Differential Rule In Rule Out Diagnostics

Diagnoses
Lymphogranuloma Incubation period (3-30 Usually one lesion Culture
Venereum days) Unilateral Direct
Shallow vulvar ulcer adenopathy immunofluorescence
Diameter of ulcer (2-10 (-) Groove sign Nucleic acid detection
mm) Chlamydia serology
Non-tender inguinal (complement fixation
lymph nodes titers >1:64)
Malaise
Fever

Chancroid Incubation period (1-14 Unilateral Gram stain

days) lymphadenopathy (extracellular school
Multiple lesions Tender of fish)
Diameter (2-20 mm) Whitish non foul Culture media
Shallow smelling
Fever discharge
Body malaise

RATIONAL LABORATORY & DIAGNOSTIC TESTS

LAB. TEST INTERPRETATION/NECESSITY
Microbiology
Tzanck smear A Tzanck smear can be used to screen for Herpes Simplex Virus. Cells
infected with herpes virus appeaer very large with many centers (also
known as multinucleated giant cells), and infected cells pick up the stain
in a different way than uninfected ones do. However, this study is
neither sensitive nor specific.
Viral cultures Viral cultures are useful in confirming the diagnosis in primary episodes
when culture sensitivity is 80%, but less useful in recurrent episodes.
Most herpes virus cultures will become positive within 2 to 4 days of
inoculation.
Polymerase Chain Reaction PCR assay is the most accurate and sensitive technique for identifying
(PCR) assay herpes virus. PCR takes a tiny piece of virus and amplifies, or copies, it
many times so that it can be identified and subsequently typed as HSV 1
or 2.
Serology
Serologic tests Serologic type-specific glycoprotein based assays are used to detect
HSV-1 and HSV-2 antibodies with a specificity of 96 percent. Type-
specific antibodies for HSV-1 and HSV-2 IgG may be used to determine
whether the patient has a primary infection as well as the serotype of
the causative organism.
Western blot assay The Western blot assay for antibodies to herpes is the most specific
method for diagnosing recurrent herpes, as well as unrecognized or
subclinical infection.