A rare form of cutaneous diphtheria is genital ulceration.
Clinical features:
(1) one or more genital ulcers
(2) local pruritis
(3) swollen, painful inguinal lymph nodes
Risk factors for genital infection:
(1) unvaccinated against diphtheria
(2) living in or travel to an endemic region for diphtheria
(3) sexual contact
A Gram stain from the ulcer may show Gram-positive coryneforms.
The diagnosis require:
(1) isolation of Corynebacterium diphtheriae from the ulcer
(2) exclusion of sexually-transmitted diseases such as syphilis and HSV
The isolate should be tested for diphtheria toxin. If the isolate is toxigenic, then the patient may be toxic if serum anti-toxin antibodies are absent.
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