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Chancroid — SCE Infectious Diseases MCQ

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ModerateSTIsChancroidSCE Infectious Diseases

A 26-year-old man presents with a large painful genital ulcer with undermined edges and associated tender inguinal lymphadenopathy. He returned from Kenya 2 weeks ago. Gram stain of ulcer material shows Gram-negative coccobacilli in a school of fish pattern. HSV PCR and syphilis serology are negative. What is the most likely diagnosis and treatment?

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Correct answer: E — Chancroid; Azithromycin 1 g oral single dose

A painful genital ulcer with undermined edges, tender inguinal lymphadenopathy, and Gram-negative coccobacilli in a 'school of fish' pattern on Gram stain is classic for chancroid (Haemophilus ducreyi). It is endemic in parts of sub-Saharan Africa and South-East Asia. Treatment is Azithromycin 1 g oral single dose or IM Ceftriaxone 250 mg single dose. Fluctuant buboes may require aspiration. HIV testing should be offered as chancroid is a risk factor for HIV acquisition.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections