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Genital ulcers may result from any of several infective agents. Appropriate treatment of genital ulcer disease (GUD) depends upon accurate diagnosis, and this can be a problem in developing countries because of poor availability of laboratories, occurrence of mixed infections, and other factors. The accuracy of diagnosis of GUD in 240 mineworkers in South Africa who attended a sexually transmitted disease clinic was studied. A laboratory diagnosis could not be made for 29 subjects. Depending on whether microscopic or blood test results were used, two or more causes were found in 14 or 37 cases, respectively. Haemophilus ducreyi, the bacterial cause of chancroid, was found in 147 patients, herpes simplex virus was found in 7, Chlamydia was found in 7, lymphogranuloma venereum (LGV) was in 8, and syphilis was found in 52 patients. Single infections were diagnosed in 68 percent of cases, including 80 percent for chancroid, 55 percent for syphilis, 27 percent for LGV, and 22 percent in cases of herpes infections. The ulcers from some infections resembled those from other causes, and laboratory results were therefore very important in arriving at correct diagnoses. Because laboratories are limited in developing regions such as areas of South Africa, a strategy for management of genital ulcers is recommended. Because chancroid is the most common cause of GUD in this population, appropriate antibiotics for that infection should be routinely considered, and antibiotics against syphilis should be considered as well. Future research will be needed to establish the rate of infection with human immunodeficiency virus (HIV; the cause of AIDS), and medical management should be reevaluated if HIV prevalence increases in this region. (Consumer Summary produced by Reliance Medical Information, Inc.)