A 20-year-old young female presented with a relatively painless ulcer of 3 cm on the labia majora with raised margins. Which of the following organisms would have most likely caused this ulcer?

Ans. b. Treponema palladium (Ref: Rooks 7/e p17.37-17, 39.58-39.59)In a female with 3x4 cm painless ulcer with raised margin on labia majora is suggestive of syphilis, caused by Treponema pallidum.Sexually Transmitted DiseasesDonovanosisSyphilisLGVChancroid* Painless indurated and bleeding ulcerQ* Mostly involving genitalia (90%)* No lymphadenopathy/ pseudobuboQ* May lead to pseudoelephantiasis of labiaQ* Caused by calymmobacterium granulomatosis* Diagnosis made by microscopy by demonstration of Donovan bodiesQ or safety pin appearanceQ within large mononuclear cells in smears or biopsy sample* DOC is doxy/ tetracyclineQ* DOC in pregnancy is Azithromycin/ erythromycinQ* Painless indurated, non bleeding usually single punched out ulcerQ* Lymph nodes are rubbery* Caused by Treponema pallidumQ* Diagnosed by dark field microscopy, FTA-ABS (most sensitive test, earliest test to become positiveQ VDRL or RPR titer (determine response to treatment as they become negativeQ TPI (most specific test)Q TPH (2nd most sensitive test)* Penicillin G is drug of choiceQ for all stages of syphilis* Lymph nodes are matted (bubo)Q may suppurate and are painfulQ* Asymptomatic, single, painless (mostly) and non-bleeding macule / ulcerQ* Caused by Chlamydia trachomatis - L1L2 (MC)Q, L3 strains* Diagnosis by microscopic examination of Giemsa stained cell scrapings for inclusion/elementary bodiesQ* Esthiomine (vaginal and rectal stricture elephantiasis of vulva)Q* Frei's test is done for diagnosisQ* Groove sign is seenQ* DOC is doxy / tetracyclineQ* Lymph nodes are fluctuant and spontaneously rupture and suppurateQ* Ulcers develop within 7 daysQ, are multiple, painful, non indurated and bleeding (soft chancre)Q* Caused by Hemophilus ducreyiQ* Diagnosis by gram staining (gram negative cocco-bacilli, school of fish and rail road appearance)Q and culture of organism* DOC is Ceftriaxone. Azithromycin / erythromycin.