The diagnosis and treatment of genital ulcers is of particular importance for decreasing the risk of HIV transmission between discordant partners. While some genital ulcers present with pain, others are relatively asymptomatic. As a routine part of the medical history, the practitioner should ask every patient if he or she has noticed bumps, sores, or ulcers on the genitalia. Worldwide, the causative organisms for genital ulcers vary greatly. In Haiti, the most common cause of a painless genital ulcer is syphilis.

Chancroid is another common form of genital ulcers. Unlike syphilis, chancroid presents with painful single or multiple ulcers and, often, enlarged inguinal nodes. Herpes simplex virus (HSV) can also present as painful ulcers, appearing as multiple, small vesicular lesions. There is no cure for HSV. Patients, especially HIV-infected patients suffering from chronic herpes outbreaks, should be offered acyclovir for symptom relief and suppressive therapy. Granuloma inguinale (also called donovanosis) presents as large, painless, nodular and spreading ulcers not associated with lymphadenopathy. Lastly, lymphogranuloma venereum (LGV) causes a painless ulcer at the genital site of inoculation and then spreads, involving the inguinal or perirectal lymph nodes (so-called “tropical bubo”); such nodes are tender and may eventually suppurate. If buboes are present, they should be drained by needle aspiration through healthy skin. If suppuration occurs, TB should be ruled out by performing AFB analysis on the purulent discharge. Long-term sequelae of LGV include rectovaginal fistula, proctocolitis, and elephantiasis of the genitals due to lymphatic obstruction. Decisions regarding treatment for syphilis, chancroid, granuloma inguinale, or LGV should be made based on local epidemiology per Protocol 2.9.