Case history
Case history #1
A 28-year-old man develops a painful ulcer on his penis 7 days after unprotected sex with a sex worker. Three weeks later he also develops a tender, suppurative inguinal lymph node.
Case history #2
A 36-year-old woman with a history of crack cocaine use presents with genital ulcerations of 3 weeks' duration. She admits to sometimes exchanging sex for drugs.
Other presentations
Men usually present with painful genital ulcers but may rarely present with purulent urethritis. Women are more likely to have spontaneous resolution of disease. In addition, symptoms in women may be subtle and include dysuria, dyspareunia, vaginal discharge, pain on defecation, or hematochezia.
Depending on their location, ulcers may also be painless with a variable appearance. They can merge to form serpiginous or giant ulcers (>2 cm). They may remain small and be mistaken for folliculitis or herpes simplex virus (HSV) lesions. Some develop raised borders, resembling condyloma latum. Extragenital lesions have been reported on the breasts, legs, mouth, and fingers; these are rare and usually result from autoinoculation.
HIV infection sometimes alters the physical manifestations and the course of infection; lesions may look atypical, occur in higher numbers, and heal more slowly.[2] Haemophilus ducreyi has also been identified as the etiologic agent of nonsexually transmitted cutaneous ulcers in yaws-endemic countries.[3][4][5][6][7][8][9]
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