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