Snapshot
- A 35-year-old woman presents to the urgent care clinic for genital ulcers. Her past medical history includes peptic ulcer disease and depression. She started having unprotected sexual intercourse with a new partner 1 month ago. She reports that he had not been tested for sexually transmitted diseases. She reports having a painful ulcer on her labia and wishes to be tested. On physical exam, there is a 1 cm ulcer with an erythematous base and irregular borders. When scraped, the ulcer easily bleeds.
Introduction
- Classification
- Haemophilus ducreyi
- gram-negative facultative anaerobic coccobacillus
- transmission
- sexually, often through a break in the skin
- causes
- chancroids
- Haemophilus ducreyi
- Epidemiology
- incidence
- highest in Asia, Africa, and the Caribbean
- location
- genitals
- risk factors
- multiple sexual partners
- unprotected sex
- incidence
- Associated conditions
- often co-infection with herpes simplex virus
- Prevention
- protected sex
- Prognosis
- most heal within a week
Presentation
- Symptoms
- painful genital lesion
- typically does not have systemic symptoms
- Physical exam
- unilateral tender inguinal lymphadenopathy
Studies
- Labs
- detection of DNA with polymerase chain reaction
- culture requires a special media (often using a mixed culture, i.e., gonoccocal agar with bovine hemoglobin and fetal calf serum) and may be difficult to grow
- Making the diagnosis
- based on clinical presentation and exclusion of other sexually transmitted diseases
Differential
- Treponema pallidum primary infection
- distinguishing factor
- nonpainful ulcer (chancre)
- distinguishing factor
- Herpes
- distinguishing factor
- painful ulcer with systemic symptoms
Treatment
- Medical
- azithromycin or ceftriaxone
- indication
- first-line
- indication
- azithromycin or ceftriaxone
- requires only a single dose
Complications
- Increased risk of HIV transmission
- Secondary bacterial infections