Genital Ulcer Disease : differentials

Genital ulcer disease (GUD) encompasses a spectrum of conditions that manifest as open sores or ulcers on the genitalia. This clinical presentation poses a diagnostic conundrum to healthcare providers due to its diverse etiologies, which span neoplastic, inflammatory, and particularly infectious causes. As a frequent reason for healthcare consultations, GUD's infectious origins are often rooted in sexually transmitted infections (STIs), which carry significant implications for individual and public health.

The herpes simplex virus (HSV), specifically types 1 and 2, and Treponema pallidum, the causative agent of syphilis, are among the most prevalent infectious agents leading to genital ulcers. Less commonly, but still of clinical relevance, are Haemophilus ducreyi, responsible for chancroid; Klebsiella granulomatis, the organism behind granuloma inguinale; and Chlamydia trachomatis, associated with lymphogranuloma venereum.

Clinical judgment alone, even by seasoned clinicians, has been shown to be inaccurate in over 50% of cases when determining the cause of GUD. This highlights the necessity for laboratory confirmation to guide appropriate management. The epidemiology of GUD varies globally, with HSV-1, HSV-2, and Treponema pallidum being the most frequently implicated pathogens. This variation underlines the importance of geographic considerations and local prevalence when formulating a differential diagnosis for GUD.

The complexity of GUD...