A 24-year-old woman sought medical attention because of the acute onset of a very painful vulvar rash. She had never experienced anything similar. Do you recognize these lesions?
A 24-year-old Hispanic woman sought medical attention because of the acute onset of a very painful vulvar rash. She had never experienced anything similar. The patient was sexually active and did not routinely use barrier protection.
Key point: Examination revealed multiple tender erosions on and near the external genitalia. The patient also had painful, bilateral inguinal adenopathy. There is an extensive differential diagnosis, and a comprehensive workup, including a biopsy, would be required. Serologic tests for syphilis and herpes cultures were both negative. Ultimately, Haemophilus ducreyi was recovered from a culture, establishing the diagnosis of chancroid. About 50 to 100 cases of this sexually transmitted disease occur yearly in the United States, although it is more common in Africa and the Caribbean. The significant pain associated with both skin lesions and enlarged regional nodes is characteristic.
Treatment: Treatment consists of a single intramuscular injection of ceftriaxone (250 mg).
Note: An acceptable alternative therapy is a single oral 1-g dose of azithromycin.