A 40-year-old man has a slowly progressive, painless, beefy red hypertrophic genital ulcer with rolled edges and pseudobubo in the inguinal region. Giemsa-stained tissue crush smears show large mononuclear cells containing bipolar safety-pin shaped inclusion bodies. First line treatment is:

• A Penicillin G benzathine 2.4 million units intramuscularly once
• B Azithromycin 1 g weekly until lesions heal ✓
• C Doxycycline 100 mg twice daily plus ceftriaxone 250 mg intramuscularly once
• D Acyclovir 400 mg thrice daily for 10 days

Explanation

Donovanosis due to Klebsiella granulomatis shows Donovan bodies, intracellular bipolar organisms within macrophages on Giemsa stain, producing painless progressive beefy red ulcers. Pseudobuboes are subcutaneous granulomas rather than true lymph node abscesses. CDC recommends azithromycin as first line therapy continued until complete healing. Benzathine penicillin treats syphilis, not this condition, and the combination regimen in option C targets chancroid, making those the key distractors to eliminate.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.