Herpes Simplex Virus (HSV) in the genital areas is more commonly type 2 although type 1 occurs as well. Painful grouped vesicles develop into pustules and then erode into ulcers. Bilateral tender adenopathy usually occurs. Commonly, a primary genital outbreak is accompanied by flu-like symptoms in individuals without previous exposure to either HSV 1 or HSV 2. The diagnosis is made by Tzanck prep, viral culture or fluorescent antibody stains. The ulcers are self limited but antivirals such as acyclovir may be used to hasten resolution. HSV is not curable and a few individuals will have reoccurrences. Antivirals may be used to reduce the number and severity of recurrences.

The name of the ulcer caused by Treponema pallidum is "chancre." Classically, it is a single painless indurated ulcer with non-tender regional adenopathy. Unfortunately, the picture can become confused if the ulcer becomes secondarily infected. Blood tests such as Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL) may not be positive when the ulcer first occurs. The serous fluid from the base of the ulcer can be sent for dark field microscopy or fluorescent antibody staining. Although the ulcer is self limited, systemic infection may occur causing secondary and tertiary syphilis. The ulcer is usually treated with an intramuscular injection of penicillin.

Hemophilus ducreyi is the cause of chancroid. Usually there are multiple painful ulcerations with scalloped edges and a red halo. Tender regional adenopathy occurs in about 60% of cases and may suppurate forming buboes. Laboratory tests are not readily available. The Centers for Disease Control recommends presumptive treatment. A one time dose of azithromycin or ceftriaxone is often used.

Lymphogranuloma venereum (LGV) is rare in the United States. It is caused by LGV serovars of Chlamydia trachomatis. Often the initial papule or ulcer goes unrecognized. Buboes (swollen, fluctuant lymph nodes) may develop. The best test is the serum complement fixation titer but it is only 80% sensitive. Treatment consists of twenty-one days of doxycycline or erythromycin.

Most genital warts are condylomata acuminata, caused by the human papillomavirus (HPV). "Acuminata" refers to the finger-like papillae that compose most warts giving them their cauliflower like appearance. There are many different HPV types. Some types are predisposed to causing condylomas while others are more likely to cause cervical dysplasia and anogenital malignancies. Condylomas are often diagnosed clinically but specimens can be sent for pathology. They resolve over time but can be treated with lasers, chemicals (e.g., podophyllin, trichloroacetic acid), or liquid nitrogen.

Condyloma lata are a much less common cause of genital warts. They are a form of secondary syphilis and are usually flat and moist. They are diagnosed by clinical appearance along with a positive RPR. They resolve over time but may progress to tertiary syphilis and so are treated with a intramuscular injection of penicillin