STD-painful ulcer

Sexually Transmitted Disease Infections

Dr Patsy Lill
Professor Emerita
University of South Carolina School of Medicine

A painful ulcer

A 43-year-old man presented with painful ulcers on his penis. He first noted painful lumps (papules) which then became “boils” (pustules) which ulcerated after about 2 weeks. The ulcers had irregular borders, were beefy red in appearance, and were painful. His inguinal lymph nodes were unilaterally enlarged and painful upon palpation. The skin appeared thin over one lymph node and it appeared that it might rupture. Gram stain showed single gram negative cocci. The patient was not febrile.

(The erythematous ring is not visible in this patient and is not always present.)

The organism MOST likely causing the ulcers is

1. Treponema pallidum
2. Calymmatobacterium granulomatis
3. Haemophilus ducreyi
4. Gonorrhea

ANSWER

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Pathology questions by Dr Patsy Lill