When most applicants think about the STI portion of their immigration medical exam, they think of the syphilis and gonorrhea tests every civil surgeon runs as a matter of course. But three other conditions – chancroid, granuloma inguinale, and lymphogranuloma venereum (LGV) – have quietly sat on the federal list of communicable diseases of public health significance for decades, even though almost no one applying for a green card today will ever be diagnosed with one. Understanding why they’re still there, and how they’d actually surface during your exam, clears up a source of confusion for applicants who stumble across the full regulatory list and wonder if they’re at risk.
Why These Three Conditions Are Still on the List
Communicable diseases of public health significance are defined in federal regulation at 42 CFR 34.2, and that definition has historically named chancroid, granuloma inguinale, and lymphogranuloma venereum alongside better-known conditions like infectious syphilis, active tuberculosis, and gonorrhea. A finding of any listed disease can render an applicant inadmissible on health-related grounds – what USCIS classifies as a Class A finding – regardless of how rare the condition actually is in the general population. The definition has been amended over time to give federal health authorities flexibility to respond to emerging outbreaks, but the underlying purpose has stayed the same: keep the list oriented toward diseases that pose a genuine transmission risk, not diseases that happen to be common.
What Each Condition Actually Is
All three are bacterial sexually transmitted infections, and all three are now uncommon in the United States compared to chlamydia, gonorrhea, and syphilis. Most current U.S. cases are linked to travel or exposure abroad rather than domestic transmission.
| Condition | Cause | Typical Presentation | U.S. Prevalence Today |
|---|---|---|---|
| Chancroid | Haemophilus ducreyi bacterium | Painful genital sores with tender, swollen groin lymph nodes | Very low incidence; most current cases traced to travel or exposure abroad |
| Granuloma Inguinale (Donovanosis) | Klebsiella granulomatis bacterium | Chronic, slow-spreading ulcerative lesions of the genital skin | Rare – well under 100 diagnosed cases per year nationally |
| Lymphogranuloma Venereum (LGV) | Specific serovars of Chlamydia trachomatis | Genital ulcers, painful groin lymph nodes (buboes), and in some cases proctocolitis | Still uncommon, though incidence has risen somewhat in recent years, particularly among certain higher-exposure groups |
Because all three conditions are endemic in different parts of the world rather than evenly distributed globally, an applicant’s exposure history has more to do with where they’ve lived or traveled than anything specific to the immigration process itself. That’s worth stating plainly: being a green card applicant does not, on its own, put anyone in a higher-risk category. The connection to Form I-693 exists only because that form is the vehicle through which any communicable disease of public health significance – common or vanishingly rare – gets documented for USCIS purposes.
Why Routine I-693 Testing Doesn’t Screen for Them
This is the part that trips people up. The immigration medical exam requires civil surgeons to run specific laboratory tests for tuberculosis, infectious syphilis, and gonorrhea as a standard part of every applicant’s panel. Chancroid, granuloma inguinale, and LGV are not part of that routine lab workup. There is no blood draw or urine test that screens for them by default. Instead, these three conditions are things a civil surgeon would only identify through the physical examination and health history that’s already part of your visit – specifically, if you present with visible genital ulcers, lesions, or swollen lymph nodes consistent with one of these infections, or disclose relevant symptoms during the exam.
In practice, this means the overwhelming majority of applicants will never encounter these three conditions during their exam at all, because the exam simply isn’t designed to hunt for something this rare in the general applicant population. They exist on the list as a regulatory backstop for the rare case where a visible, active infection is actually present – not as a routine screening target.
What Happens If One Is Found
If a civil surgeon does identify signs consistent with chancroid, granuloma inguinale, or LGV during your exam, the process follows the same general path as any other communicable disease of public health significance found on Form I-693: it’s documented as a Class A finding, which on its own would make the medical portion of your application incomplete for approval. That is not necessarily the end of the road. Bacterial STIs in this category are generally treatable, and the civil surgeon is expected to advise you on how to obtain treatment through an appropriate local provider or health department. Once treatment is documented, many applicants are able to move forward with an updated medical certification. Waiver pathways also exist for communicable disease findings in appropriate circumstances, though the mechanics of those waivers are a separate topic from the exam itself.
The Bottom Line
Chancroid, granuloma inguinale, and lymphogranuloma venereum remain, on paper, named communicable diseases of public health significance that can affect your I-693 – but they’re a footnote for almost every applicant, not a routine concern. Your civil surgeon isn’t testing for them by default, and unless you have visible, active symptoms during your exam, they simply won’t come up. What matters far more for most people is showing up prepared for the tests that actually are part of the standard panel: the syphilis and gonorrhea screening every applicant goes through as a matter of course.