inflammatory papule that ruptures early with the formation of a ragged ulcer

Inflammatory papule that ruptures early with the

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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 disease caused 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 diagnosis of chancroid does not rule out syphilis and the subsequent development of syphilis should be anticipated 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 as erosions 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, which erode through the skin to produce clean, sharply defined lesions, which are usually painless. The lesions typically demonstrate hypertrophic, vegetative granulation tissue which is soft, has a beefy-red appearance, and bleeds readily. The regional lymph nodes are usually not enlarged. This is caused by Calymmatobacterium granulomatis. Lymphogranuloma venereum (choice D) is incorrect, because it is a sexually transmitted disease characterized by suppurative inguinal adenitis with matted lymph nodes, inguinal bubo with secondary ulceration, and constitutional symptoms. The primary lesion consists of herpetiform vesicle or erosion develops on the glans penis followed by bilateral lymphadenopathy. It is caused by Chlamydia trachomatis, serotypes L1, L2 and L3.
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Primary syphilitic chancre (choice E) is incorrect, because it typically presents as a crusted superficial erosion that becomes a round or oval, indurated, slightly elevated papule, with an eroded, but not ulcerated surface that exudes a serous fluid. The lesion is usually painless. The regional lymph nodes on one or both sides are usually enlarged, firm, nontender and do not suppurate. With this said, when a patient presents with a penile ulcer, it is wise to obtain a serum RPR since patients can often times have 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 for the first time 3 weeks ago after "pulling his groin" in a high school football game. The groin pull has improved but the discomfort in the testicle has not. He also states that he has noticed the left testicle is larger than the right testicle. His pain is non-radiating, dull in character, and not associated with any dysuria or discharge. He admits to an
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  • Spring '14
  • Andrology, Prostate cancer, testicular cancer, Testicle

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