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


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


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


Multiple painful blisters or vesicles: likely herpes

  • Aciclovir 400 mg every 5 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

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


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