Genital ulcer disease: current challenges and perspectives

Aim. To analyze the role of etiological factors of genital ulcer disease based on data from professional literature and to develop proposals for improving diagnostic algorithms, as well as a syndromic approach to treatment and prevention, in particular, regarding current trends in world medical practice. Materials and methods. Full-text articles were searched and analyzed in Google Scholar, Scopus, PubMed, and Web of Science databases. The search was performed using the following key terms: genital ulcer disease, genital herpes, syphilis, chancroid, lymphogranuloma venereum, donovanosis. Statistical data from the European Center for Disease Prevention and Control and the Centers for Disease Control and Prevention in the United States were also used. Results. The World Health Organization pays considerable attention to sexually transmitted diseases and more specifically discusses the effective management and treatment of genital ulcers. The main causes of genital ulcers are infections caused by five major pathogens: herpes simplex virus type 2, syphilis, chancroid, donovanosis and lymphogranuloma venereum. According to recent studies, herpes simplex virus type 2 and syphilis remain the leading pathogens among infections that cause genital ulcers, but their role differs depending on the region and socioeconomic factors. The most important among these pathogens are herpes viruses due to the ability to cause recurrent and lifelong infection that are perhaps the main cause of genital ulcers. Infections such as chancroid and donovanosis are gradually decreasing in prevalence even in regions where they were more common in the past owing to changes in sexual behavior and improved access to modern means of prevention. Conclusions. For effective treatment and diagnosis of genital ulcer disease and associated asymptomatic urogenital infections, it is important to improve diagnostic algorithms that will allow to identify the causative agents accurately and apply a comprehensive approach to treatment. An important area is the development of vaccines that will provide long-term immunity against major pathogens, in particular herpes simplex viruses and lymphogranuloma venereum, and thus will help to increase the protection of populations as well as reduce recurrences and antimicrobial resistance.