Chancroid and Lymphogranuloma Venereum

A 32-year-old man from Mumbai presents with a small, painless ulcer on the coronal sulcus noticed 2 weeks ago. He reports unprotected intercourse 4 weeks prior. Examination reveals the ulcer is 3 mm, painless, with a clean base. Inguinal lymph nodes are enlarged, tender, and matted. The patient reports recent onset of fever, malaise, and rectal pain. Nucleic acid amplification test (NAAT) for *Chlamydia trachomatis* L2 is positive. What is the most likely diagnosis?

A 28-year-old man from Mumbai presents with a painful ulcer on the glans penis for 5 days. He reports unprotected sexual contact 3 days prior. On examination, the ulcer is deep, with undermined edges, purulent base, and surrounding erythema. Regional lymph nodes are tender and suppurative. Gram stain of the ulcer exudate shows gram-negative coccobacilli in a 'school of fish' pattern. What is the most likely diagnosis?

A 32-year-old man from Chennai presents with a small, painless ulcer on the coronal sulcus noted 2 weeks ago, which he initially ignored. He now complains of severe inguinal pain and swelling for the past 5 days. On examination, the primary ulcer is small and shallow with clean margins; inguinal lymph nodes are matted, tender, and show signs of coalescence. Serological testing is positive for *Chlamydia trachomatis* L2. What is the most appropriate next step in management?

A 28-year-old man from Delhi presents with a painful ulcer on the glans penis for 5 days. He reports a single sexual exposure 3 days prior to ulcer onset. On examination, the ulcer is 8 mm, with a sharply demarcated edge, purulent base, and surrounding erythema. Regional lymph nodes are tender and suppurative. A Gram stain of the ulcer exudate shows gram-negative coccobacilli arranged in a "school of fish" pattern. What is the most likely diagnosis?