Genital ulcer

[4] Since it is difficult to determine a cause of a genital ulcer from history, examination, and population characteristics alone, further testing is often needed.

The most common diagnostic tools used are targeted towards the most common etiologies of genital ulcers: syphilis (syphilis serology, PCR testing, or dark-field examination), herpes simplex virus (PCR, culture, or type specific HSV antibodies), and haemophilus ducreyi (culture on special media currently not widely available in most hospital systems) if the individual is in a known endemic region.

[3] Further diagnostic tools such as a biopsy or culture are often utilized if ulcers appear unusual or do not respond as expected to therapy.

[9][4] Most sexually active adolescents with genital ulcers have a herpes simplex virus infection, more commonly type 2.

[10] Following syphilis and genital herpes infections, a chancroid is the third most common cause but tends to occur in focused outbreaks over time.

[4] Genital ulcers are not strictly a sign of a sexually transmitted illness, although non-infectious sources are significantly more infrequent in comparison.

[11] A fixed drug eruption in comparison does not present as a toxic appearing patient but rather single or multiple erythematous patches that vary in size and shape which eventually turn dark brown in color and become itchy.

[11] Cutaneous tuberculosis typically presents initially as red or yellow nodules that eventually break down to form soft, painful, and roughly circular ulcers, which as a rule are covered in a pseudomembrane.

[11] Primary tuberculosis chancre, on the other hand, often presents as a painless ulcer with well defined edges that appears rather nonspecific.