• Diagnosis is based only on the patient's medical history and physical examination often is inaccurate
• Evaluation of all patients who have genital ulcers should include a serologic test for syphilis and a diagnostic evaluation for genital herpes; in settings where chancroid is prevalent, a test for Haemophilus ducreyi should also be performed
• Specific tests for evaluation of genital ulcers include:
  • Serology, and either darkfield examination or direct immunofluorescence test for T. pallidum;
  • Culture or antigen test for herpes simplex virus (HSV); and
  • Culture for H. ducreyi.
• Testing can be performed by commercial laboratories that have developed their own PCR tests:
  • Type-specific serology for HSV type 2 may be helpful in identifying persons with genital herpes
  • Biopsy of ulcers may be helpful in identifying the cause of unusual ulcers or ulcers that do not respond to initial therapy.
• HIV testing should be performed in the management of patients who have genital ulcers caused by T. pallidum or H. ducreyi. Such testing should be considered for those who have ulcers caused by HSV
• Chancroid
  • A definitive diagnosis of chancroid requires identification of H. ducreyi on special culture media that is not widely available from commercial sources; even using these media, sensitivity is <80%.
  • Testing can be performed by commercial laboratories that have developed their own PCR test
  • A probable diagnosis, for both clinical and surveillance purposes, can be made if all the following criteria are met:
    • The patient has one or more painful genital ulcers
    • The patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers
    • The clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for chancroid
    • A test for HSV performed on the ulcer exudate is negative. The combination of a painful ulcer and tender inguinal adenopathy, symptoms occurring in one third of patients, suggests a diagnosis of chancroid; when accompanied by suppurative inguinal adenopathy, these signs are almost pathognomonic

References

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