Genital ulcerations are shallow wounds or erosions on the mucous membranes or surrounding skin of the genital region in both men and women. They are usually caused by sexually transmitted diseases, such as genital herpes, syphilis or chancroid. Genital ulcerations may also be non-sexually acquired, and can result from candidiasis, scabies, bacterial infections, genital trauma or Behçet disease.
Types of genital ulcerations
Up to 60-70% of genital ulcerations result from an infection by the Herpes simplex virus type 2 or type 1. Ulcerations can appear as primary infections in the form of redness, multiple blisters as well as small sores on the genitals. The sizes of the sores may vary. The sores heal within 5 to 14 days, and are accompanied by pain, itching and swelling of the surrounding lymph nodes.
Recurrent genital herpes results from the activation of a virus which is dormant in the sacral ganglion, and will remain there throughout the patient’s lifetime. It is characterized by severe redness, multiple blisters and painful sores which subside within 7 days. The existence of genital herpes is proven by testing for antibodies for HSV type 2 and type 1, and it is treated with antiviral medication – acyclovir.
Primary, early syphilis makes up for 10-20% of all genital ulcerations. The ulceration – a firm chancre – usually appears around 21 days at the site of infection by the bacteria Treponeme palidum. Wounds typical for this type of ulceration are round, with a firm clean base and sharp edges. Also, the surrounding tissue is not inflamed, and the ulceration is painless and can be found on all parts of the genital region. The ulceration is accompanied by a swelling of the lymph nodes, which are firm and elastic, yet separated. Syphilis is diagnosed by testing for anticardiolipin and antitreponemal antibodies, which appear in the serum 10 to 20 days after the primary ulceration. The effect of the antibiotic therapy is checked by monitoring antibodies.
Chancroid is an infectious disease characterized by numerous genital ulcerations which appear 3 to 7 days after exposure to the Haemophilus ducreyi bacteria. In this case, the ulcer has jagged edges, the bottom is covered by purulent exudate and bleeds easily. The ulceration site is inflamed and often accompanied by several other ulcerations in the genital region. The disease is accompanied by an inflammation and tenderness of regional lymph nodes, which may suppurate and drain onto the skin surface. The diagnosis is made based on the identification of the bacteria, and it is treated with antibiotics, administered either orally or intramuscularly.
Bacterial causes of genital ulcerations are usually Staphylococcus aureus, Streptococcus piogenes, as well as other gram negative bacteria. In addition to redness and secretion, shallow irregular erosions may appear. In such cases, the diagnosis is made by identifying the bacterial cause and treated with antibiotics.
Candida albicans is normally present in mucous membranes, but in cases of a change in the environment inside the vagina or changes in immunity, it can cause inflammation. This type of ulceration is manifested as redness, small blisters which burst and leave suppurating ulcerations on the skin. It is accompanied by an intense itching and burning sensation and, rarely, even pain. A bacterial superinfection can often exacerbate the existing erosions. It is diagnosed via a clinical examination, which is confirmed by isolating Candida albicans, and is treated locally with antimicotics.
Behçet’s disease is a systemic disease characterized, among other things, by frequent genital sores which are painful, with a necrotic base, and covered by a white fibromembrane. It is diagnosed by excluding all other causes of genital ulcerations, and it can be treated locally with corticosteroids.
It is important to mention that there are other diseases, such as lichen sclerosis et atrophicus, genital psoriasis and others, which can manifest as mucous membrane ulcerations, due to its thinning and atrophy.