Genital Ulcers

A genital ulcer is an open sore or break in the skin on or around the genitals or anus. Symptoms vary depending on the underlying cause.

You may notice:

• A painful or painless sore
• Small blisters that break down into ulcers
• Itching, tingling, or burning before a sore appears
• Pain when passing urine if it comes into contact with the ulcer
• Swollen lymph nodes in the groin
• Unusual genital discharge
• Fever, headache, or body aches, particularly during an initial infection

Even if a sore is painless or appears to heal on its own, the underlying condition may still require treatment. If you notice any unusual sores or skin changes, seek a medical assessment.

Yes. Some genital ulcers cause little or no discomfort, so they can go unnoticed.

For example, the ulcer caused by early syphilis is often painless and may be hidden inside the vagina, on the cervix, or in the rectum. Mild herpes lesions can sometimes be mistaken for minor skin irritation or an ingrown hair.

If you've been at risk of an STI or have concerns about a possible ulcer, testing is recommended even if you have no obvious symptoms.

Untreated genital ulcers can lead to complications, depending on the underlying cause.

These may include:

• An increased risk of acquiring or passing on HIV
• Progression of infections such as syphilis, which can affect the heart, brain, and nervous system if left untreated
• More frequent or severe herpes outbreaks
• Secondary bacterial infection of the ulcer
• Scarring or ongoing pain
• Pregnancy-related complications with some infections

Early diagnosis and treatment can help prevent these complications.

The time it takes for a genital ulcer to develop depends on the underlying cause.

For example:

• Genital herpes: Symptoms usually appear 2–12 days after exposure.
• Syphilis: A painless ulcer typically develops around 3–4 weeks after exposure but can appear anywhere between 10 and 90 days later.

Because other causes have different incubation periods or may not be sexually transmitted, any new genital sore or ulcer should be assessed to determine the cause and whether treatment is needed.

A genital ulcer is a sore or break in the skin around the genitals or anus. The most common causes are sexually transmitted infections (STIs), but non-infectious conditions can also be responsible.

Common causes include:

• Genital herpes (herpes simplex virus)
• Syphilis
• Less common STIs such as chancroid or lymphogranuloma venereum (LGV)
• Skin conditions such as lichen sclerosus
• Inflammatory conditions, including Behçet's disease or Crohn's disease
• Physical trauma, friction, allergic reactions, or certain medications
• Fixed drug eruption

Because treatment depends on the underlying cause, any new genital ulcer should be assessed by a healthcare professional.

Several factors can increase your risk of developing a genital ulcer.

These include:

• Having unprotected vaginal, anal, or oral sex
• Having a new sexual partner or multiple partners
• Being exposed to an STI such as herpes or syphilis
• Having a weakened immune system
• Having certain inflammatory or skin conditions
• Injury or irritation to the genital skin

Not all genital ulcers are caused by infections, so medical assessment is important to determine the cause.

The best way to reduce your risk of genital ulcers is to lower your risk of the infections that commonly cause them.

You can help protect yourself by:

• Using condoms or dental dams during vaginal, anal, and oral sex
• Having regular STI testing, especially with new or multiple partners
• Vaccination against HPV and hepatitis B, where appropriate
• Avoiding sexual contact if you or your partner has a sore or ulcer until it has been assessed
• Discussing sexual health and STI testing with partners

Although condoms and vaccinations reduce the risk, they do not provide complete protection against infections spread through skin-to-skin contact, such as genital herpes.

Yes. Condoms reduce the risk of many STIs but do not cover all of the genital skin.

Infections such as genital herpes and syphilis can spread through direct skin-to-skin contact with affected areas that are not covered by a condom. If you develop a genital ulcer, it should be assessed to identify the cause and determine whether treatment is needed.

Kissing alone does not usually cause a genital ulcer.

However, infections such as herpes or syphilis can be passed from the mouth to the genitals during oral sex. For example, the virus that causes cold sores can cause genital herpes if it is transmitted through oral-genital contact.

If you notice a new genital sore after sexual contact, arrange a medical assessment.

It is very unlikely.

Most infections that cause genital ulcers spread through direct skin-to-skin sexual contact rather than by sharing towels, clothing, or toilet seats. Although there is a very small theoretical risk from sharing items such as razors immediately after use, this is not considered a common route of transmission.

If you develop a genital ulcer, seek medical advice to identify the underlying cause.

The risk is extremely low.

Transmission through blood transfusion is not considered a route by which genital ulcer disease is acquired. Genital herpes, the most common cause of genital ulcers, is not spread through blood transfusions because the virus remains within nerve cells rather than circulating in the bloodstream.

If you have a genital ulcer or are concerned about possible exposure to an STI, appropriate testing is recommended.

A genital ulcer is diagnosed through a combination of a medical history, physical examination, and laboratory tests.

Your healthcare provider will examine the ulcer and may recommend:

• A PCR swab of the ulcer to identify infections such as genital herpes
• Blood tests for infections such as syphilis and HIV

Testing helps determine the underlying cause so that the appropriate treatment can be started.

The tests used depend on the appearance of the ulcer and your symptoms.

Common tests include:

• A PCR swab taken directly from the ulcer to detect infections such as genital herpes
• Blood tests for syphilis and HIV, together with additional swabs or PCR tests where clinically indicated.

If the ulcer has already healed, blood tests may provide more useful information than a swab in some cases.

A diagnosis is based on your symptoms, examination findings, and test results.

Helpful information includes:

• When the ulcer first appeared
• Whether it is painful or painless
• Whether you have had similar sores before
• Any other symptoms, such as fever or swollen lymph nodes
• Recent sexual contacts and relevant travel history

Providing an accurate medical and sexual history helps ensure the right tests are performed.

Yes. Several conditions can resemble a genital ulcer.

These include:

• Skin conditions such as eczema, psoriasis, or lichen sclerosus
• Fungal infections that cause painful skin cracks
• Friction or minor injuries
• Allergic or irritant reactions
• Inflamed ingrown hairs or cysts

Because these conditions require different treatments, a medical assessment is recommended for any new genital sore.

Yes. While PCR swabs and blood tests are the main diagnostic tools, additional tests may be needed in some cases.

If a non-infectious skin condition is suspected, a healthcare provider may recommend a skin biopsy. This involves taking a small sample of tissue for examination under a microscope.

The type of testing depends on the suspected cause of the ulcer.

Not usually.

Although the appearance of the ulcer provides important clues, different conditions can look very similar. Laboratory tests, such as PCR swabs and blood tests, are usually needed to confirm the diagnosis and guide treatment.

No. It is not possible to reliably diagnose the cause of a genital ulcer at home.

Many infections and skin conditions can cause similar-looking sores, and the correct treatment depends on the underlying cause. If you notice a genital ulcer or any unusual sore, seek medical assessment rather than relying on self-diagnosis or over-the-counter treatments.

What is the long-term outlook for someone with a genital ulcer?

The long-term outlook depends on the underlying cause of the ulcer.

• Bacterial infections, such as syphilis, can usually be cured with appropriate antibiotic treatment.
• Viral infections, such as genital herpes, remain in the body but can be managed with antiviral medication. Many people find that outbreaks become less frequent and less severe over time.
• Non-infectious skin conditions may require ongoing treatment to control symptoms.

Early diagnosis and treatment help reduce the risk of complications and improve long-term outcomes.

No. Treatment does not make you immune to the conditions that cause genital ulcers.

If the ulcer was caused by a bacterial infection such as syphilis, treatment clears the infection, but you can become infected again if you are exposed in the future.

If it was caused by genital herpes, the virus remains in the body and can cause recurrent outbreaks, although these often become less frequent over time.

It depends on the underlying cause.

If recurrent genital herpes is responsible, antiviral medication may reduce the frequency of outbreaks. You can also help lower the risk of recurrences by:

• Managing stress where possible
• Getting enough rest
• Avoiding friction that may trigger symptoms

If ulcers are caused by another condition, preventing recurrence involves treating and managing that specific cause.

If the ulcer is caused by a sexually transmitted infection, it is important to tell your current or recent sexual partner(s).

This allows them to seek assessment and appropriate testing or treatment and helps prevent further transmission. If you're unsure of the cause, it's best to wait until you've been assessed and received a diagnosis before discussing the next steps with a healthcare professional.

If your genital ulcer is caused by an infection, you can reduce the risk of transmission by:

• Avoiding vaginal, anal, and oral sex until you have been assessed and, where appropriate, completed treatment
• Avoid sharing or using sex toys
• Using condoms or dental dams during sex, while recognising they do not eliminate the risk of infections spread through skin-to-skin contact
• Following any treatment as prescribed
• Informing recent sexual partners if an STI is diagnosed

Prompt diagnosis and treatment are the best ways to protect both your health and that of your partners.

Yes, some infections that cause genital ulcers can be passed to a baby during pregnancy or childbirth.

Genital herpes can be transmitted during vaginal delivery if there is an active outbreak at the time of labour.
Syphilis can pass through the placenta during pregnancy if left untreated.

Prompt diagnosis and treatment greatly reduce the risk of transmission. If you develop a genital ulcer during pregnancy, seek medical advice as soon as possible.

Yes. The risks depend on the underlying cause.

Genital herpes can lead to neonatal herpes if a baby is exposed during delivery, particularly if it is the mother's first infection late in pregnancy.

Untreated syphilis can cause serious pregnancy complications, including miscarriage, stillbirth, premature birth, or congenital syphilis.

Early diagnosis and treatment significantly reduce these risks.

Genital ulcers are uncommon during pregnancy, but they do occur.

The most common cause is genital herpes. Less commonly, ulcers may be caused by syphilis or certain skin conditions. Because some infections can affect pregnancy, any new genital sore should be assessed promptly.

Treatment for non-infectious causes (e.g. inflammatory skin conditions) will depend on the diagnosis and pregnancy stage.

• Genital herpes is usually treated with antiviral medication such as aciclovir, which is considered safe during pregnancy.
• Syphilis is treated with penicillin, which is safe in pregnancy and helps prevent infection from being passed to the baby.

Your healthcare provider will recommend the safest treatment based on your diagnosis and stage of pregnancy.

You can help reduce the risk by:

• Attending all routine antenatal appointments, including STI screening
• Using condoms if you or your partner may be at risk of an STI
• Avoiding sexual contact if your partner has active genital sores or oral herpes during oral sex
• Seeking medical advice promptly if you develop any genital sores or ulcers

If you have a history of genital herpes, your healthcare provider may recommend antiviral medication in the final weeks of pregnancy to reduce the risk of an outbreak during labour.

It can, depending on the cause.

Genital ulcers may make recovery after childbirth more uncomfortable if they are painful or become infected. However, most causes of genital ulcers do not prevent breastfeeding.

If herpes sores develop on the breast or nipple, breastfeeding from the affected breast should be avoided until the sores have completely healed. Speak to your healthcare provider about safe feeding options and any medications if you are breastfeeding.