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Gram stain smears of ulcer exudate or bubo aspirate are 50% reliable; blood agar cultures are 75% reliable. Biopsy confirms the diagnosis but is reserved for resistant cases or cases in which cancer is suspected. Dark-field examination and serologic testing rule out other STDs that cause similar ulcers. Testing for HIV infection should be done at the time of diagnosis.
Source: Professional Guide to Diseases (Eighth Edition), 2005
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