A lady approaches a physician for contraceptive advice. On examination, there were two symmetrical ulcers on vulva, which were well-defined with firm base. Which of the following is the most likely cause?

Ans. is a, i.e. ChancreRef: Harrison 17th/edf pl040; William's Gynae lst/ed, p58-9, Current diagnosis and treatment of STD's p21KEY POINTSPainless well-defined ulcers with firm base should raise the suspicion of chancre.(The lesion in the question is thought to be painless as the lady in the question is not coming because of ulcer, but for contraceptive advice. Presence of ulcer is an incidental finding).Chancre is the primary lesion of primary syphilis.* It is most commonly found on the labium majus, labium minus, fourchette, clitoris, urethral orifice or cervix but can be found anywhere on the lower genital tract.* In 10% cases more than one primary lesion is present.* The first manifestation is a small papule which breaks to form an ulcer.* Ulcer is firm, painless with raised edges and granulomatous base.* In fact any sort of discrete relatively painless ulceration on the vulva may be primary syphilitic lesion.* Inguinal glands enlarge when the primary is on the vulva or lower vagina.* Lymph nodes are hard, shotty, painless, and do not suppurate.