Genital ulcers are seen in all except: (PGI May 2010)
Correct Answer: H. aegvpticus
Description: A ns: A (H. aegypticus) Ulcerative Genital or Perianal Lesions Harrison 17th/ 831-32# Genital ulceration reflects a set of important STls, most of which sharply increase the risk of sexual acquisition and shedding of HIV.#In a 1996 study of genital ulcers in 10 of the U.S. cities with the highest rates of primary syphilis, PCR testing of ulcer specimens demonstrated HSV in 62% of patients, Treponema pallidum in 13%, and Haemophilus ducreyi in 12-20%.# Today genital herpes probably represents an even higher proportion of genital ulcers in the United States and other industrialized countries.# Asia and Africa,chancroid was once considered the most common type of genital ulcer, followed in frequency by primary syphilis and then genital herpes.With increased efforts to control chancroid and syphilis, together with more frequent recurrences or persistence of genital herpes attributable to HIV infection, genital herpes is the most common cause of genital ulceration in most developing countries,LGV (Chlamydia trachomatis LI-3) and danovanosis (granuloma inguinale) continue to cause genital ulceration in developing countries.Other causes of genital ulcer include (1) candidiasis and traumatized genital warts--both readily recognized: (2) lesions due to genital involvement by more widespread dermatoses; and (3) cutaneous manifestations of systemic diseases, such as genital mucosal ulceration in Stevens- Johnson syndrome or Behpet's disease.FeatureSyphillisHerpesChancroidLympho-granlomaVenereumDonovanosisIncubation period9-90 days2-7 days1- 14davsQ3 davs-6 weeks1-4 weeks (up to 6months)Early primary lesionsPapuleVesiclePustulePapule, pustule, or vesiclePapuleNo. of lesionsUsually oneMultipleUsually multiple, may coalesceUsually one; often not detected, despitelymphadenopa thyVariableDiameter5-15 mm1-2 mmVariable2-10 mmVariableEdgesSharply demarcated. elevated, round, or ovalErythematousUndermined, ragged, irregularElevated, round, or ovalElevated, irregularDepthSuperficial or deepSuperficialExcavatedSuperficial or deepElevatedBaseSmooth, nonpu- rulent, relatively nonvascularSerous,erythematous,nonvascularPurelent, bleeds easilyVariable, nonvascularRed and velvety, bleeds readilyIndurationFirmNoneSoftOccasionaly firmFirmPainUncommonFrequentlytenderUsually very tenderVariableUncommonLymphadenopathyFirm, nontender, bilateralFirm, tender, often bilateral with intial episodeTender, may suppurate, loculated, usually unilateralTender, may suppurate, loculated, usually unilateralNone; pseudobuboes
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