A 30 year old male, Kallu, with a history of sexual exposure comes with a painless indurated ulcer over the penis with everted margins. The diagnosis is :
Ans. is 'a' i.e., Syphilis Painless indurated ulcer with everted margins, h/o of sexual exposure and lack of systemic symptoms favours the diagnosis of syphilis.This is one of the most frequently asked question . You are required to be well versed with differential diagnosis of Genital sores.GENITAL SORESGENITAL SORESFeaturesSyphilis (Hardchancre)Chancroid (SoftChancre)LymphoGranulomaVenereumGranulomaInguinale (Donovanosis)HepesInfectionorganismTpallidum*Haemophilus Ducreyi*Chlamydia trachomatis*Calymmato -bacterium Granulomatis*HSV*IncubationPeriod9-90 days*Average 21 days*3-5 days*Several days to several weeks1-4 weeks2-7 daysClinical featuresPainless indurated papule that may laier on turn to ulcerPainless shotty lymph adenopathyPainful non indurated ulcer (soft chancre)Painful lymphadenopathyPainless Papule that often go unnoticed.Sometimes it may ulcerateAfter the genital lesion has healed painful matted suppurative lymphadenopathyMultiple sinus tracts are formed in lymph nodes*Groove's Sign*- Enlarged nodes are present below and above the inguinal ligamentVaginal and rectal strictures*Elephantiasis of valva** Begins as one or more subcuta -nous nodules that erode through skin to produce clean, granulo matous sharply defined painless lesionsNo lymphadenopathy*Pseudobubos are seen*Painful papule that ulerate in 3-6 daysSystemic symptoms fever, Headche maliseInguinal Lymphadeno pathy occurs commonly.Diagnosis Ito test*Frei's intradermal testDonovan bodies*
Syphilis
Chancroid
Lymphogranuloma venerum
Granuloma inguinale
Infection