Thursday, November 11, 2010

Sounds Like the Last Case

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?


Madam Roxanne said...

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.

Madam Roxanne said...

I wanna say a chancroid or syphilis or herpes.
more likely herpes since syphilis isn't painful in early stages.

palvi said...

primary syphilis

sid said...

Genital herpes.....

Craig Chen said...

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
Sounds Like the Last Case

The last case was titled Hermes; this is herpes.

Source: UpToDate.