancroid is called as soft sore soft chancre and ulcus molle. It is an Acute infectious disease
caused by a gram negative bacillus, Haemophilus ducreyi

16. Incidence
The male to female ratio ranges from 3:1 to 53:1.
The Disease is transmitted from person to person mainly through heterosexual contact, and is
usually acquired from Prostitutes.
Patients from lower socioeconomic groups, commercial sex workers, uncircumcised men are at
higher risk for acquiring disease.

17. Clinical Features
Classically the ulcers are painful, sharply circumscribed with ragged undermined edges
The base of the ulcer is non-indurated.
A typical chancroid lesion is characterized by the triad of undermined ulcer edge, purulent dirty
gray base, moderate to severe pain.

18. Painful inguinal lymphadenitis develops in 30 to 60% of the patients within 1 to 2 weeks of the
development of genital ulcers
Other complications of chancroid include phimosis, paraphimosis, urethral fistula and
phagedenic ulcerations.

20. Diagnosis
Isolation of H.ducreyi from the genital ulcer or bubo is important in the diagnosis of chancroid.
Smears are taken with cotton swabs from beneath the undermined edges of ulcers and stained
with Gram’s or Wright’s stain.
Pleomorphic gram negative coccobacilli arranged in parallel chains of two’s or four’s described
as “school of fish” may be demonstrated.

21. Centres for disease control(cDc)
1. One or more painful genital ulcers.
2. Dark field examination of ulcer exudate is negative for T.pallidum.
3. A non-reactive serological test for syphilis performed at keast 7 days after the onset of ulcer.
4. A typical clinical presentation with findings suggestive of chancroid along with regional
lymphadenopathy.
5. A negative test for herpes simplex virus (HSV).

22. Differential diagnosis
The differential diagnosis includes genital herpes especially in immunocompromised patients,
primary chancre, granuloma inguinale, chancroidal ulcers and traumatic lesions with secondary
bacterial infection.

23. Management
General Advice
1. Patients should be advised to avoid unprotected sexual intercourse until they and their partners
have completed treatment and follow-up.
2. Condoms, when correctly used will prevent transmission in most cases.
3. Local hygiene with saline cleaning.

24. Cdc (2006) regimens
a. Azithromycin 1gm orally in a single dose
or
a. Ceftriaxone 250mg intramuscularly in a single dose
or
a. Ciprofloxacin 500mg orally two times a day for 3 days
or
a. Erythromycin base 500mg orally three times a day for 7 days

25. GENITAL HERPES

26. ETIOLOGY
Herpes genitalis is caused by a DNA virus ,
Herpesvirus hominis

27. INCUBATION PERIOD
5-14 days

28. MODES OF TRANSMISSION
Infection with the herpes simplex virus follows contact with the infected secretions through
1. oral to oral
2.oral to genital
3.Genital to genital contact

29. CLINICAL FEATURES
The lesions start as grouped vesicles but rapidly become pustular and ulcerate.
During presentation , large coalescent areas of ulceration often with polycyclic margins are
usually present.
Constitutional symptoms include fever, headache, myalgia, malaise

30. VESICULAR STAGE &
MULTIPLE POLYCYCLIC, SUPERFICIAL ULCERS STAGE

31. COMPLICATIONS
CNS involvement include Aseptic meningitis, transverse myelitis and sacral radiculopathy.
Extra genital are frequent on the thigh, buttock or groin, but occasionally on hand or eye.
Secondary infection include bacterial superinfection manifesting as cellulitis and secondary
pyoderma is not uncommon.

32. LAB TESTS
Tzanck smear
Histopathology
Viral culture
Serology
PCR

33. TREATMENT
INITIAL EPISODES
Acyclovir 400mg thrice daily for 7-10days
Valacyclovir 1g twice daily for 7-10days
Famcyclovir 250mg twice daily for 7-10days
RECURRENT EPISODES
Acyclovir 400mg orally three times a day for 5 days
Famcyclovir 125mg orally twice daily for 5 days
Valacyclovir 500mg orally twice a day for 3days

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