Snapshot A 35-year-old woman presents to the urgent care clinic for genital ulcers. Her past medical history includes peptic ulcer disease and depression. She started having unprotected sexual intercourse with a new partner 1 month ago. She reports that he had not been tested for sexually transmitted diseases. She reports having a painful ulcer on her labia and wishes to be tested. On physical exam, there is a 1 cm ulcer with an erythematous base and irregular borders. When scraped, the ulcer easily bleeds. Introduction Classification Haemophilus ducreyi gram-negative facultative anaerobic coccobacillus transmission sexually, often through a break in the skin causes chancroids Epidemiology incidence highest in Asia, Africa, and the Caribbean location genitals risk factors multiple sexual partners unprotected sex Associated conditions often co-infection with herpes simplex virus Prevention protected sex Prognosis most heal within a week Presentation Symptoms painful genital lesion typically does not have systemic symptoms Physical exam genital papule that develops into an ulcer has a grey-yellow base with irregular borders may bleed when touched often has an exudate unilateral tender inguinal lymphadenopathy Studies Labs detection of DNA with polymerase chain reaction culture requires a special media (often using a mixed culture, i.e., gonoccocal agar with bovine hemoglobin and fetal calf serum) and may be difficult to grow Making the diagnosis based on clinical presentation and exclusion of other sexually transmitted diseases Differential Treponema pallidum primary infection distinguishing factor nonpainful ulcer (chancre) Herpes distinguishing factor painful ulcer with systemic symptoms Treatment Medical azithromycin or ceftriaxone indication first-line requires only a single dose Complications Increased risk of HIV transmission Secondary bacterial infections