[Mondoshawan]

A 45-year-old businessman presents with a unilateral tender enlarged inguinal lymph node. He travels overseas several times a year, and admits to having sex with prostitutes while away. Upon returning from his most recent business trip last month, he noticed a painless ulcer on his penis. He self-medicated with penicillin, and the ulcer resolved after several days. A few weeks later the lymphadenopathy began to develop. VDRL and HIV screening are negative. From what is the patient most likely suffering?

• Chancroid caused by H. ducreyi
• Genital herpes caused by HSV-2
• Granuloma inguinale caused by K. granulomatis
• Lymphogranuloma venereum caused by C. trachomatis
• Primary syphilis caused by T. pallidum
• Secondary syphilis caused by T. pallidum

 

[FrontalBossing]

I'm going to go with C, donovanosis, it's the odd-man out in inguinal lymphadenopathy when it comes to STD's. This a good question, lots of answer choices that are attractive.

 

[absolutjag9]

Granuloma inguinale caused by K. granulomatis?? h.ducreyi causes painful ulcers i think...

side note-what would borat say to pt? naughty naughty!!! )

 

[pnreddy]

the answer is lymphogranuloma venereum .,b'coz the buzz word here seems 2 be PAINLESS ULCER--So i exclude chancroid,n herpes and in granuloma inguinale even though it is a painless ulcer,.adenopathy seems to be rare.....so i thnk the answer is LGV.,because after a period of dev of ulcer.,the pt has TENDER LYMPHADENOPATHY

 

[mle2resident]

D. Lgv

Painless ulcer, resolved with self-medicated penicillin: i thought it could be primary syphillis which few weeks later became secondary, but with VDRL negative and unilateral tender enlarged lymphadenopathy clearly indicates buboes.. Hence my answer LGV caused by C.Trachomatis.

 

[drahmednawaz]

Answer is D.

Easy way to solve and remember this Q is as follows:

First boil down to the two options: Granuloma inguinale and Lymphogranuloma. This is where most students are at loggerheads.

Both have granuloma in their names, so both cause chronic granulomas, leading to fibrosis and resulting complications; but only Lymphogranuloma has word lympho, so only Lymphogranuloma causes lymphadenopathy.

Classic sign for Granuloma inguinale is painless beefy red ulcer without adenopathy that leads to fibrosis and lymphatic obstruction.

Classic sign for Lymphogranuloma is painless vesicopapular ulcer that by itself heals and later on leads to adenopathy.

Pencillin won't treat either. Give doxy.

click image to enlarge

 

[Mondoshawan]

Correct!

The patient is suffering from the second stage of lymphogranuloma venereum (LGV) caused by Chlamydia trachomatis serotype L1, L2, or L3 (D). The primary lesion was a painless ulcerating papule at the point of transmission, which more likely resolved coincidentally with his administration of penicillin rather than because of it. Tender, swollen inguinal lymph nodes (buboes) characterize the secondary stage. The tertiary stage could manifest more seriously or systemically - as proctitis, fever, pneumonitis, meningo-enchephalitis, hepatitis, or elephantiasis. Our patient would be treated with doxycycline (indeed, the same course of treatment is indicated for granuloma inguinale, so those who chose donovanosis would have still cured the patient).

• Chlamydia trachomatis serotypes A, B, and C cause trachoma, a serious eye infection.
• Chlamydia trachomatis serotypes D through K cause sexually transmitted cervicitis, urethritis, proctitis, etc.
• Chancroid (A) and genital herpes (B) are characterized by painful lesions.
• The nodules of granuloma inguinale (C), also called Donovanosis, erode to form granulomatous beefy red ulcers.
• The primary lesion of syphilis (E and F) is also a painless ulcer, but the VDRL test is 80-85% sensitive for primary syphilis and approach 100% sensitivity for secondary syphilis.

Good reasoning and great teaching in the answers everyone! :happy:

 

[preeti617]

You have included LGV in lesions with ulcers while chlamydia has been included in lesions with ulcers?Isn't chlamydia the causative org for LGV?

Answer is D.

Easy way to solve and remember this Q is as follows:

First boil down to the two options: Granuloma inguinale and Lymphogranuloma. This is where most students are at loggerheads.

Both have granuloma in their names, so both cause chronic granulomas, leading to fibrosis and resulting complications; but only Lymphogranuloma has word lympho, so only Lymphogranuloma causes lymphadenopathy.

Classic sign for Granuloma inguinale is painless beefy red ulcer without adenopathy that leads to fibrosis and lymphatic obstruction.

Classic sign for Lymphogranuloma is painless vesicopapular ulcer that by itself heals and later on leads to adenopathy.

Pencillin won't treat either. Give doxy.

View attachment 1044
click image to enlarge

 

[..sharma]

@preeti - i think the differentiatn is between the serotypes of chlamydia
serotypes D to K cause NGU... an std an no ulcers
serotypes L1,2,3 cause lymphogranuloma venerum

any way thanks for bringing this Q up.... great explanations given... wud have missed that... Happy-2Happy-2