Grading & Level of Importance: C
Bubo; Soft chancre; Ulcus molle.
Very rare in Europe except endemic hotspots and most commonly found in tropical and subtropical regions of Africa, the Caribbean, South America and southwest Asia; in Europe, mainly seen in travellers and patients originating from endemic areas.
Sexually transmitted infection caused by Haemophilus ducreyi with characteristic painful ulcers in the genital area; often unilateral swollen inguinal lymph nodes.
Aetiology & Pathogenesis
The causative agent Haemophilus ducreyi is a rod shaped gram negative bacterium, which is transmitted during sexual intercourse by direct inoculation from affected skin and mucosal sites.
Signs & Symptoms
Appear during the first week after transmission. Typically, there are one or more painful ulcers in the genital area. The site of most infections in men is the foreskin and other parts of the penis. In women ulcers may be located on the labia, perineum or intravaginal. Women may demonstrate less specific symptoms such as dysuria, vaginal discharge or rectal bleeding. Some women may have less or no symptoms at all.
No classification applicable.
Laboratory & other workups
Bacterial culture of Haemophilus ducreyi requires special culture media which are not widely available. Other swab tests using nucleic acid amplification are available only in specialized laboratories.
Usually not necessary.
Ulcers usually last for some weeks; if not treated many patients develop chronic inguinal lymphadenopathy.
If not treated, many patients develop painful inflammation of the inguinal lymph nodes (i.e. buboes), typically on one side. Chancroid increases the risk of HIV-transmission, so HIV testing and screening for other STI should be undertaken.
Usually the diagnosis is based on typical clinical features (related to foreign travel to endemic areas) and ruling out syphilis and genital herpes simplex.
Genital herpes simplex and syphilis (primary chancre) and in travel related cases to endemic regions granuloma inguinale. Lymphogranuloma venereum, if inguinal lymphadenopathy is present.
Prevention & Therapy
Prevention: barrier contraception.
A single dose of p.o. azithromycin 1 g or i.m. Ceftriaxone 250 mg is usually effective. Alternatives are p.o. Ciprofloxacin 500 mg b.i.d. (3 days) or p.o. Erythromycin 500 mg t.i.d. (7 days). Rarely, surgical treatments are required to drain infected lymph nodes.
Sexual activity should not take place until all lesions have healed. Sexual partners should be requested for clinical examination and treatment.
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