<prompt> DOC in chancroid isTetracyclineDoxycyclineErythromycinStreptomycin  <response>: C i.e. Erythromycin Distinguishing Features of Genital Ulcers Features Syphilis 1degchancre Chancroid soft chancre Lymphogranuloma Venereum Donovanosis Granuloma veneruminguinale Herpes genitalis Causative agent Treponema Haemophilus Chlamydia Calymmatobacterium Herpes simplex pallidiumQ ducreyiQ trachomatisQ granulomatisQ virus type HQ LI,L2,L3 rarely type I Incubation period 9 - 90 daysQ 1 - 7 days rarely 10 days 3 days - 6 weeks 1-4 weeks upto 6 months 2-7 days No. of attacks Only one 1 1 or 2 Only one 1 Only one 1 Reccurent No. of lesions Usually 1 Usually multipleQ may coalesce Usually 1 Variable MultipleQ, may coalesce Early 1deg lesion Papule Pustule Papule, pustule Papule VesicleQ Diameter 5-15 mm Variable 2-10 mm Variable 1-2 mm Depth Superficial or deep Excavated Superficial or deep Elevated Superficial Edges Sharply demarcated, elevated, round or oval Undermined, ragged, sloughedQ irregular Elevated, round or oval Elevated, irregular serpiginous Erythematous Base Smooth, non- purulent, non- vascula,Q relatively Purulent, bleeds easily Variable, nonvascular Red velvety beefy red, bleeds easily with exuberant granulation tissueQ Serous, erythematous, nonvascular. Induration FirmQ SoftQ mostly Occasionly firm Firm None Pain UncommonQ Usually very tender Variable Uncommon Frequenctly tenderQ Lymphadenopathy Firm, non tender, shotty, bilateralQ Tender, may suppurate, loculated, usually unilateral Bubo Tender, may suppurate, loculated, usually unilateral Bubo No lymphadenopathy pseudobuboesQ subcutaneous nodules in inguinal region, may ulcerate Firm, tender, often bilateral Diagnosis - Dark field - Clinical features - Demonstration of - On tissue smear - Multinucleate microscopyQ - Serologicaltests - Gram staining gram -ve cocco- baccili with rail road appearance LGV as elementary inclusion bodies - Fries testQ - Hyper gamma- globulinemia - Complement fixation ve histopathological microscopy using Giemsa, Wrights or Silver stain or Leishman Stain 1. Gram negative C. granulomatis may be seen within characteristic large mono nuclear cell as d giant cell on Tzank smear - Culture is confirmatory Donovan bodies 2. Donovan bodies are seen in vacuolated cytoplasm of large mono nuclear cells as bipolar inclusionsQ safety pin or telephone handle appearance measuring 1 to 2 um x 0.5 to 0.7 um. Drug - Benzathineprocaine - Azithro - Doxy tetra DoxycyclineW tetracycline AcyclovirQ Penicillin in all erythromycin cyclineQ Azithromycin except neurosyph- ilis congenital syphilis in which crystalline penicillin - Ciftriaxone . - Ciprofloxacin - Erythromycin erythromycin in pregnancy aqueous benzyl penicillin is used - In penicillin sensitive patient, Tetracycline or erythromycin is used 