Genital Ulcers as a Manifestation of COVID-19: A Detailed Exploration of Diagnosis and Clinical Significance


Genital ulcers can present as a clinical manifestation with various underlying causes, including viral infections, autoimmune diseases, and sexually transmitted diseases (STDs).

Among the viral infections, Herpes zoster virus (HZV) types 1 and 2, Epstein–Barr virus (EBV), cytomegalovirus (CMV), and others can contribute to the development of genital ulcers.

Autoimmune diseases such as Behcet’s disease, Reiter’s syndrome, and psoriasis are also potential causes. Additionally, sexually transmitted diseases can lead to the formation of genital ulcers.

In a study conducted by Krapf et al. (2021), it was suggested that Lipschütz ulcers, which are reactive non-sexually related genital ulcers in adolescent women, could be associated with COVID-19 infection. However, another study reported that genital ulcers as a manifestation of COVID-19 infection were rare and uncommon.

While multiple viral infections like HZV, HIV, CMV, and EBV have been known to trigger Lipschütz ulcers, the inclusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this list should be considered based on reports associating it with these ulcers (Jacyntho et al., 2022).

Autoimmune diseases have also been identified as potential causes of genital ulcers, as mentioned earlier. Daunt et al. (1982) reported a case of a woman with Reiter’s syndrome who exhibited genital manifestations. In some cases, the skin manifestations of Reiter’s syndrome may be localized to the genital area and may be accompanied by other lesions. The diagnosis of Reiter’s syndrome is established by ruling out other possible causes through multiple laboratory tests.

Behcet’s disease is another autoimmune disease that has been associated with genital ulcers. It is a chronic, recurrent, multisystemic vasculitis that can present with various clinical manifestations. In a study by Guedes-Barbosa (2019), it was reported that genital ulcers can be one of the manifestations of Behcet’s disease. The author described a case where the patient experienced recurrent oral and genital ulcers along with a history of erythema nodosum.

Although most studies reporting genital ulcers as a complication of COVID-19 infection have focused on female patients, there is limited evidence regarding genital manifestations in men. Nevertheless, our findings align with previous studies, underscoring the importance of recognizing genital manifestations as a potential complication of COVID-19. However, it is crucial to establish a diagnosis by ruling out other possible causes through appropriate laboratory tests.

In conclusion, COVID-19 can exhibit a wide spectrum of clinical manifestations and symptoms. Genital ulcers can be one of these symptoms. While most studies have documented genital ulcers in female patients, our study highlights that such lesions can also occur in male genitalia. Therefore, SARS-CoV-2 infection should be considered as a possible differential diagnosis for genital ulcers. However, a definitive diagnosis can only be made after excluding other probable causes through appropriate laboratory testing.

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