Table 1.

Ulcer

Differentiating factors

Primary syphilis

Painless ulcer with regional adenopathy.  Visualization with dark field microscopy.  Serologic VDRL positive with secondary confirmation i.e FTA-Abs

Chancroid

Painful ulcer with tender suppurative adenopathy. Culture showing H.ducreyi

Condyloma acuminata

Painless or pruritic lesion.  May have cauliflower or verrucous eruptions. Polymerase chain reaction test may show HPV type.

Leishmaniasis

Ulcer with adenopathy.  Biopsy border of the lesion with Giemsa stain, indirect fluorescent antibody testing.

Squamous cell carcinoma

Biopsy