Tender papule that evolves into a painful purulent ulcer with unilateral inguinal adenopathy is most consistent with which diagnosis?

Tender papule that evolves into a painful purulent ulcer with unilateral inguinal adenopathy is most consistent with which diagnosis?

• A. Chancroid
• B. Genital herpes
• C. Syphilis
• D. LGV

Answer: (A)

This presentation points to chancroid. The key idea is a painful genital ulcer that progresses to a painful, purulent ulcer accompanied by unilateral inguinal adenopathy. Haemophilus ducreyi causes ulcers that are typically shallow with ragged or undermined borders and a purulent exudate. The infection travels through lymphatics to the groin, producing tender, often unilateral lymphadenopathy that can suppurate into a buboe. In contrast, a painless chancre with usually non-tender or minimally tender nodes suggests syphilis, while genital herpes typically causes multiple painful ulcers arising from vesicles and often presents with bilateral, tender inguinal lymphadenopathy and episodic recurrences. LGV can involve painful inguinal buboes as well, but the primary lesion is often unnoticed or painless, with the lymphadenopathy being a prominent feature. So the combination of a tender, evolving ulcer and unilateral tender inguinal lymphadenopathy best fits chancroid. Treatment is typically targeted at this infection while also addressing other sexually transmitted infections.

This presentation points to chancroid. The key idea is a painful genital ulcer that progresses to a painful, purulent ulcer accompanied by unilateral inguinal adenopathy. Haemophilus ducreyi causes ulcers that are typically shallow with ragged or undermined borders and a purulent exudate. The infection travels through lymphatics to the groin, producing tender, often unilateral lymphadenopathy that can suppurate into a buboe.

In contrast, a painless chancre with usually non-tender or minimally tender nodes suggests syphilis, while genital herpes typically causes multiple painful ulcers arising from vesicles and often presents with bilateral, tender inguinal lymphadenopathy and episodic recurrences. LGV can involve painful inguinal buboes as well, but the primary lesion is often unnoticed or painless, with the lymphadenopathy being a prominent feature.

So the combination of a tender, evolving ulcer and unilateral tender inguinal lymphadenopathy best fits chancroid. Treatment is typically targeted at this infection while also addressing other sexually transmitted infections.