Summary
Definition
History and exam
Key diagnostic factors
- history of unprotected intercourse
- history of multiple sex partners
- genital ulcers
- inguinal lymphadenitis and buboes
- genital papules
Other diagnostic factors
- dysuria
- vaginal discharge
- dyspareunia
- rectal pain or bleeding
- rectovaginal fistula
- urethral fistula
- extragenital ulcers
Risk factors
- multiple sex partners
- sexual contact with sex worker
- unprotected intercourse
- substance abuse
- male sex
- lack of circumcision
- poor personal hygiene
- asymptomatic carriage
Diagnostic tests
1st tests to order
- culture of ulcer swabs
- Haemophilus ducreyi polymerase chain reaction (PCR)
- Gram stain of ulcer swabs
- syphilis testing
- Herpes simple virus (HSV) PCR and viral cultures
- HIV test
Tests to consider
- Haemophilus ducreyi serology
- Haemophilus ducreyi antimicrobial sensitivity
- ulcer biopsy
Emerging tests
- immunofluorescence: direct or indirect Haemophilus ducreyi antigen testing
Treatment algorithm
Contributors
Authors
Professor Michael Marks, MRCP, DTM&H, PhD
Honorary Consultant in Infectious Diseases
Faculty of Infectious and Tropical Diseases
London School of Hygiene & Tropical Medicine
Hospital for Tropical Diseases
University College London
London
UK
Disclosures
MM declares that he has no competing interests.
Acknowledgements
Professor Michael Marks would like to gratefully acknowledge Dr Tara Babu, Dr Marguerite A. Urban, and Dr Christina Bailey, previous contributors to this topic.
Disclosures
TB, 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.
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