A Male Heterosexual, presenting with non indurated painful ulcers with undermined edges and enlarged lymph nodes probably suffers from

Question 64

A Male Heterosexual, presenting with non indurated painful ulcers with undermined edges and enlarged lymph nodes probably suffers from 

a. Herpes genitalis.

b. Aphthous ulcer.

c. Syphilis.

d. Chancroid.

Answer

Chancroid

Reference

Harrison 16^th Edition Pages 772, 773, 866 Table 115-7 and 115-8

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Discussion

Haemophilus ducreyi is the etiologic agent of chancroid, a sexually transmitted disease characterized by genital ulceration and inguinal adenitis. In addition to being a cause of morbidity in itself, chancroid is associated with infection with HIV because of the role of genital ulceration in the transmission of HIV

Infection is acquired as the result of a break in the epithelium during sexual contact with an infected individual. After an incubation period of 4 to 7 days, the initial lesion - a papule with surrounding erythema - appears. In 2 to 3 days, the papule evolves into a pustule, which spontaneously ruptures and forms a sharply circumscribed ulcer that is generally not indurated. The ulcers are painful and bleed easily; little or no inflammation of the surrounding skin is evident. Approximately half of patients develop enlarged, tender inguinal lymph nodes, which frequently become fluctuant and spontaneously rupture.

Explanation

Self Explanatory

Comments

The presentation of chancroid does not usually include all of the typical clinical features and is sometimes atypical. Multiple ulcers can coalesce to form giant ulcers. Ulcers can appear and then resolve, with inguinal adenitis and suppuration following 1 to 3 weeks later; this clinical picture can be confused with that of lymphogranuloma venereum.

Multiple small ulcers can resemble folliculitis. Other differential diagnostic considerations include the various infections causing genital ulceration, such as primary syphilis, condyloma latum of secondary syphilis, genital herpes, and donovanosis. In rare cases chancroid lesions become secondarily infected with bacteria; the result is extensive inflammation.

Tips

• Be Careful when the choices have LGV and Chanchroid together

Disease	%
Herpes	62 &
Chanchroid	12 to 20 %
Syphilis	13 %
LGV and Granuloma Inguinale

·         Herpes Ulcers are painful, vesicular, multiple and are associated with firm tender lymphadenopathy

• Donovanosis is caused by Calymmatobacterium granulomatis, an

o       intracellular,

o       gram-negative,

o       pleomorphic,

o       encapsulated (when mature) bacterium

o       measuring 1.5 by 0.7 um.