Name
CHANCROID
DESCRIPTION
DETAIL
CAUSES : CAUSED BY HAEMOPHILUS DUCREYI, PRESENTED BY GENITAL ULCERS & INGUINAL ADENITIS D.D.: - BALANITIS - BALANITIS CIRCINATA OF REITER DISEASE - HERPES GENITALIS - GRANULOMA VENEREUM ( INGUINALE) - LYMPHOGRANULOMA INGUINALE - EPITHELIOMA - PAPILLOMA - GUMMATOUS ULCERATION - TUBERCULAR ULCERATION - INJURY AS BITE OR ZIPPER INJURY - SYPHILIS -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Syphilis β’ Herpes simplex virus (HSV 1 and 2) β’ Lymphogranuloma venereum (LGV) β’ Granuloma inguinaleOTHER TESTS : * GRAM STAINING - CHARACTERISTIC GRAM NEGATIVE COCCOBACILLI * CULTURE OF HAEMOPHILUS DUCREYI FROM THE LESION * LYMPHADENOPATHY ASSOCIATED VIRUS ( LAV ) MONOCLONAL ANTIBODY TEST β’ PCR testing of ulcer exudate for H. Ducreyi DNA β’ Dark-field examinations of exudate to rule out Treponema pallidum β’ Culture or PCR testing for HSV
TYPENOTES
RISK FACTORS: β’ Multiple sexual partners β’ Uncircumcised males β’ Prostitutes often are carriersGENERAL MEASURES: β’ Saline or Burowβs solution soaks to ulcers β’ Aspiration of buboes if greater than 5 cm; done through adjacent uninvolved skin ACTIVITY :Refrain from sexual intercourse until genital lesions fully resolved PATIENT EDUCATION: β’ Sexual counseling β’ Use of condoms β’ Local wound care β’ Treatment of all sexual partners with same regimen as index case β’ HIV testing DRUG(S) OF CHOICE: β’ Azithromycin 1 gm po single dose (more expensive than other treatments) β’ Ceftriaxone 250 mg IM single dose β’ Ciprofloxacin 500 mg po bid for 3 days or other quinolone β’ Erythromycin base 500 mg qid x 7 days PATIENT MONITORING: β’ Patient followed until all clinical signs of infection resolved β’ Should see symptomatic improvement within 3 days and objective improvement by day 7 β’ Baseline syphilis serology and at 3 months β’ HIV testing at baseline and at 3 months post-treatment PREVENTION/AVOIDANCE Avoidance of sexual activity until ulcers resolved POSSIBLE COMPLICATIONS: β’ Phimosis β’ Balanoposthitis β’ Rupture of buboes with fistula formation and scarring EXPECTED COURSE/PROGNOSIS: β’ Full clinical resolution with appropriate treatment β’ 5% relapse after treatment β’ Primary infection is not believed to provide immunity
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT, PCR, PUS CULTURE TEST, GRAM STAINING