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Infectious diseases
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| Herpes genitalis |
HSV 1 or HSV 2 is to be found via swab and amplification technique (PCR) or Tzanck test Lesions are typically smaller Often typical history (previous or partners herpes infection) Often recurrent; history of labial herpes possible Sexually and non‐sexually transmission possible
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| Primary syphilis lesion |
May be painful, but in the majority, it is not painful In the majority of cases, there is only one lesion, multiple are possible, but this is rare Lymphadenopathy is often predominant Serological tests or dark field microscopy will verify infection with Treponema pallidum
A previous sexual contact is reported
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| Ulcus molle (Chancroid) |
Rarely in Western European countries Endemic in tropic/subtropic regions Swab from ulcer: gram stain from ulcer: ‘school of fish’ chain, culture, PCR
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| Lymphogranuloma venereum |
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Non‐infectious systemic conditions
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| Crohn's disease |
Usually recurrent ulcers and erosions, mainly at the anal or perineal region, seldom at vulva and vagina Predominantly fistulas Ask for diarrhoea or gastrointestinal problems
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| Side effects of medication (e.g. methotrexate) |
Take medical history of medications on regular basis but also those on demand and check the correct intake/dosage! Consider ulcerous variant of fixed drug eruption Consider variants of erythema multiforme variants and check integument
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| Topicals |
Some patients may use inappropriate emollients |
| Behcet's disease |
History of recurrent oral aphthae and genital aphthae, as well as uveitis/retinal vasculitis Mainly men – between 20 and 40 years Various other organs may be involved – skin, gastrointestinal tract, neurological, vascular disease or arthritis Positive pathergie test
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| Bullous diseases |
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| Traumatic cause |
Sexual intercourse/mechanic manipulation/dermatitis factitia |
| Malignant tumours |
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