Pockets of Doubt – Are Your Ulcerations Due To an STD?
What Types of STDs Cause Ulcerations?

Pockets of Doubt – Are Your Ulcerations Due To an STD?

Any abnormalities, particularly those that are visible and are causing some level of pain to the affected individual, are always a matter of great concern.

Any abnormalities, particularly those that are visible and are causing some level of pain to the affected individual, are always a matter of great concern.

Sure, there are a lot of things that may cause such abnormalities – leading us to assume that a condition is probably caused by another else entirely – but one should not forget that the critical factoid in this situation is the way that anyone would react when it comes to visible problems like blisters, ulcerations, and sores.

When it comes to the STDs, the manifestations are not always as evident and are often asymptomatic throughout its incubation period – only producing severe symptoms when the condition has already progressed into more severe complications. STDs are often confused with other diseases or perhaps physical irritation due to the highly similar symptomatic manifestations of the majority of these conditions. Adding the fact that it requires an in-depth laboratory examination to provide a comprehensive and conclusive view on whether it is an STD plaguing the infected individual, it is nearly impossible to offer a surefire diagnosis from looking at the symptoms alone.

Going back to the issue of skin abnormalities, upon seeing some changes within your genitalia, especially those that resemble wounds, ulcerations, and discharge-producing sores, one would automatically steer their assumptions towards STDs – and that is entirely understandable. STDs have this negative connotation that guides people to assume that they would only manifest in horrific odd-looking ways when infected – not considering that they might also have other systemic and more implicit manifestations that could not be observed by a simple physical examination of the region. This is the primary reason for various false self-diagnoses, leading to the misuse of antimicrobials that would then result in resistance – an issue that will do more harm than good in the long run.

The primary thing to remember when addressing abnormalities within the genitalia is that assumptions are no better than blindly ignoring the symptoms, as these would only often result in the abuse of precious medications that are slowly becoming less and less effective against pathogens. Without the appropriate laboratory tests that could provide you with an insight into the microscopic structure of the causative microorganism, an STD could mimic another condition, and a physical irritation may likewise mimic an STD. Ultimately, it becomes a notorious never-ending cycle that revolves around the lack of information and fear of the condition itself.

To avoid such repercussions from occurring, you must be familiar not only with the physical factors that could produce such manifestations but with the STDs that would likewise produce these symptoms along with other distinctive manifestations that would help in narrowing down the probable cause of your condition. Sure, self-medication is still discouraged at all costs, but the opportunity to have yourself tested with the proper procedure will produce better outcomes for your management, and of course, for your budget as well.

Sores and Blisters

Genital ulcers or ulcerations are breaks in the skin that are often found on or around the vagina and the penis. They have no specific description of what constitutes a genital ulcer, but they are generally round in shape, and they would sometimes precipitate pain or may produce some fluid from the open part of the wound. They may also be found in or around the anus, and they are generally evident with STIs that may include but are not limited to herpes, syphilis, and chancroid. The risk factor for this condition, particularly those that are found in the genitalia, is the practice of unsafe sexual intercourse or the overuse of potential irritants within the area. The disease may likewise be caused by other factors apart from infections – with sores resulting from the damage employed to the skin by physical or chemical conditions.

Classifications of Sores, Blisters, and Ulcers

The classification of these ulcerations is not necessarily particular in the most basic sense. Essentially, they are only distinguished depending on the probable cause of the condition and not the physical manifestations and characteristics of this symptom.

Sexually Acquired

Sexually acquired ulcerations are just like what its name suggests – they are acquired through sexual contact with another individual who is potentially carrying an infection that may have caused the manifestation of this condition. Such ulcerations are often sexually transmitted, and they are considered the most common type of genital ulcer.

Non-Sexually Acquired

Non-sexually acquired genital ulcerations are also coined as acute genital ulcerations – being particularly predominant in individuals who are not or not yet sexually active. This may be precipitated by various irritants being applied to the region, a trauma that may have caused an injury to the skin surface, or an inflammatory condition that may have been caused by another disease entirely.

Do I Have an STD if I See Sores Around My Genitalia?

The short answer? No. To make things simple, the assumption that an STD is causing your ulcerations is an understandable yet potentially dangerous one. The treatment regimen for sexually transmitted infections is commonly a course of antimicrobials – a medication that is notorious for its tendency to lose its potency with the rise of resistance along with its improper use. Immediately jumping towards the assumption that an STD is causing your condition – although it would allow you to employ abstinence just in case – would encourage you to take medications without the proper advice of a physician. Likewise, not knowing that an STD could cause such a manifestation would prompt you to ignore the presentations and allow the condition to progress to its severe complications.

Perhaps, the point in this charade is that equal knowledge of the probable causes is necessary for an informed decision rather than a shot at the dark. No, ulcerations are not necessarily indicative of an STD, but the possibility remains that it might. Although this outline will provide you with the distinctive characteristics of each probable condition, it should only be used to guide the proper testing and baseline management procedures. It should not be utilized as a guide towards complete healing.

Other Conditions that May Precipitate Sore Formation

To give you a more comprehensive insight into what other conditions may cause such manifestations, the following conditions are likewise known for their tendency to develop sores and ulcerations within the genitalia.

Vaginal Yeast Infection

Otherwise known as vulvovaginal candidiasis, this condition is likewise notorious for its tendency to develop symptoms that highly mimic other potential diseases, STIs and non-STIs alike. Vaginal yeast infections are known to develop ulcers or erosions within the area, but it is likewise found to cause an abnormal discharge from the genitalia. It may also include other symptoms like dysuria and pyuria, itchiness, and an increase and change to consistency of your discharge.

Viral Infection

Another type of infection that could cause the formation of blisters and sores is a viral infection, particularly the following causative microorganisms:

  • Epstein-Barr Virus
  • Cytomegalovirus
  • Varicella Zoster Virus

Among the three, the Varicella Zoster Virus or VZV is the most commonly known for its ability to cause chickenpox and shingles. The ulcerations and blisters that this condition can form may resemble a genital ulcer created by an STD. Still, considering that it also develops these ulcers in other parts of the body, it is relatively easier to distinguish the two conditions from each other. If you are somewhat doubtful of the potential presentations of your genital ulcers, you may opt to have yourself checked for an STD despite having an ongoing VZV infection.

Bacterial Infection

Similarly treated with antibiotics, other bacterial infections that are not transmitted through sexual contact may be mistaken for such as they could also be transmitted through a simple close physical contact with an infected individual. The manifestations could be highly similar, but do note that their management strategies could vary depending on the progression and the causative agent of the condition. Group A Streptococcus and Mycoplasma bacteria are some of the species known to develop sores within the genitalia.

Inflammatory Conditions

Inflammatory conditions, or autoimmune diseases that force the body to attack itself, are also conditions that might produce such ulcerations, especially as it continues to progress without any proper management procedure. These conditions would only often have small and sometimes unnoticeable lesions, but they may progress to full-blow ulcerations depending on the progression of the disease. Although most of these diseases can be diagnosed during childhood – allowing the affected individual to be aware of the potential manifestations of their condition later in life – it is still imperative for you to be mindful of such conditions, especially in late-onset cases or those that are only diagnosed upon presenting with a particular manifestation.

Some autoimmune conditions that may result in the formation of these sores may include:

  • Crohn’s Disease
  • Behcet’s Disease
  • Steven-Johnson Syndrome
  • Darier Disease
  • Erosive Lichen Planus
  • Pyoderma Gangrenosum
  • Hidradenitis Suppurativa

Trauma

As previously mentioned, physical contact with the particular skin surface may result in ulcerations, primarily when the contact has caused some level of damage or injury to the region of concern. Chronic friction, irritation with a particular fabric, allergies with the object of contact, or an extreme impact on the concerned area may all cause ulcerations depending on the severity of the reaction and the body's response towards this level of irritation. Although it is challenging to ascertain a particular causative outline for this condition, it might still be essential for you to be aware that such sources of damage are likewise a potential cause for the development of ulcerations.

Comorbidity with Other Conditions

Similar to how other non-sexually transmitted infections may cause blisters and ulcerations, other systemic conditions primarily located in other parts of the body may result in genital ulceration despite the lack of any connection (physical, that is) between the two regions. Conditions like tonsilitis, upper respiratory tract infections, and virus-borne diarrhea have all been found to cause genital ulceration in women. Although the connection between the disease and this particular manifestation is still being studied, it is still essential for you to be aware that this is possible in rare instances.

Use of Medications

Medications are essential for human life as they are used to manage infections, infestations, and systemic manifestations – prolonging the life of someone who could potentially contract a fatal complication without the proper management strategy. However, despite the benefits that are provided by the medications that various pharmaceutical companies have developed, it is still undeniable that side effects are a normal part of their design – creating some effects that are not necessarily wanted but are otherwise still inherent to the drug’s design because of its mechanism of action. Medications like nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonamides, and other antibiotics have been found to produce genital ulcerations upon intake. Consult your doctor for any side effects that you should expect from your prescribed medications.

Cancerous Lesions

Although it is notably more prominent in older women, vulvar cancer is likewise a condition that may produce ulcerations and lesions around the vagina as it progresses. Consult your physician regularly, especially considering that your risk factors increase as you age.

Skin Reaction with Products

Much like how physical contact and constant friction with the affected region could develop skin abnormalities, chemical products, especially scented ones like lotions and soaps, might cause some irritation when your skin is not entirely suitable for the product you have used. Observe the pattern of the manifestations and discontinue the product immediately if you could find some level of correlation between the use of the scented products and the formation of the lesions.

STDs That Result in the Formation of Sores

Genital Herpes

Symptoms

For most cases, infected individuals would often remain asymptomatic for the entire duration of the condition – urging people to mistake the condition for a simple skin problem, especially when the vesicles are not as prominent as one would expect from an STD. The common manifestation of genital herpes is herpes lesions and blisters around the genitals, rectum, and mouth, depending on the point of contact with the infected tissue during intercourse. The virus mainly colonizes mucosal tissues, manifesting in these areas after around 2 to 12 days of its incubation period following exposure. The manifestation of these blisters that then break off to form ulcerations is known as an “outbreak,” and this usually resolves on its own without any intervention after 2 to 4 weeks.

Recurrent outbreaks are likewise possible, but these are accompanied by prodromal symptoms, including genital pain and shooting painful or tingling sensation in the legs, hips, and buttocks. The first outbreak is often coupled with systemic symptoms that may include fever, body aches, swollen lymph nodes, and headaches, along with a longer duration of the visible lesions before healing.

Diagnostic Procedure

The main diagnostic procedure often employed for genital herpes is a nucleic acid amplification test (NAAT) due to its high sensitivity to the virus. However, it may also show false-negative results due to the intermittent viral shedding of the Herpes Simplex Virus or HSV. Type-specific virologic tests may also be employed depending on the availability of resources, but a confirmatory NAAT is still recommended to provide a conclusive result.

Management Strategy

Unfortunately, there is still no confirmed and approved cure for genital herpes, and the condition is allowed to minimize to levels where outbreaks are lessened and the transmission of the virus is avoided. Nevertheless, the provision of antiviral medications is still advised to prevent its further progression and allow an infected individual to resume their previous quality of life. Continuous medicines to suppress the virus are often recommended and prescribed by physicians.

Syphilis

Symptoms

Syphilis is a condition transmitted by the pathogen Treponema pallidum, and its manifestations are usually categorized into four different stages, depending on the severity and magnitude of the evident symptoms that the patient is experiencing. In the primary stage, the patient may develop syphilitic sores known as chancres, and these are usually firm, round, and generally painless. It usually appears at the first point of contact with the infected site, and the sores would last for 3 to 6 weeks following its initial presentation. On the one hand, the secondary stage is where skin rashes and mucous membrane lesions would be more apparent in the mouth, vagina, or anus. It may also be accompanied by swollen lymph glands, sore throat, fever, hair loss, headache, and weight loss. The latent stage is when the condition undergoes clinical latency – showing no signs and symptoms throughout this duration. Lastly, tertiary syphilis is the relatively rare stage that only occurs when the disease progresses to more severe complications. This phase may affect the brain, nerves, heart, eyes, liver, bones, and joints.

Diagnostic Procedure

Treponemal tests are commonly utilized to diagnose syphilis as they can detect antibodies of the pathogen as early as possible and detect the antibodies for life. However, although treponemal tests are arguably more sensitive than non-treponemal ones, non-treponemal tests are likewise required for positive results in the former procedure due to its tendency to detect antibodies even following a previous infection that was already resolved.

Management Strategy

The recommended medication for most cases of syphilis in any age and stage is 2.4 million units of Benzathine Penicillin G, administered in a single dose intramuscularly. However, this medication may be altered by the physician depending on the severity of the condition and any compatibility issues that the patient may have with this drug. Furthermore, presentations of syphilis in other parts of the body may likewise require a different medication that could specifically target the sensitive organs that were invaded by the pathogen. Lastly, although a combination of penicillin variants would often be used as an alternative regimen, some are not suitable to replace Benzathine Penicillin G.

Chancroid

Symptoms

Chancroids would often result in the formation of a reddish papule that often appears following the 4 to 10 days of the incubation period and a microtrauma or abrasion within the infected sites. This rare condition usually affects the corona, prepuce, and glans of the penis in men, while it manifests in the labia and perianal areas when it comes to women. The sores would often appear with an uneven edge, slowly growing until it turns into an extremely painful ulcer, sometimes known as a “soft chancre.” Depending on the level of abrasion, kissing ulcers or multiple ulcers in adjacent areas could likewise be formed due to the contact between the two regions. The ulcers would usually resolve in 1 to 3 months on their own, and throughout this duration, it may produce a yellow-grayish discharge. The ulcer itself is susceptible to bleeding even upon minor friction. It might also be essential to note that a small portion of affected individuals may develop lymphadenopathy wherein their lymph nodes may become swollen and infected – potentially becoming superinfected, wherein it could cause tissue damage that could change the structure of the genitalia.

Diagnostic Procedure

The commonly accepted diagnostic procedure for chancroids is the use of a special culture media designed to allow the growth of Haemophilus ducreyi – the causative agent of chancroids. The medium itself is not available commercially, and the sensitivity rate, at best, of this procedure only averages at around 80%. NAATs are not particularly recommended when utilized using its conventional process, but specially-altered NAATs may be used depending on the accuracy of the test administered to the patient.

Management Strategy

Antimicrobial therapy of varying durations and doses may be administered to the patient depending on the severity and progression of the condition. The patient may be prescribed Azithromycin, Ceftriaxone, Ciprofloxacin, or Erythromycin depending on the physician's clinical judgment, with its doses varying depending on the drug prescribed. In cases where the infection has resulted in structural damage, the antibiotic regimen cannot reverse the damage done and may require supportive reconstructive therapy to address these further problems.

Chlamydia

Symptoms

Chlamydia is coined as the “silent” infection due to its great tendency to remain asymptomatic for the duration of the disease – only providing evident symptoms when the condition has progressed into its more severe stages. With such variability in its presentations, the CDC is yet to determine an actual incubation period for the pathogen itself – making it harder for physicians to provide a more accurate initial diagnosis from the presentations and reports about the sexual activity of an infected individual alone.

In women, the infection mainly manifests within the cervix, causing an endocervical discharge and bleeding that may be observed if the patient is part of the symptomatic population. They may also experience a burning or painful sensation when urinating, and the infection may likewise affect the upper reproductive tract to produce more severe complications that could lead to permanent damage.

Conversely, males may likewise experience discomfort during urination, and a mucoid or watery discharge may also be observed.

Diagnostic Procedure

Several diagnostic processes may be employed for the diagnosis of chlamydia. However, NAATs are still considered the more sensitive option that could provide physicians with a more accurate and conclusive outlook into the patient's condition. Vaginal swabs and urine are the most common samples required from the patient for NAATs, and self-collection of the samples is sometimes allowed depending on the verification process of the pertinent laboratory performing the required test.

Management Strategy

Similar to how other infections are managed, the treatment of chlamydia likewise entails a 7-day course of antibiotics prescribed by an authorized physician to eliminate the presence of the pathogen from the body of the infected individual. Physicians also recommend that patients undergoing treatment employ abstinence throughout the 7-day treatment period or seven days following the intake of a single dose treatment regimen. Reinfection is likewise raised as a potential concern – informing individuals that immunity is not developed after a successful treatment when exposed to the pathogen.

Donovanosis (Granuloma Inguinale)

Symptoms

Donovanosis, also known as Granuloma Inguinale, is a condition that is caused by the pathogen Klebsiella granulomatis, and it is a chronic and relapsing condition that is endemic in tropical and developing countries such as India, Guyana, New Guinea, Central Australia, and Southern Africa. The usual incubation period of the condition is around 1 to 12 weeks following exposure, and it mainly begins with the manifestation of painless nodules that would break off to form ulcerations that have a deep-red base in its center. Although the lesions are primarily evident in the genitalia, they could likewise appear in skin, perineal areas, lower abdomen, and thighs. The condition again coexists with other secondary infections due to the susceptibility introduced by the deep ulcerations following the formation of the nodules.

Diagnostic Procedure

The diagnostic process for donovanosis is the visualization of the Donovan bodies – otherwise described as the presence of the pathogen within macrophages upon staining and testing. It is usually performed using dark staining of the Donovan bodies inside a tissue sample (possibly obtained through a biopsy), but the procedure itself is challenging to achieve, and the necessary equipment is not routinely available in testing areas.

Management Strategy

The following antimicrobial regimens have been found to halt the progression of the lesions, but relapse was still observed to occur 6 to 8 months following successful therapy for Donovanosis:

  • Azithromycin: 1 g once a week or 500 mg daily for more than three weeks until lesions have healed
  • Doxycycline: 100 mg orally twice a day for at least three weeks until lesions have healed
  • Erythromycin: 500 mg orally four times a day for at least three weeks until lesions have healed
  • Trimethoprim-Sulfamethoxazole: one double-strength tablet orally twice a day for at least three weeks until lesions have healed

Testing Options That You May Check Out for Potential Infections

If, upon examination of your symptoms with this writing as a guide, you have potentially narrowed down the root cause of your condition to a particular STD, the following testing sites will be of great help in providing you with a more accurate initial diagnosis before your scheduled visit to your physician:

Laboratory

Chancroid

Chlamydia

Syphilis

Donovanosis

Herpes

Package Prices

What it Offers

STD Check Labs

No

Yes

Yes

No

Yes

Maximum expenses of $99

  • Trichomoniasis and Donovanosis tests unavailable
  • Obtain result in 1 to 2 days
  • On-site sample collection and testing
  • Purchasing the package panel will provide a more comprehensive routine test

myLAB Box

Yes

Yes

Yes

No

Yes

8-Panel STD Kit at $269.00

  • Obtain results in 2 to 5 days
  • Collect samples privately
  • At-home testing kit
  • Utmost confidentiality
  • Multiple sample types available to collect

HealthLabs

Yes

Yes

Yes

No

Yes

Maximum expenses of $298

  • Obtain results in 1-3 days
  • Trichomoniasis testing is available in only 2 packages
  • Donovanosis testing not included in any packages
  • Orders performed by phone or online

GetTested (CDC)

Yes

Yes

Yes

Yes

Yes

Free to use

  • Free search engine utilized to provide available testing laboratories within your area

Note: All testing options are not currently covered by insurance plans as it would nullify the confidentiality feature of these testing options

Frequently Asked Questions

Do chancroids resolve even without proper management?

In the most ideal cases, yes. However, it should not be construed as an avenue not to test yourself, as complications may still arise from this condition.

What are the complications of untreated chancroids?

The primary complication of chancroids is the disfigurement of the genitalia due to severe damage to the region. This formation of ulcerations primarily brings this about.

What is the incubation period of chancroids?

The incubation period is relatively short, ranging from 2 to 10 days and maxing out at around ten days.

Is fever a common symptom of chancroid progression?

Not necessarily. Fever is only precipitated once the infection reaches the lymph nodes – causing other symptoms like chills and malaise along with it.

What is the average incubation period of donovanosis?

The average incubation period of donovanosis could last for as long as 50 days. Longer periods may reach even up to a year.

Is donovanosis as rare as trichomoniasis?

It is hard to ascertain that one condition is rarer than the other, but yes, donovanosis can be construed as a condition somewhere along with the same rarity as trichomoniasis and shigellosis.

Can you acquire an STD if an infected person used the toilet seat previously?

No. STDs are mainly transmitted through sexual contact and not through casual physical contact – much less remote contact with inanimate objects exposed to an infected individual.

References

Mark Riegel, MD
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