Genital Ulcers - Atypical causes of genital ulcers that can be difficult to diagnose & manage. 

This list excludes typical ulcerative STI's.

Infections	

 - CMV	GI ulcers from mouth to anus; immunocompromised patients

 - Atypical syphilis chancre	Can be painful; if RPR(-), consider dark field and biops

 - Candida balanitis	Multiple small papules, blotch erythema, +/- white exudate

 - Other rare: TB, leishmaniasis, amoebiasis, mold	Amoebic (thick undermined edges, discharge, looks like cancer but painful, insertive anal sex, in endemic areas), TB (can be anything, great mimic), Leishmania (painless, in endemic areas)

Others:	

 - Psoriasis	Not scaly but more intensely red patch/plaque, +/- psoriatic rash elsewhere; +Koebner

 - Circinate balanitis	Painless, serpiginous or ring-shaped, seen in reactive arthritis

 - Zoon's balanitis	Painless, exclusively in uncircumcised penis

 - Erythroplasia of Queyrat / malignancy	Painless, looks similar to Zoon's balanitis, uncircumcised penis

 - Lipschutz ulcer	Vulvar lesions only seen in young women, non-sexually acquired, necrotic in appearance; juvenile gangrenous vasculitis maybe equivalent in young men (?)

 - Foscarnet-induced	Excreted drug induces a contact dermatitis-like/fixed-drug reaction; seen especially in uncircumcised men receiving the drug

 - Contact dermatitis	From any topical products

 - Behcet's disease	Usually a/w recurrent oral ulcers

 - Crohn's disease	 +/- accompanying GI and other systemic manifestations



WuidQ: Washington University ID Questions @WuidQ



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