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Genital ulcers

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“Genital ulcers” can refer to sexually transmitted infections, noninfectious inflammatory disease, drug reactions, trauma, or malignancy. Urgent assessment is needed for severe pain, fever, rapidly spreading lesions, urinary retention, pregnancy, immunocompromise, or possible sexual assault.
Key areas:
  1. Infectious causes: herpes simplex, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale
  2. Noninfectious causes: aphthous ulcers, Behçet disease, fixed drug eruption, inflammatory dermatoses, cancer
  3. Clinical approach: lesion features, sexual history, examination, targeted testing
  4. Management and prevention: cause-specific therapy, pain relief, partner care, STI screening
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Choose the focus for genital ulcers.

“Genital ulcers” can refer to sexually transmitted infections, noninfectious inflammatory disease, drug reactions, trauma, or malignancy. Urgent assessment is needed for severe pain, fever, rapidly spreading lesions, urinary retention, pregnancy, immunocompromise, or possible sexual assault.
Key areas:
  1. Infectious causes: herpes simplex, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale
  2. Noninfectious causes: aphthous ulcers, Behçet disease, fixed drug eruption, inflammatory dermatoses, cancer
  3. Clinical approach: lesion features, sexual history, examination, targeted testing
  4. Management and prevention: cause-specific therapy, pain relief, partner care, STI screening
Which focus would help most?

Treatment in aphthous ulcer

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aphthous ulcers AND treatment

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aphthous ulcer treatment clinical guidelines topical corticosteroids

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genital aphthous ulcers treatment Behcet Lipschutz topical corticosteroid guideline

For aphthous genital ulcers after sexually transmitted infections such as herpes and syphilis have been excluded:
  • Supportive care: reassurance, rest, loose cotton underwear, gentle saline cleansing, avoid soaps/fragrances and friction.
  • Pain control: oral paracetamol or an NSAID if safe; topical lidocaine gel can reduce pain before urination. A barrier ointment such as petrolatum or zinc oxide protects the ulcer.
  • Topical corticosteroid: a potent topical corticosteroid is first-line for painful inflammatory ulcers, prescribed for a short course by a clinician. This is recommended for mild genital ulceration in Behçet disease. British Association of Dermatologists guideline
  • If extensive or severe: a short course of oral corticosteroid may be considered by a specialist, though it is not universally required for non-sexually acquired genital ulceration. DermNet guidance
  • Recurrent ulcers, especially Behçet disease: colchicine is generally the next systemic option when topical treatment is inadequate. Persistent severe disease may require rheumatology/dermatology-directed treatment such as azathioprine, mycophenolate, apremilast, or biologic therapy. NHS Behçet treatment
Non-sexually acquired aphthous genital ulcers often resolve spontaneously within a few weeks and rarely recur. Seek urgent review if there is fever, inability to pass urine, pregnancy, eye pain/redness, joint symptoms, recurrent oral ulcers, or an ulcer that does not heal.
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