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Old 06-10-2012
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Question Syphillis or LGV or Granuloma Inguinale?

A 15-year-old male had a painless papule on his genitals that resolved,
but he has now developed a unilateral draining inguinal lymphadenitis.

A 19-year-old female has a few small papules on her labia and perineum.
The papules become pustular, eroded, and ulcerated over the next
few days; at the same time, the patient develops painful, tender inguinal

please give explnation for the same.
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Old 06-10-2012
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2.granuloma inguinale ???
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Old 06-11-2012
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Primary infection (Mucosal): Painless

Secondary infection (Lymphatic involvement): Painful

LGV is primarily an infection of lymphatics and lymph nodes. Chlamydia trachomatis is the bacterium responsible for LGV. It gains entrance through breaks in the skin, or it can cross the epithelial cell layer of mucous membranes. The organism travels from the site of inoculation down the lymphatic channels to multiply within mononuclear phagocytes of the lymph nodes it passes.

Primary syphilis is typically acquired by direct sexual contact with the infectious lesions of another person.[7] Approximately three to 90 days after the initial exposure (average 21 days) a skin lesion, called a chancre, appears at the point of contact.[4] This is classically (40% of the time) a single, firm, painless, non-itchy skin ulceration with a clean base and sharp borders between 0.3 and 3.0 cm in size.[4] The lesion, however, may take on almost any form.[8] In the classic form, it evolves from a macule to a papule and finally to an erosion or ulcer.[8] Occasionally, multiple lesions may be present (~40%),[4] with multiple lesions more common when coinfected with HIV. Lesions may be painful or tender (30%), and they may occur outside of the genitals (2–7%). The most common location in women is the cervix (44%), the penis in heterosexual men (99%), and anally and rectally relatively commonly in men who have sex with men (34%).[8] Lymph node enlargement frequently (80%) occurs around the area of infection,[4] occurring seven to 10 days after chancre formation.[8] The lesion may persist for three to six weeks without treatment.[4]
Primary syphilis

The diagnosis is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue. In contrast to syphilitic ulcers, inguinal lymphadenopathy is generally absent. Tissue biopsy and Wright-Giemsa stain is used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis. Donovan bodies are rod-shaped, oval organisms that can be seen in the cytoplasm of mononuclear phagocytes or histiocytes in tissue samples from patients with granuloma inguinale.[11] They appear deep purple when stained with Wright's stain.[11] These intracellular inclusions are the encapsulated gram-negative rods of the causative organisms.
Granuloma inguinale

Last edited by Novobiocin; 06-11-2012 at 10:34 AM.
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Infectious-Diseases, Step-2-Questions

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