Understanding and addressing sexually transmitted infections (STIs) is of utmost importance when it comes to protecting our sexual health. In this comprehensive discussion, we will delve into the topic of STIs that can lead to genital ulcers. By exploring the symptoms, methods of transmission, and the criticality of early detection and treatment, we aim to emphasize the significance of knowledge and awareness in safeguarding our well-being.

How common are the sexually transmitted infections?

Short answer: Surprisingly common! The World Health Organization reveals that there are approximately 1 million new cases of STIs diagnosed every day worldwide. It’s astonishing to note that many of these infections show no symptoms. In 2018, the CDC estimated that about 68 million people, or 1 in 5 individuals living in the United States, were affected by STIs. That’s a pretty huge number.

Now let’s talk about the 5 most common ulcerative sexually transmitted infections:

1-GENITAL HERPES

This is the most widely known cause of genital ulcers. Its prevalence in the United States is 12%, with an incidence of 572 000 new cases every year. The causative agents of genital herpes are two strains of virus of the Herpes family, Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2). These viruses can be transmitted through skin-to-skin contact, most commonly during sexual activities. HSV-2 is the primary culprit for genital herpes, although HSV-1 can also lead to genital infections.

Genital herpes can be asymptomatic, but when it is one of the symptomatic cases, it is hard to miss. It is mainly characterized by clusters of painful vesicles containing clear fluids, which subsequently turn into exquisitely painful superficial ulcers on or around the genitals or anal region. These ulcers may be accompanied by itching, burning, and flu-like symptoms, such as fever and body aches.

While anti-viral medication, such as acyclovir, can shorten the duration of the symptoms, genital herpes remains an incurable infection. The virus has the capability to “hide” in a dormant state regional ganglion and reactivate whenever the immune system is not paying attention (Read also “WHY DOES YOUR HERPES KEEP COMING BACK“?).

2- SYPHILIS

This STI incidence has been in sharp rise during the past decade. The CDC reported 176,713 new cases of syphilis (all stages) in 2021, men having sex with men (MSM) being the most impacted.

Syphilis, caused by the bacterium Treponema pallidum, is a multi-stage STI known for its varied and complex progression. In its primary stage, it initially presents with a firm red papule which evolves into a painless, firm ulcer with a clean base called a syphilitic chancre. The edges around the chance is slightly elevated as opposed to the herpetic ulcer. It typically appears at the site of infection, often the genitals. This stage usually occurs a few weeks after exposure.

If syphilis is not promptly addressed, it can progress into advanced stages and result in severe complications such as neurosyphilis and aortitis. Additionally, there is a risk of vertical transmission from an infected pregnant woman to her fetus, causing grave congenital malformations. Early detection through regular STI testing and timely treatment with antibiotics are vital to prevent the progression of syphilis and its complications.

3-CHANCROID

This one might sound a little bit unusual. Indeed, it is relatively rare in comparison to the other STIs. In 2019, there were only eight cases reported by the CDC. However, the true incidence of chancroid might be underestimated due to the unvailability of diagnostic resources and the difficulty of culturing the causative organism, Haemophilus ducrei.

Chancroid begins as a papule which quickly progress to a pustule and painful ulcer formation. The ulcer is typically soft (a soft chancre) and supurative with a dirty base as opposed to the clean-based indurated syphilitic chancre. It is also usually accompanied by large apainful inguinal lymphadenopathy that can also ulcerate.

Chancroid may seem unpleasant, but the good news is that it is highly treatable and does not typically lead to serious complications, especially when detected early. Rest assured, with proper care and treatment, one can overcome this condition without major difficulties.

4-GRANULOMA INGUINALE

It is also called Donovanosis. The causative agent is bacterium named Klebsiella granulomatis. It is mainly prevalent in tropical region where warm and humidity facilitates its transmission.

This rare STI is characterized by slowly progressive genital ulcers that can be painless and cause tissue destruction. The ulcers often have a beefy-red appearance and can bleed easily upon contact.

Untreated infections can have significant consequences, including potential complications such as genital disfigurement, secondary bacterial infections, and lymphedema/elephantiasis. Even with treatment, donovanosis can leave lasting effects, such as extensive fibrosis and stricture. It is crucial to promptly diagnose this condition through thorough clinical examination and utilize appropriate antibiotic treatment.

5-LYMPHOGRANULOMA VENEREUM

Lymphogranuloma venereum is caused by Chlamydia trachomatis, the same old Chlamydia that causes urethritis and pelvic inflammatory disease that we all know, but different serovars (L1, L2, L3). It is more commonly seen in tropical and subtropical regions, as well as among individuals engaging in high-risk sexual behaviors.

Lymphogranuloma venereum (LGV) is an infectious disease that can cause genital ulcers. These ulcers are often accompanied by swollen lymph nodes in the groin region. As the infection progresses, more severe symptoms may arise, such as genital swelling. It can also proctocolitis, particularly among individuals engaging in receptive anal intercourse, cause rectal pain and bleeding. These cases can be confusd with other gastrointestinal conditions causing colitis.

It is worth noticing that the danger of these ulcerative genital infections is, other than how scary they can look, the increased risk of HIV transmission they carry with them. As we know, a damaged skin or mucosa is the easiest portal of entrance of any microorganism.

Understanding the STIs that can cause genital ulcers is vital for promoting sexual health and well-being. To minimize the risk of infection and transmission, individuals should practice safe sex, communicate openly with partners, and undergo regular STI testing. If any symptoms, including genital ulcers, are experienced, seeking prompt medical attention is essential. Early diagnosis and appropriate treatment can significantly impact an individual’s quality of life and prevent the progression of potentially serious complications. By being informed and proactive, individuals can take charge of their sexual health and contribute to the prevention of STIs in their communities.

Yours in good health

MDLINE HEALTH