Genital Ulcer Disease (GUD) Syndrome

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ICD10 CODES: N76.5-6, N48.5

Genital ulcer syndrome is one of the commonest syndromes that affect men and women. Single or multiple ulcers can be present.

Causes

Multiple organisms can cause genital sores, commonly:

• Treponema pallidum bacteria: syphilis
• Herpes simplex virus: genital herpes
• Haemophilus ducreyi: Chancroid
• Donovania granulomatis: Granuloma inguinale
• Chlamydia strains: lymphogranuloma venerium (LGV)

Clinical features

Mixed infections are common

• Primary syphilis: the ulcer is at first painless and may be between or on the labia or on the penis
• Secondary syphilis: multiple, painless ulcers on the penis or vulva
• Genital Herpes: small, multiple, usually painful blisters, vesicles, or ulcers. Often recurrent
• Granuloma inguinale: an irregular ulcer which increases in size and may cover a large area
• Chancroid: multiple, large, irregular ulcers with enlarged painful suppurating lymph nodes

Differential diagnosis

• Cancer of the penis in elderly men
• Cancer of the vulva in women >50 years

Investigations

• Swab: for microscopy
• Blood: for VDRL/TPR

Management

Treatment

TREATMENT	LOC
Multiple painful blisters or vesicles: likely herpes Aciclovir 400 mg every 6 hours for 7 days If RPR positive add Benzathine penicillin 2.4 MU IM single dose (half in each buttock) If lesions persist, repeat acyclovir for 7 days	HC4 HC3
All other cases Ciprofloxacin 500 mg every 12 hours for 3 days plus Benzathine penicillin 2.4 MU IM single dose (half into each buttock) In penicillin allergy, give Erythromycin 500 mg every 6 hours for 14 days If ulcer persists >10 days and partner was treated Add Erythromicin 500 mg every 6 hours for 7 days If ulcer still persists Refer for specialist management

Note

• Negative RPR does not exclude early syphilis
• Genital ulcers may appear with enlarged and fluctuating inguinal lymph nodes (buboes). Do not incise buboes