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chancroid (soft chancre)

Venereal disease due to Haemophilus ducreyi. Etiology: - Haemophilus ducreyi Epidemiology: more common in tropical developing countries Pathology: - deep necrotizing ulcers Clinical manifestations: 1) constitutional symptoms - fever, malaise, headache, anorexia 2) lesions begin on genitalia or adjacent skin as small erythematous papules that suppurate, resulting in soft, painful ulcers with eroded or ragged edges - may be single or multile lesions 3) regional (inguinal) lymphadenitis (bubo) in 1/3 of patients 4) dyspareunia (women) 5) dysuria (women) Laboratory: 1) smear of lesion 2) culture of lesion 3) test for coexistent sexually transmitted disease, including HIV Differential diagnosis: 1) syphilis 2) Herpes simplex 3) lymphogranuloma venereum 4) granuloma inguinale Management: 1) pharmaceutical agents of choice a) azithromycin 1 g PO once b) ceftriaxone 250 mg IM once 2) alternative agents a) ciprofloxacin 500 mg PO BID for 3 days c) erythromycin 500 mg PO QID for 7 days c) Augmentin 500 mg PO TID for 7 days 3) aspiration of fluctuant nodes to prevent rupture 4) avoid sexual activity for 1 week after treatment 5) follow-up evaluation within 1 week - treatment failure may indicate incorrect diagnosis [3]

Related

Haemophilus ducreyi

General

bacterial infection sexually-transmitted disease; sexually-transmitted infection; venereal disease (STD, STI)

References

  1. DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 873
  2. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 541
  3. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 443-444
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.