Chancroid, LGV and Granuloma Inguinale. Genital ulcers are sores or breaks in the skin around the vulva, vagina, penis, anus or groin. In the UK, the most common causes are usually herpes and syphilis, but there are some rarer infections that can also cause genital ulcers.
Wikipedia also defines Genital Ulcers as an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents (fungal infections, secondary bacterial infections, or sexually transmitted infections such as genital herpes, syphilis or chancroid).
Three uncommon sexually transmitted infections linked with genital ulcers
Three uncommon sexually transmitted infections linked with genital ulcers are chancroid, lymphogranuloma venereum, and granuloma inguinale, also called donovanosis. These infections are rare in the UK, but they may be seen in people who have had sexual contact in areas where the infections are more common.
1. Chancroid
Chancroid is a sexually transmitted infection caused by a bacterium called Haemophilus ducreyi.
It usually causes painful genital ulcers. The sore may start as a small red bump, then become a blister or pustule, and later break down into a painful open ulcer. The ulcer may have rough edges, a yellow or grey base, and may bleed easily.
Some people also develop painful swollen glands in the groin. These swollen glands are sometimes called buboes and may become large or filled with pus.
Chancroid is now very rare in the UK and is also uncommon in many parts of Europe. It is more likely to be considered if someone has painful genital ulcers after sexual contact in a country where chancroid is still seen.
How is chancroid diagnosed?
Doctors will usually test for other more common causes of genital ulcers first, especially herpes and syphilis. A swab may be taken from the ulcer. Specialist testing, such as PCR or NAAT testing, is preferred where available.
How is chancroid treated?
Chancroid can be treated with antibiotics. BASHH guidance includes treatment options such as ceftriaxone injection or azithromycin tablets as single-dose treatments. Sexual partners should also be checked and treated if needed.
Sex should be avoided until treatment is completed and symptoms have settled.
2. Lymphogranuloma venereum
Lymphogranuloma venereum, often shortened to LGV, is caused by certain types of Chlamydia trachomatis bacteria.
LGV is different from the more common type of chlamydia infection. It can cause deeper inflammation and more serious symptoms, especially around the rectum and anus.
In recent years, LGV has mainly affected men who have sex with men, particularly those with other sexually transmitted infections, including HIV. However, it can affect anyone who has sexual contact with someone carrying the infection.
What symptoms can LGV cause?
LGV may start with a small sore, blister or ulcer where the infection entered the body. This early sore may be painless and can easily go unnoticed.
Later symptoms may include:
- Painful swelling of the glands in the groin
- Rectal pain
- Bleeding from the back passage
- Mucus or pus-like discharge from the anus
- Constipation or difficulty opening the bowels
- Feeling generally unwell, with fever or tiredness
In some people, LGV causes proctitis, which means inflammation of the rectum. This can sometimes look like inflammatory bowel disease, such as Crohn’s disease.
If untreated, LGV can lead to long-term problems such as scarring, narrowing of the rectum, fistulas, or long-term genital swelling.
How is LGV diagnosed?
Testing usually starts with a test for chlamydia from the affected area. This may be a rectal swab, genital swab, throat swab, urine sample or sample from an ulcer.
If chlamydia is found and LGV is suspected, the sample can be sent for more specific testing to look for LGV types.
People being tested for LGV are usually also offered tests for other infections, including gonorrhoea, syphilis, HIV, hepatitis C and herpes.
How is LGV treated?
LGV is treated with antibiotics. The usual first-choice treatment in BASHH guidance is doxycycline for 21 days.
Sexual partners should be tested and treated. Sex should be avoided until treatment is completed and follow-up advice has been given.
3. Granuloma inguinale / Donovanosis
Granuloma inguinale, also called donovanosis, is a rare sexually transmitted infection caused by a bacterium called Klebsiella granulomatis.
It is very uncommon in the UK and is mainly found in small areas of some tropical countries.
What symptoms can donovanosis cause?
Donovanosis usually causes painless ulcers around the genitals, anus or groin.
The sores may begin as firm lumps or nodules, then slowly break down into ulcers. These ulcers can look red and fleshy, may bleed easily, and can gradually enlarge if not treated.
Because the ulcers may be long-lasting or destructive, donovanosis can sometimes be mistaken for other conditions, including cancer.
Read also: Abnormal Uterine Bleeding (AUB)
How is donovanosis diagnosed?
BASHH testing guidance describes diagnosis using a sample from the ulcer. This may include:
- A smear from the ulcer examined under a microscope
- A biopsy, where a small sample of tissue is taken and examined in the laboratory
There are no widely available commercial DNA tests for donovanosis.
How is donovanosis treated?
BASHH’s previous donovanosis guideline has been retired, so current treatment advice is not available from BASHH’s website. Anyone suspected of having donovanosis should be referred to a specialist sexual health clinic for assessment and management.
When should you seek medical advice?
You should seek medical advice if you notice:
- A sore, blister or ulcer around the genitals, anus or groin
- Painful swollen glands in the groin
- Unusual genital or anal discharge
- Rectal pain or bleeding
- Symptoms after sex with a new partner or after sex abroad
Key message on Chancroid, LGV and Granuloma Inguinale: Rare Causes of Genital Ulcers
Chancroid, LGV and donovanosis are rare sexually transmitted infections, but they are important because they can cause genital ulcers, swollen glands and sometimes long-term complications if untreated.
Most genital ulcers are caused by more common infections such as herpes or syphilis, but if you have symptoms, especially after sexual contact abroad, it is important to attend a sexual health clinic for testing and treatment.
Early diagnosis protects your health and helps prevent passing the infection to others.
Do not try to diagnose yourself based on appearance alone. Many genital ulcers can look similar, and the right tests are needed to find the cause.
Remember, ALWAYS consult with your GP and/or your gynecologist for your specific treatment options. Every woman is different!
BASHH: British Association for Sexual Health and HIV