Last reviewed: 30 Sep 2024
Last updated: 08 Jun 2023
Summary
Definition
History and exam
Key diagnostic factors
- genital papules
- genital ulcers
- lymphadenitis and buboes
Full details
Other diagnostic factors
- urethritis and dysuria
- vaginal discharge
- dyspareunia
- rectal pain or bleeding
- rectovaginal fistula
- extragenital ulcers
Full details
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
Full details
Diagnostic tests
1st tests 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])
- rapid plasma reagin (RPR) test
- HSV PCR and viral cultures
- HIV test
Full details
Tests 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
Treatment algorithm
ACUTE
HIV-negative
HIV-positive
ONGOING
no response to initial treatment
Contributors
Authors
Tara Babu, MD, MSc
Adjunct Assistant Professor of Medicine
Division of Infectious Diseases
University of Rochester Medical Center
Rochester
NY
Disclosures
TB declares that she has no competing interests.
Acknowledgements
Dr Tara Babu would like to gratefully acknowledge Dr Marguerite A. Urban and Dr Christina Bailey, previous contributors to this topic.
Disclosures
MAU and CB declare that they have no competing interests.
Peer reviewers
Eva Jungmann, FRCP, MSc
Consultant Physician
GUM/HIV Camden Primary Care Trust
Archway Sexual Health Clinic
London
UK
Disclosures
EJ declares that she has no competing interests.
Diane M. Janowicz, MD
Assistant Research Professor in Medicine
Indiana University Department of Medicine
School of Medicine
Indianapolis
IN
Disclosures
DMJ declares that she has no competing interests.
Differentials
- Syphilis infection
- HSV infection
- Lymphogranuloma venereum
More DifferentialsGuidelines
- Reducing sexually transmitted infections
- Sexually transmitted diseases treatment guidelines, 2021
More GuidelinesPatient information
Chlamydia
Genital herpes
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