Last reviewed: 6 Apr 2021
Last updated: 01 May 2020



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 sex
  • 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

Investigations to consider

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

Emerging tests

  • direct or indirect Haemophilus ducreyi antigen testing

Treatment algorithm


Adjunct Assistant Professor of Medicine

Division of Infectious Diseases

University of Rochester Medical Center




TB declares that she has no competing interests.

Dr Tara Babu would like to gratefully acknowledge Dr Marguerite A. Urban and Dr Christina Bailey, previous contributors to this topic. MAU and CB declare that they have no competing interests.

Peer reviewersVIEW ALL

Consultant Physician

GUM/HIV Camden Primary Care Trust

Archway Sexual Health Clinic




EJ declares that she has no competing interests.

Assistant Research Professor in Medicine

Indiana University Department of Medicine

School of Medicine




DMJ declares that she has no competing interests.

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