Ref: E s sent to Is in Dermatology, 1st editionExplanation:* Presence of 3 cm ulcer with raised edges in the labia majora suggests Syphilis. (See the following table) SyphilisGranuloma Inguinale (Donovanosis)Chancroid(Soft sore. Soft Chancre, Ulcus molle)LymphogranulomaVenereumEtiologyTreponema pallidumCalymmatobacteriumdonovaniGram negative Obligate intracellularHemophilus ducreiChlamydia trachomatis (LI, L2 and L3 types)IncubationPeriodPrimary syphilis: 1-3 weeks Secondary syphilis: 6-12 weeks8-12 days(17 days average)3 days - 2 weeks (1-5 days average)3-30 daysClinicalSigns* Painless indurated* Single punched out* Usually non-bleeding* Lymph nodes are rubbery* Dark field microscopy* FTA-ABS - Most sensitive test and Earliest lest to become positive* VDRL* RPR liters* TPT - Most specific* TPH - 2nd most sensitive test* Painless genital ulcer* Soft. Beefy* Clean friable base* Distinct raised rolled margins* Massive scarring* Lymphatic obstruction* Pseudobubos(Subcutaneous granulomas not nodes)* Extremely painful. Suppurative ulcers of genital mucosa* Soft friable, non- indurated, ragged undermined edges* Foul smelling yellow grey exudate* Suppurative inguinal lymph nodes (Bubo)* Ito-Reenstierna test - Intradermal test* Skin or mucosal ulcer followed by ulcerated inguinal lymph nodes* "Sign of the groove"* Frei's Test: Intradermal test* Genital elephantiasis (Esthiomene)Pathology Hypertrophic ulcers Donovan Bodies (Safety pin shaped)Pyogenic ulcerationNecrotising granulomatous inflammation with stricture formationTreatmentPenicillin G -Drug of Choice forall stages of syphilisDoxycycline 100 mgBD for 3 weeksAzithromycin 1 gsingle oral dose (or)Ceftriaxone 250 mg1M single dose (or)Ciprofloxacin 500 mgbd for 3 daysDoxycycline 100 mgBD for 3 weeks