Genital Ulcer Disease (GUD)

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This is an ulcerative, erosive, pustular or vesicular genital lesion(s) with or without regional lymphadenopathy; caused by a number of sexually transmitted infections (STIs) and non-STI-related conditions.

Causes

STIs 

Non-STI-related infections or conditions

-Herpes Simplex Virus type 1 or 2 (HSV-1 or HSV-2)

- Treponema pallidum. causing primary syphilis

- Haemophilus ducreyi causing chancroid

- Chlamydia trachomatis serotypes L1-L3 causing

-Lymphogranuloma venereum (LGV)

-Klebsiella granulomatis causing granuloma inguinale (donovanosis)

-Infectious non-STI-related causes of genital ulcers

-Non-infectious non-STI-related causes of genital ulcers
  • Genital ulcer
  • Pain
  • Urethral discharge

Differential diagnosis

  • Cancer of the penis or vulva

Evaluation/Investigations

  • Diagnosis is mostly clinical
  • Swab for microscopy, culture and sensitivity
  • Serology
  • Blood for VDRL/TPHA

Treatment objectives

  • Treat small ulcers and vesicles, especially if recurrent for Herpes Simplex
  • Direct initial management of all ulcers at both syphilis and chancroid

Non-pharmacological treatment

  • Keep lesions dry and clean

Pharmacological treatment

For Herpes Simplex

Acyclovir oral

400 mg every 6 hours for 7 days

AND

Paracetamol

500 mg every 6-8 hours or when necessary

In patients with recurrence

Repeat acyclovir, the same dose for 5 days

PLUS

Paint lesions with

Povidone iodine topical

OR

Mercurochrome topical

OR

Gentian violet solution topical

Note:

  • If syphilis is present refer to section on syphilis treatment
  • If chancroid is present refer to section on chancroid treatment

Referral

  • If not responding to treatment refer for specialist care