Version May 2024
| Primary syphilis | Genital herpes | Chancroid | Lymphogranuloma venereum | Donovanosis | |
| Etiology | Treponema pallidum. | Herpes simplex. | Haemophilus ducreyi. | Chlamydia trachomatis. | Klebsiella granulomatis. |
| Incubation period | 9 to 90 days; average 2 to 4 weeks. | 2 to 7 days. | 1 to 35 days; average 3 to 7 days. | 3 days to 3 weeks; average 10 to 14 days. | Precise data unavailable; probably a few days to several months. |
| Number of lesions | Usually single lesion, but multiple lesions may occur. | Multiple; may coalesce; more lesions appear in primary episodes than in recurrences. | Usually 1 to 3, but multiple lesions may occur. | Usually single. | Single or multiple. |
| Appearance of genital ulcers | Sharply demarcated round or oval ulcer with slightly elevated edges; may be irregular or symmetrical ("kissing chancre"). | Small superficial grouped vesicles and/or erosions; lesions may coalesce, forming bullae or large areas of ulceration; lesions have irregular borders. | Deep, sharply demarcated ulcer; irregular ragged undermined edge; ranges in diameter from a few mm to 2 cm. | Papule, pustule, vesicle, or ulcer; discrete and transient; frequently overlooked. | Sharply defined irregular ulcerations or hypertrophic, verrucous, necrotic, or cicatricial granulomas. |
| Base | Red, smooth and shiny, or crusted; serous exudate occurs when squeezed. | Bright, red, and smooth. | Rough, uneven, yellow to gray in color. | Variable. | Usually friable, rough, beefy granulations; can be necrotic, verrucous, or cicatricial. |
| Induration | Firm; does not change shape with pressure. | None. | Soft; changes shape with pressure. | None. | Firm granulation tissue. |
| Pain | Painless; may become tender if secondarily infected. | Common; more prominent with initial infection than with recurrences. | Common. | Variable. | Rare. |
| Inguinal lymphadenopathy | Unilateral or bilateral; firm, movable, and nontender; do not suppurate. | Usually bilateral, firm, and tender; more common in primary episodes than in recurrences. | Unilateral (rarely bilateral); overlying erythema; matted, fixed, and tender; may suppurate. | Unilateral or bilateral; initially movable, firm, and tender; later indolent; fixed and matted; "sign of Groove" may suppurate; fistulas. | Pseudobuboes; subcutaneous perilymphatic granulomatous lesions that produce inguinal swelling. |
| Constitutional symptoms | Rare. | Common in primary episode; less likely in recurrences. | Rare. | Frequent. | Rare. |
| Course of disease if untreated | Slowly resolves to latency (2 to 6 weeks). | Typically recurs. | May progress to erosive lesions. | Local lesions heal; systemic disease may progress; disfigurement; late complications. | Worsens slowly. |
| Diagnostic tests | Darkfield exam, direct immunofluorescence, FTA-ABS, VDRL, RPR. | Culture, PCR, direct immunofluorescence, serology, Tzanck smear, Pap smear, electron-microscopy, direct immunoperoxidase staining. | Culture, biopsy (rarely done); Gram stained smears have low specificity. | LGV complement fixation test; isolation of the microorganism by culture. | "Donovan bodies" in tissue smears; biopsy. |
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