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 #Genital #Ulcers #Atypical #causes #differential #diagnosis
