Clinical characteristics of infectious causes of genital ulcer disease

GUD syndrome	Etiologic agent	Classic ulcer characteristics	Incubation	Pain	Adenopathy
HSV	HSV-1 and HSV-2	Multiple small grouped ulcers; erythematous base. Occasionally, single lesions/fissures can be seen	2 to 7 days	Usually painful; can be painless or pruritic	Reactive painful nodes common
HSV		Vesicles can open, forming shallow ulcers/erosions that may coalesce
Syphilis	Treponema pallidum	Indurated, smooth firm borders	7 to 90 days	Usually painless; rarely can be painful	Firm, rubbery nodes
		Clean base			Not tender
		Heals spontaneously			Regional
		Usually singular, although multiple chancres can occur			Discrete
Chancroid	Haemophilus ducreyi	Sharply circumscribed or irregular, ragged undermined edges	3 to 10 days	Marked	50 percent with inguinal adenopathy
		Not indurated			Usually unilateral
		Base may have gray or yellow exudate			Often painful
		Multiple ulcers			May suppurate/rupture
LGV	Chlamydia trachomatis L1-L3	Usually not observed	5 to 21 days	Usually painless	More common in males
		Small and shallow			Matted clusters
		Rapid spontaneous healing			Unilateral or often bilateral
					Large painful fluctuant "buboe"
					Painful groove sign
					Sinus tracts common
Granuloma inguinale	Klebsiella granulomatis	Extensive, progressive	7 to 90 days	Usually painless	Pseudobuboes
		Granulation-like tissue
		Rolled edges

GUD: genital ulcer disease; HSV: herpes simplex virus; LGV: lymphogranuloma venereum.

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