软下疳

溃疡通常为孤立性、发硬且无痛的溃疡（硬下疳）。

引起无痛性腹股沟淋巴结炎，且常为双侧。

在混合感染时可能伴有杜克雷嗜血杆菌感染。

常合并全身系统性症状如发热及皮疹。[15]Morse SA. Chancroid and Haemophilus ducreyi. Clin Microbiol Rev. 1989 Apr;2(2):137-57.http://cmr.asm.org/content/2/2/137.longhttp://www.ncbi.nlm.nih.gov/pubmed/2650859?tool=bestpractice.com[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

尖锐湿疣往往伴随皮疹。

RPR试样为阳性。

RPR 检测是非特异性的，且须由梅毒螺旋体血清学检测来确认。

病灶形成水疱。

疱疹形成的溃疡浅，基底部较软下疳溃疡整洁。

淋巴结常为双侧肿大且无波动性。

在混合感染时可能伴有杜克雷嗜血杆菌感染。

更常见全身症状，包括发热，头痛及心悸。[13]Spinola, SM. Chancroid and Haemophilus ducreyi. In: Holmes KK, Sparling PF, Stamm WE, et al, eds. Sexually transmitted diseases. 4th ed. New York, NY: McGraw-Hill, 2008:689-700.[15]Morse SA. Chancroid and Haemophilus ducreyi. Clin Microbiol Rev. 1989 Apr;2(2):137-57.http://cmr.asm.org/content/2/2/137.longhttp://www.ncbi.nlm.nih.gov/pubmed/2650859?tool=bestpractice.com[19]Marrazzo JM, Handsfield HH. Chancroid: new developments in an old disease. In: Remington JS, Swartz MN, eds. Current clinical topics in infectious diseases. Malden MA: Blackwell Science; 1995:129-52.[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

PCR 检测出疱疹 DNA，疱疹培养呈阳性，或者活检病灶的 Tzanck 涂片呈阳性。[Figure caption and citation for the preceding image starts]: 赞克氏试验涂片显示多核巨细胞，提示存在疱疹病毒改编自美国疾病预防控制中心公共卫生图片库 J. Miller（1975 年） [Citation ends].

腹股沟淋巴结肿大，有触痛，不伴生殖器溃疡形成。

如有破损存在，则为无痛性病变。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.[58]Black CM, Morse SA. The use of molecular techniques for the diagnosis and epidemiologic study of sexually transmitted diseases. Curr Infect Dis Rep. 2000 Feb;2(1):31-43.http://www.ncbi.nlm.nih.gov/pubmed/11095835?tool=bestpractice.com

腹股沟淋巴结抽吸物行 PCR 检测或细菌培养可见沙眼衣原体。

无痛性生殖器溃疡。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.[24]Ronald AR, Plummer FA. Chancroid and granuloma inguinale. Clin Lab Med. 1989 Sep;9(3):535-43.http://www.ncbi.nlm.nih.gov/pubmed/2676322?tool=bestpractice.com

淋巴结炎少见。

溃疡处刮擦或活检显示肉芽肿克雷伯菌（也称为肉芽肿荚膜杆菌）阳性。

常有外伤史。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

不大可能形成淋巴结炎。

依赖临床诊断。

无突出特征。

病原体PCR、培养及血清学检查均阴性。

病灶活检可提供确诊依据。

口腔病变更常见。

发热，关节痛，葡萄膜炎及腹痛等全身表现常见。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

针刺反应阳性，且48小时内针刺部位有脓疱形成。

近期抗生素或化疗药的使用。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

皮肤活检具有诊断意义。

患者主要表现为肛周病变。

常有全身系统性表现，如发热，腹泻，体重减轻及腹痛。

腹股沟淋巴结炎不常见。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

结肠镜检查及组织活检可帮助确诊。

不伴有生殖器溃疡。

全身样表现如发热，皮疹及关节炎更为常见。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

革兰染色可见革兰阴性球菌。

细菌培养显示淋病奈瑟球菌呈阳性。

核酸扩增检测显示淋病奈瑟菌呈阳性。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.[58]Black CM, Morse SA. The use of molecular techniques for the diagnosis and epidemiologic study of sexually transmitted diseases. Curr Infect Dis Rep. 2000 Feb;2(1):31-43.http://www.ncbi.nlm.nih.gov/pubmed/11095835?tool=bestpractice.com

不伴生殖器溃疡及腹股沟淋巴结炎。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

发热及腰腹部疼痛常见。

尿培养阳性。

不伴生殖器溃疡及腹股沟淋巴结炎。[21]Augenbraun MH. Genital skin and mucous membrane lesions. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders; 2015:1341-8.

发热及腰腹部疼痛常见。

尿培养阳性。