MEDizzy - A 23-year-old college student is seen in the student health

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Infection causing diseases 1

A 23-year-old college student is seen in the student health clinic for evaluation of multiple genital ulcers that he noted developing over the past week. They started as pustules and, after suppuration, are now ulcers. The ulcers are extremely tender and occasionally bleed. Examination shows multiple bilateral deep ulcers with purulent bases that bleed easily. They are exquisitely tender but are soft to palpation. Which of the following organisms is likely to be found on culture of the lesions?

ExplanationThe most common causes of genital ulceration are herpes simplex virus, syphilis, and chancroid. Gonorrhea typically manifests as a urethritis, not genital ulcers. Syphilitic ulcers (primary chancre) are frm, shallow single ulcers that are not pustular and are generally not painful. Despite these usual fndings, rapid plasma reagin (RPR) testing is indicated in all cases of genital ulceration given the disparate presentations of Treponema pallidum. HSV ulcers are quite painful but are vesicular rather than pustular. In primary infection, they may be bilateral, although with reactivation, they are generally unilateral. Haemophilus ducreyi, the agent responsible for chancroid, causes multiple ulcers, often starting as pustules, that are soft, friable, and exquisitely tender, as was present in this case. Primary infection with HIV usually will cause an acute febrile illness, not focal ulcers. The presence of genital ulcers increases the likelihood of acquisition and transmission of HIV.