Introduction Non-sexually transmitted genital ulcers are a cause of significant morbidity among sexually active young men and women. Establishing the underlying cause of the genital ulcer and differentiation from sexually transmitted infections may be challenging for the treating physician.
Case reports Patient data were collected from a STD clinic in a tertiary care hospital in south India from 2008 to 2010. All the patients were routinely screened for syphilis and HIV infection. Smears from the ulcers were taken and stained with Gram stain and/or Giemsa stain. Biopsy from the ulcer edge was taken whenever indicated. Following causes for non-sexually transmitted genital ulcers were recorded: Behcet's disease was seen in two male patients. Infectious ulcers; One pregnant woman presented with multiple painful genital ulcers caused by Klebsiella spp. An HIV infected man on antiretroviral therapy presented with ecthyma gangrenosum of scrotum with unilateral lymphadenopathy caused by Pseudomonas sp. Chancroid-like ulcers; a monogamous, HIV-negative office worker and an HIV positive widow, sexually inactive since 5 years, presented with multiple, small shallow genital ulcers with excruciating pain simulating herpes genitalis. The ulcers did not respond to adequate therapy with acyclovir and organism could not be demonstrated on gram stain or bacterial culture. In both the cases, the ulcers healed completely with azithromycin. Factitious ulcer; seen over the shaft of penis in an unmarried man. Genital apthae due to chikungunya fever; during an epidemic of chikungunya fever in the region, 25 patients with acute disease presented with multiple aphthous ulcers involving scrotum, penoscrotal junction and adjacent crural region. Skin biopsy from the ulcers reveals lymphocytic vasculitis.
Conclusion Causes of genital ulcers in patients referred to STD clinic may be varied. Atypical cases must be examined with care to identify the cause. Counselling plays an important role in the management of patients with non-sexually transmitted genital ulcer.
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