Genital sores in men, in general, are sores or breaks in the skin and tissue of the genital area which may occur on the penis, scrotum, or urethra. Genital sores can be just minor irritations or may be more serious. They can be very distressing for men because they can cause them emotional embarrassment, pain, and/or discomfort. Many genital sores cause no significant concerns and will heal on their own, however, some genital sores can indicate a medical condition or infection that requires medical treatment. Being aware of the causes, symptoms, diagnosis and treatment of appropriate male genital sores is very important so that properly cared for and managed should that be necessary. This article discusses the most common and typical causes of genital sores in men, how these might be contracted, their typical signs and symptoms, diagnosis, treatment options and reduced risk of reoccurrence.

 Male genital sores can be the result of sexually transmitted infections, but they may also be from a noninfectious cause like an allergic reaction, chronic skin disease or injury. The sores can vary in size, severity and underlying cause. The most common causes include:

1. Sexually Transmitted Infections (STIs): STIs are one of the most common causes of genital sores in males. STIs are transmitted via sexual contact with someone with an STI. Sexual contact can be vaginal, anal and oral. There are multiple STIs that can cause sores, for example:
   • Herpes Simplex Virus (HSV): HSV is one of the most common causes of genital sores. There are two types: HSV-1 and HSV-2. HSV-1 most often causes cold sores around the mouth but may cause genital sores through oral-genital contact. HSV-2 often causes genital herpes and is the most common cause of painful genital blisters. The sores look like small groups of fluid-filled blisters that will eventually rupture and become painful ulcers. These types of sores can come back over time, with newer outbreaks being linked to stressors and/or poor immune function.
   • Syphilis: The bacterium Treponema pallidum causes syphilis. It starts with a single firm, painless sore called a chancre on the penis, anus, or mouth. The sore usually lasts 3 or 6 weeks and goes away. If left untreated, however, the infection would progress to later stages and may lead to rashes, fever, swollen lymph nodes, and damage to internal organs, including the brain and heart.
   • Chancroid: Chancroid is caused by the bacterium, Haemophilus ducreyi. The developing infection results in soft, painful ulcers that may appear on the genitalia. The ulcer may appear along with swollen, tender g., lymph nodes. This interacts mainly in areas with no sanitation and is considered a co-factor for transmitting HIV.
   • Human Papillomavirus (HPV): One of the types of HPV causes genital warts. These warts can present as small, flat bumps or cauliflower like growths, and also develop on the genitals, anus, or mouth. While these are not technically “sores”, genital warts can become irritated, bleed, or become unpleasant. In rare instances, the genital warts become infected or can even ulcerate to a minor degree.
   • Chlamydia trachomatis: This bacterial infection can sometimes cause small, painless, unnoticed sores. One defining feature is unilateral, painful swelling of regional lymph nodes, usually in the groin. These can sometimes rupture and release pus.
   • Klebsiella granulomatis (Donovanosis): This rare bacterial infection typically causes small, beefy-red bumps on the genitalia that can gradually grow and become open, ulcerating sores. These are typically not associated with pain although they can bleed easily and can lead to tissue destruction if not detected and treated early.
2. Allergic Reactions: An allergic reaction to hygiene products, latex condoms, spermicides, body lotions or even laundry detergent can produce irritation or rash to the genital area. In some situations a person encounters repeated exposure to allergens which may cause skin to appear red, inflamed and broken with sores or blisters. More intense allergic reactions may produce hives, itching or swelling which could lead to ulceration from scratching or friction.
3. Fungal Infections: Fungal infections are also a potential source of genital sores, including candidiasis (yeast infections), especially among men with diabetes, obesity, compromised immunity, and with poor hygiene practices. These infections are often characterized by severe itching, redness, irritation, and sometimes even white patches or discharge. Itching may cause an individual to scratch, which can result in small open sores or cracked skin that may become painful, at least initially, and may also result in a secondary infection. 
4. Bacterial Infections: In addition to sexually transmitted strains of bacteria, other bacteria are capable of causing inflections of the genital skin. Poor hygiene, breaks in the skin, and/or excessive sweating can provide a suitable environment for the bacteria to thrive in. These non-venereal infections can lead to red, swollen, pus-filled, bumps and sometimes open sores, especially among men who shave their genital area or who wear nonbreathable, or tight-fitting clothes. Folliculitis (infection of a hair follicle) is one example of this type of infection where the skin condition may be characterized by the presence of small pustules or ulcer-like sores.
5. Trauma or Injury: Physical injury to the genital area is a separate cause of sores. These injuries can occur during rough sexual activity, friction from tight underwear, vigorous masturbation, use of sex toys, or even sports injuries. Minor injuries like abrasions or skin tears can develop into painful ulcers or bruising, and can become infected when not cleaned and cared for properly. Minor injuries often heal quickly, but repeated and/or vigorous trauma can cause sores or scarring to last longer.
6. Skin Conditions: A few chronic skin issues can affect the genital region, causing sores or mimicking sores. These include: 
   • Psoriasis: A chronic autoimmune disease that leads to rapid skin cell turn over and build up which causes scaly, red patches. With psoriasis on the genital area, you may get smooth, red plaques because of the moisture and constant friction. The constant irritation can lead to cracked or bleeding skin that might look like open sores. 
   • Lichen Planus: An inflammatory condition thought to be autoimmune in nature. It presents as small, shiny, purplish bumps. The bumps can be flat-topped and itchy. The bumps in the genital area can become ulcerated and cause discomfort, burning, or pain with urination or intercourse. 
   • Eczema and Dermatitis: Common skin problems with dry, itchy skin and inflammation. When it occurs in the genital area, you may find that scratching leads to the breakdown of the skin, or oozing, bleeding, or secondary infections. In this case, any sores are chronic irritation by scratching, not infection.
7. Autoimmune Disorders: Autoimmune diseases can also result in recurrent genital ulcers as part of a systemic disease process. Behçet’s disease is the condition that is associated with recurrent mouth and genital ulcers and sometimes associated inflammation of the eyes, aching of the joints or flu-like symptoms, some skin lesions, and is usually characterized by the presence of deep, painful genital ulcers that may also scar. Other autoimmune diseases that can produce genital ulcers, such as lupus or inflammatory bowel diseases (e.g., Crohn’s disease), may also produce genital ulceration, but this is a very rare phenomenon.

There are also several ways for a man to get genital sores with sex being by far the most common. Here are the primary ways a man can contract genital sores:

1. Unprotected Sexual Contact: The most common way to acquire genital sores is through unprotected vaginal, anal, or oral sex with an infected partner. Many infections that cause genital sores—for example, herpes and syphilis—have the potential to be passed on even when the infected person has no visible symptoms. Everyone’s risk of getting genital sores increases in direct proportion to the number of partners, inconsistent condom use, and lack of STI testing. 
2. Direct Skin-to-skin Physical Contact: With some infections, such as a human papillomavirus (HPV) infection, the virus can be passed on from skin-to-skin contact even if penetration does not take place. This means that genital sores can be contracted through any close physical contact including kissing, genital rubbing, or mutual masturbation. Close physical contact has the potential to transmit viruses or bacteria that lead to sores (especially if there are crazy breaks in the skin, probably from shaving, or scratching the genitals).
3. Hygiene Issues: Poor personal hygiene can lead to the development of genital sores in warm, wet environments. Not washing or not thoroughly drying the genital area, wearing tight-fitting or non-synthetic underwear, or generally not changing underwear can cause irritation, or a fungal overgrowth or introduce a bacterial infection. There are many conditions that can injure or damage the skin, leading to painful sores, and/or ulcers. 
4. Pre-existing Medical Conditions: Chronic conditions such as immunodeficiency disorders that can severely weaken the immune system, (e.g., diabetes, HIV/AIDS) make the body more prone to infection. A weakened immune response allows bacteria, fungi and viruses to replicate easily and increase the risk of developing genital sores. With the potential of developing sores or ulcers from pre-existing conditions, even minor skin damage or irritations can lead to something more serious if not managed.

Genital sores in men can appear in a range of varieties depending on the cause. An infected person may not exhibit any symptoms at all, especially in the early stages of certain infections. When symptoms do appear, the symptoms are typically as follows:

• Pain or Tenderness: Genital sores can be very painful; especially when they come in contact with clothing or by movement. Men can struggle with extreme discomfort during sexual activity, as well as walking or sitting for long periods of time.
• Genital Itching/Burning: Genital itching or burning can be caused by conditions such as eczema, fungal infections or herpes. These symptoms often lead to scratching, which may further irritate the skin.
• Fluid-Filled Blisters or Ulcers: Infections such as herpes simplex virus (HSV) or syphilis can cause sores which lead to fluid-filled blisters or open ulcers. These sores will even burst, leak fluid and then crust over as they heal.
• Redness and Inflammation: The skin surrounding the sores can appear red, swollen, and inflamed. The irritation can become stronger due to friction or lack of hygiene with tight clothing or humidity.
• Discharge: Several sexually transmitted infections such as gonorrhea and chlamydia can cause a person with a penis to have a yellowish or greenish discharge from the penis. Discharge might also be accompanied by inflammation or sores located near the urethral opening.
• Swollen Lymph Nodes: STIs like syphilis and herpes can cause the lymph nodes in the groin to swell. Some swollen lymph nodes may be tender to the touch, and swelling indicates that the person’s body is working to fight off an infection.
• Painful Urination: When sores are present near to or inside the urethra, it can cause burning or pain during urination. Painful urination is frequently reported with discharge or genital inflammation.

 In order to make a diagnosis of male genital sores the healthcare provider will perform a physical examination and will review the patient’s symptoms, sexual history, and potential exposure to infections.

To determine the cause of the sores the provider may use the following diagnosis procedures:

1. Diagnostic Tests:

• Swab test: This test involves taking a sample of a live sore and has it submitted to a laboratory to identify the pathogen, such as herpes simplex virus (HSV), or human papillomavirus (HPV), or if a syphilis test is required.
• Blood Tests: With an active infection, blood tests can detect antibodies with the infection and these are typically tests to assess the presence of syphilis, herpes, or HIV will usually (but not always) determine if the person is infected currently or has had the infection previously.
• PCR Test: Polymerase chain reaction (PCR) testing can determine the viral DNA from the swab sample, one of the best tests for diagnosing viral causes such as HSV because of its high sensitivity.

2. Urine Tests: Urine tests can also be used to assess infections like chlamydia and gonorrhea and involve assessing for presence of bacterial DNA or antigens.

3. Biopsy or Culture: A small amount of the sore’s tissue may be taken (biopsy), or cultured for microscopic examination, especially if a non-infectious condition such as psoriasis or lichen planus is suspected.

Male genital sores are treated based on the underlying cause. Some conditions need topical creams, some require oral medications, yet some may require both forms of treatment. In some cases, it may require lifestyle modifications or supportive care. The following options are commonly used:

1. Antiviral Medication: For infections due to a herpes simplex virus (HSV), antiviral medications would include acyclovir, valacyclovir or famciclovir. These medications work to reduce the severity, duration and/or prevent future outbreaks.
2. Antibiotics: A bacterial infection, such as syphilis or chancroid or gonorrhea would be treated with antibiotics. Penicillin is the first allowed antibiotic for syphilis. For chlamydia or gonorrhea, azithromycin or doxycycline would be prescribed. This is to allow for prevention of complications, and further transmission.
3. Other topical options: Fungal infections can be treated with over-the-counter antifungal creams (for example, clotrimazole or miconazole) or by prescription antifungal creams that can be placed directly onto the area impacted, to alleviate symptoms and promote healing.
4. Pain Control: Nonprescription pain medications such as ibuprofen or acetaminophen may assist in alleviating pain and inflammation. You may also consider topical anesthetics (lidocaine), if applicable, to temporarily lessen local pain or burning.
5. Steroid creams: For autoimmune-associated skin conditions like psoriasis or lichen planus, topical corticosteroids can help decrease inflammation and facilitate healing.
6. Sitz Baths: Warm sitz baths will help comfort irritation, decrease inflammation and facilitate healing—these are helpful for painful sores or inflammation.
7. Hygiene measures:
   • Remember to practice good genital hygiene.
   • Gently clean the area with mild soap and water.
   • Use a clean towel to pat the area dry and minimize the risk of irritation and/or infection.
   • Wear loose-fitting clothing; avoid harsh products.
8. Cool Compress: Using a cold compress can help relieve pain, decrease swelling and calm irritated skin.

Sores on the male genitals can arise from many different causes including sexually transmitted infections (STIs), skin disorders, allergic reactions, and physical injuries. Being able to identify symptoms early, seeing a doctor as needed, and following treatment directions is critical for maintaining and recovering from sores on the genitals.

Some common preventative measures like safe sex practices, using condoms during intercourse, not sharing personal items (clothing, towels, etc.), and practicing regular hygiene can help avoid genital sores. If anything persists, hurts, or is abnormal in appearance, see a healthcare provider soon to determine what might be causing the sores and how to treat them appropriately.

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