Approach

Symptoms typically appear 4 to 7 days after unprotected intercourse with an infected partner. Some patients develop papules that resolve spontaneously (more common in women). Other patients progress to pustules that ulcerate (more common in men). The diagnosis is classically based on clinical features and isolation of the causative organism.

A probable diagnosis can be made if all of the following are present: 1 or more painful genital ulcers; darkfield microscopy or direct fluorescent antibody testing for Treponema pallidumof the ulcer and serology for syphilis performed at least 7 days after ulcer onset are negative; clinical presentation of the genital ulcer with or without lymphadenitis is consistent with chancroid; and ulcer is negative for herpes simplex virus (HSV).[39]

However, clinical features are non-specific, culture of the organism can be difficult, and mixed infections are common. Infection with HSV and syphilis must therefore be excluded in all patients.[40][41][42][43][44][45]

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