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inflammatory papule that ruptures early with the formation of a ragged ulcer that lacks the induration of a chancre. The ulcers have undermined irregular edges surrounded by mild hyperemia, and the base is usually covered with purulent, dirty exudate. This is an infectious, contagious, ulcerative, sexually transmitted diseasecaused by the Gram-negative bacillus Haemophilus ducreyi. It is characterized by 1 or more deep or superficial tender ulcers on the genitalia and painful unilateral inguinal adenitis. However, the diagnosisof chancroid does not rule out syphilis and the subsequent development of syphilis should beanticipated since the incubation time for a chancre is longer than that of chancroid.Gonococcal dermatitis (choice B) is incorrect because it is a rare infection that occurs mostly aserosions on the median raphe without urethritis. Grouped pustules on an erythematous base is the usual presentation.Granuloma inguinale (choice C) is incorrect because it is a mildly contagious, chronic, granulomatous,locally destructive disease characterized by progressive indolent, serpiginous ulcerations of the groins,pubis, genitalia, and anus. The disease begins as single or multiple subcutaneous nodules, whicherode through the skin to produce clean, sharply defined lesions, which are usually painless. Thelesions typically demonstrate hypertrophic, vegetative granulation tissue which is soft, has a beefy-redappearance, and bleeds readily. The regional lymph nodes are usually not enlarged. This is caused byCalymmatobacterium granulomatis.Lymphogranuloma venereum (choice D) is incorrect, because it is a sexually transmitted diseasecharacterized by suppurative inguinal adenitis with matted lymph nodes, inguinal bubo with secondary ulceration, and constitutional symptoms. The primary lesion consists of herpetiform vesicle or erosiondevelops on the glans penis followed by bilateral lymphadenopathy. It is caused by Chlamydiatrachomatis, serotypes L1, L2 and L3.
Primary syphilitic chancre (choice E) is incorrect, because it typically presents as a crusted superficialerosion that becomes a round or oval, indurated, slightly elevated papule, with an eroded, but notulcerated surface that exudes a serous fluid. The lesion is usually painless. The regional lymph nodeson one or both sides are usually enlarged, firm, nontender and do not suppurate. With this said, when apatient presents with a penile ulcer, it is wise to obtain a serum RPR since patients can often timeshave more than one sexually transmitted disease.An 18-year-old man comes to the clinic complaining of heaviness in his left testicle. He noticed this forthe first time 3 weeks ago after "pulling his groin" in a high school football game. The groin pull hasimproved but the discomfort in the testicle has not. He also states that he has noticedthe left testicle islarger than the right testicle. His pain is non-radiating, dull in character, and not associated with anydysuria or discharge. He admits to an