Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 17) Diagnosis Although most genital ulcerations cannot be diagnosed confidently on clinical grounds alone, clinical findings plus epidemiologic considerations (Table 124-7) can usually guide initial management (Table 124-8) pending results of further tests. Clinicians should order a rapid serologic test for syphilis in all cases of genital ulcer and a dark-field or direct immunofluorescence test (or PCR test, where available) for T. pallidum in all lesions except those highly characteristic of infection with HSV (., those with herpetic vesicles). All patients presenting with genital ulceration should be counseled and tested for HIV infection. Table.
