Genital and oral ulcers
Approach to oral and anogenital ulcers; HSV, syphilis, mpox, LGV and donovanosis versus aphthae, Behçet syndrome, drugs and blistering disease, the PCR-plus-serology work-up, benzathine penicillin during the shortage, and EULAR 2025 Behçet treatment.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- In Australia the commonest cause of an anogenital ulcer is HSV, then syphilis. Mpox, LGV and drug eruptions are less common; donovanosis and chancroid are now very rare.
- Every anogenital ulcer gets HSV PCR, syphilis PCR and syphilis serology, HIV testing and a full STI screen. Add mpox PCR when the history fits.
- Recurrent oral aphthae are common and usually benign. Oral plus genital ulcers with eye, skin or vascular disease suggest Behçet syndrome.
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Sources
- Australian STI Management Guidelines for Use in Primary Care: syphilis (updated 13 October 2026), donovanosis, genital herpesAU/NZASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine), Current online edition, checked November 2026
- Therapeutic Guidelines: Dermatology (oral mucosal disorders) and Antibiotic (genital ulcers)AU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (topic version not verified)
- Workowski KA et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70(4):1-187US Centers for Disease Control and Prevention, 2021 (latest full edition; later CDC topic updates not checked)
- Hatemi G et al. EULAR recommendations for the management of Behçet's syndrome: 2025 update. Ann Rheum Dis 2026;85:1010-25European Alliance of Associations for Rheumatology (EULAR), 2025 update (replaces 2018)
- International Team for the Revision of the International Criteria for Behçet's Disease. The International Criteria for Behçet's Disease (ICBD). J Eur Acad Dermatol Venereol 2014;28:338-47Journal of the European Academy of Dermatology and Venereology, 2014
- Hatemi G et al. Trial of apremilast for oral ulcers in Behçet's syndrome (RELIEF). N Engl J Med 2019;381:1918-28New England Journal of Medicine, 2019
- Last updated
- 14 November 2026
What changed
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