Clinical Features of Genital Ulcers
| Feature | Syphilis | Herpes | Chancroid | Lymphogranuloma Venereum | Donovanosis |
|---|---|---|---|---|---|
| Incubation period | 9-90 days | 2-7 days | 1-14 days | 3 days-6 weeks | 1-4 weeks (up to 6 months) |
| Early primary lesions | Papule | Vesicle | Pustule | Papule, pustule, or vesicle | Papule |
| No. of lesions | Usually one | Multiple | Usually multiple, may coalesce | Usually one; often not detected, despite lymphadenopathy | Variable |
| Diameter | 5-15 mm | 1-2 mm | Variable | 2-10 mm | Variable |
| Edges | Sharply demarcated, elevated, round, or oval | Erythematous | Undermined, ragged, irregular | Elevated, round, or oval | Elevated, irregular |
| Depth | Superficial or deep | Superficial | Excavated | Superficial or deep | Elevated |
| Base | Smooth, nonpurulent, relatively nonvascular | Serous, erythematous, nonvascular | Purulent, bleeds easily | Variable, nonvascular | Red and velvety, bleeds readily |
| Induration | Firm | None | Soft | Occasionally firm | Firm |
| Pain | Uncommon | Frequently tender | Usually very tender | Variable | Uncommon |
| Lymphadenopathy | Firm, nontender, bilateral | Firm, tender, often bilateral with initial episode | Tender, may suppurate, loculated, usually unilateral | Tender, may suppurate, loculated, usually unilateral | None; pseudobuboes |
Source: From RM Ballard, in KK Holmes et al (eds): Sexually Transmitted Diseases, 4th ed. New York, McGraw-Hill, 2008.