Comparative table of genito ulcerative disease
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Comparative Table of Genital Ulcerative Diseases
The image below (from Berek & Novak's Gynecology) shows the cross-sectional ulcer morphology: (A) Chancroid - wide, deep, undermined; (B) Herpes - shallow, superficial; (C) Syphilis - narrow, deep, clean base.
Table: Clinical Features of Genital Ulcer Diseases
(Based on Harrison's Table 141-7, Tintinalli's Table 153-3, and Jawetz Table 48-6)
| Feature | Syphilis | Genital Herpes (HSV) | Chancroid | Lymphogranuloma Venereum (LGV) | Donovanosis (Granuloma Inguinale) |
|---|---|---|---|---|---|
| Causative organism | Treponema pallidum (spirochete) | HSV-2 (mainly); HSV-1 | Haemophilus ducreyi (gram-negative rod) | Chlamydia trachomatis serovars L1, L2, L3 | Klebsiella granulomatis (formerly Calymmatobacterium) |
| Incubation period | 9-90 days (avg. 3 weeks) | 2-7 days | 1-14 days (avg. 3-5 days) | 3 days - 6 weeks | 1-4 weeks (up to 6 months) |
| Primary lesion | Papule → ulcer (chancre) | Vesicle → pustule → ulcer | Pustule → ulcer | Papule, pustule, or vesicle (often transient, missed) | Papule → nodule → ulcer |
| Number of lesions | Usually one | Multiple, clustered | Usually multiple, may coalesce | Usually one; often undetected | Variable |
| Diameter | 5-15 mm | 1-2 mm each | Variable | 2-10 mm | Variable |
| Edges | Sharply demarcated, elevated, round/oval | Erythematous, irregular | Undermined, ragged, irregular | Elevated, round, or oval | Elevated, irregular |
| Base | Smooth, clean, nonpurulent, relatively avascular | Serous, erythematous, nonvascular | Purulent, bleeds easily | Variable, nonvascular | Red, velvety ("beefy"), bleeds readily |
| Depth | Superficial or deep | Superficial | Excavated (deep) | Superficial or deep | Elevated/hypertrophic |
| Induration | Firm (indurated) | None | Soft | Occasionally firm | Firm |
| Pain | Uncommon (painless) | Frequently tender | Usually very tender | Variable | Uncommon (painless) |
| Inguinal lymphadenopathy | Firm, nontender, bilateral (rubbery nodes) | Firm, tender, often bilateral (initial episode) | Tender, may suppurate ("bubo"), loculated, usually unilateral | Tender, may suppurate, loculated, unilateral - "groove sign" | None; pseudobuboes (subcutaneous granulomas) |
| Systemic features | Secondary: rash, mucous patches, lymphadenopathy. Tertiary: cardiac, CNS, gummas | Fever, headache, malaise (primary episode) | Usually localized | Systemic: fever, malaise, proctocolitis, fistulas, strictures | Usually localized; may spread via autoinoculation |
| Key mnemonic | Painless, indurated, "clean" | Painful vesicles, recurrent | Painful, purulent, soft | "Groove sign"; inguinal bubo dominates | Painless, beefy-red, bleeds |
| Diagnostic tests | Dark-field microscopy; RPR/VDRL (non-treponemal); FTA-ABS / MHA-TP (treponemal); PCR | Viral culture, direct FA, PCR; type-specific serology | Culture on enriched vancomycin medium at 33°C; PCR | NAAT (PCR); serology; culture of bubo aspirate | Tissue biopsy: Donovan bodies (intracellular gram-negative rods in macrophages) |
| Treatment (1st line) | Benzathine penicillin G 2.4 MU IM single dose (primary/secondary) | Acyclovir / Valacyclovir / Famciclovir (episodic or suppressive) | Azithromycin 1 g PO single dose OR Ceftriaxone 250 mg IM single dose | Doxycycline 100 mg PO BD x 21 days | Azithromycin 1 g PO weekly OR Doxycycline 100 mg BD x ≥3 weeks |
| Treatment (alternative) | Doxycycline 100 mg BD x 14 days (if penicillin allergy) | Topical antivirals less effective; suppressive therapy for recurrences | Ciprofloxacin 500 mg BD x 3 days; Erythromycin 500 mg TID x 7 days | Erythromycin 500 mg QID x 21 days | Erythromycin, trimethoprim-sulfamethoxazole, or ciprofloxacin |
| Recurrence | No (each stage is progressive) | Yes (latent in dorsal root ganglia; HSV-2 recurs more than HSV-1) | No | No | No |
| HIV risk | Increased (disrupted mucosal barrier) | Increased | High cofactor (10% coinfection with HSV or syphilis) | Increased | Increased |
| Epidemiology | Worldwide; resurgent in MSM | Most common cause of genital ulcer in developed countries | Prevalent in Africa, Asia, Caribbean; rare in USA | Developing countries; outbreaks in MSM (Europe, North America, Australia) | Endemic in Africa, India, Papua New Guinea, Australia; rare in USA/Europe |
Quick Clinical Memory Aid
| Disease | Pain? | Lesion feel | Nodes | Organism type |
|---|---|---|---|---|
| Syphilis | No | Hard (indurated) | Rubbery, non-tender | Spirochete |
| Herpes | Yes | Soft (vesicles/shallow) | Tender, bilateral | Virus |
| Chancroid | Yes (very) | Soft, deep, purulent | Tender, bubo | Gram-negative rod |
| LGV | Variable | Transient ulcer; nodes dominate | Tender bubo (groove sign) | Intracellular bacteria |
| Donovanosis | No | Firm, beefy-red | None (pseudobuboes) | Intracellular gram-negative |
Sources:
- Harrison's Principles of Internal Medicine 22E (2025), Table 141-7 - Clinical Features of Genital Ulcer
- Tintinalli's Emergency Medicine, Table 153-3 - Clinical Features of Genital Ulcerative Infections
- Jawetz, Melnick & Adelberg's Medical Microbiology 28E, Table 48-6 - Major Genital Sore Diseases
- Berek & Novak's Gynecology - Genital Ulcer Disease section
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