A 30 year old woman presents with pain on urination. She is empirically prescribed a course of trimethoprim/sulfamethoxazole but her dysuria persists. On examination, you note painful genital ulcers and tender local inguinal lymphadenopathy. There are multiple pustular vesicles and ulcers that arise after a 4 day incubation period and last 2-3 weeks. In addition, she complains about fever, headache, malaise, and myalgias.
Challenge: What's the most likely diagnosis?
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My initially thought is that b/c the antibiotic treatment didn't work the problem is likely intracellular like a virus or syphilis.
Syphilis ulcers are initially not painful, but b/c there are additional symptoms this could be a later stage and the ulcers have become painful.
the Lymphadenopathy suggests a long-term infection of syphilis.
I wanna say a chancroid or syphilis or herpes.
more likely herpes since syphilis isn't painful in early stages.
primary syphilis
Genital herpes.....
Ah yes, any STD is on the differential, but a painful ulcer is closer to herpes than syphilis - though you are right, inguinal LAD is also a prominent feature of the syph
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Sounds Like the Last Case
The last case was titled Hermes; this is herpes.
Source: UpToDate.
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