Diagnostik und Behandlung genitoanaler Ulzera infektiöser Genese

Diagnosis and therapy of genitoanal ulcers of infectious etiology



In dieser Übersichtsarbeit werden diagnostische und therapeutische Prinzipien genitaler Ulzera infektiöser Genese beleuchtet. Neben häufigen ursächlichen Infektionen werden auch seltene, jedoch differenzialdiagnostisch relevante Erkrankungen besprochen.

Material und Methoden

Dieser Arbeit liegen eine Pubmed-Literaturrecherche, Leitlinien diverser Arbeitsgruppen sowie klinische Erfahrungen zugrunde.


Herpes-simplex-Virus-Infektionen gefolgt von der Syphilis sind weiterhin die häufigsten Ursachen infektiöser genitaler Ulzera. Ein endemisches Auftreten früher in Europa seltener Infektionserkrankungen wurde in den letzten Jahren beobachtet. Insbesondere Risikogruppen wie Männer, die Sex mit Männern haben (MSM), Sexarbeiter oder Sextouristen sind hiervon betroffen. Auch seltenere Lokalisationen wie die Mundhöhle oder das Rektum [z. B. Lymphogranuloma venereum (LGV)-Proktitis] und eine atypische Klinik (z. B. Unterbauchschmerzen mit pelviner Lymphadenopathie bei LGV) müssen differenzialdiagnostisch in Betracht gezogen werden.


Erkrankungen durch STI (sexuell übertragbare Infektionen) nehmen seit einigen Jahren auch in den westlichen Industrienationen wieder erheblich zu. Bei allen diagnostisch unklaren Befunden im Genital- und Analbereich (aber auch in der Mundhöhle!) muss differenzialdiagnostisch wieder vermehrt an STI-Erkrankungen gedacht werden.



In this review article the diagnostic and therapeutic principles of genital ulcers of infectious etiology are highlighted. Besides frequent causative infections rare but relevant diseases in the differential diagnosis are discussed in detail.

Material and methods

A Pubmed literature search was carried out, guidelines from different task groups and clinical experiences are presented.


Infections with herpes simplex virus (first) and syphilis (second) are still the most common causes of infectious genital ulcers. An endemic occurrence, previously rare in Europe, has been observed in recent years. Particular risk groups, such as men who have sex with men (MSM), sex workers or sex tourists are affected. Even less common locations, such as the mouth or the rectum, lymphogranuloma venereum (LGV) and atypical clinical symptoms (e.g. pelvic pain in pelvic lymphadenopathy with LGV) must be considered in the differential diagnosis.


In recent years sexually transmitted infections (STI) have shown a significant increase in western industrialized nations. In all cases with unclear findings in the genital and anal areas (and also in the oral cavity) STI diseases must be reconsidered in the differential diagnosis.

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Correspondence to Prof. Dr. H. Schöfer.

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B. Malisiewicz und H. Schöfer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Malisiewicz, B., Schöfer, H. Diagnostik und Behandlung genitoanaler Ulzera infektiöser Genese. Hautarzt 66, 19–29 (2015). https://doi.org/10.1007/s00105-014-3551-3

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  • Sexuell übertragbare Infektionen
  • Syphilis
  • Herpes-simplex-Virus
  • Risikogruppen
  • Lokalisation


  • Sexually transmitted diseases
  • Syphilis
  • Herpes simplex virus
  • Risk groups
  • Locations