Last reviewed: November 2017
Last updated: October  2016

Summary

Definition

History and exam

Key diagnostic factors

  • genital papules
  • genital ulcers
  • lymphadenitis and buboes

Other diagnostic factors

  • urethritis and dysuria
  • vaginal discharge
  • dyspareunia
  • rectal pain or bleeding
  • rectovaginal fistula
  • extragenital ulcers

Risk factors

  • multiple sex partners
  • sexual contact with sex worker
  • unprotected intercourse
  • substance abuse
  • male gender
  • lack of circumcision (in men)
  • poor personal hygiene
  • asymptomatic carriage

Diagnostic investigations

1st investigations to order

  • Gram stain of ulcer swabs and bubo aspirates
  • culture of ulcer swabs or bubo aspirates
  • Haemophilus ducreyi PCR
  • syphilis serology (FTA-ABS test, Treponema pallidum particle agglutination [TPPA], treponemal enzyme immunoassay [EIA])
  • RPR test
  • HSV PCR and viral cultures
  • HIV test
Full details

Investigations to consider

  • Haemophilus ducreyi serology
  • Haemophilus ducreyi antibiotic sensitivity
  • ulcer biopsy
  • darkfield microscopy for Treponema pallidum
Full details

Emerging tests

  • direct or indirect Haemophilus ducreyi antigen testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor

Department of Medicine, Infectious Diseases

University of Rochester Medical Center

Rochester

NY

Disclosures

MAU declares that she has no competing interests.

Dr Marguerite A. Urban would like to gratefully acknowledge Dr Christina Bailey, a previous contributor to this monograph. CB declares that she has no competing interests.

Peer reviewers VIEW ALL

Consultant Physician

GUM/HIV Camden Primary Care Trust

Archway Sexual Health Clinic

London

UK

Disclosures

EJ declares that she has no competing interests.

Assistant Research Professor in Medicine

Indiana University Department of Medicine

School of Medicine

Indianapolis

IN

Disclosures

DMJ declares that she has no competing interests.

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