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Advances in the diagnosis and management of chancroid.

Abstract：

:Improved technologies for the cultural diagnosis of chancroid have resulted in increased interest in the management and control of genital ulcer disease. New treatment regimens have been identified, and new control strategies have evolved. These strategies now permit localized introductions of chancroid into developed countries to be contained rapidly. However, additional work is still necessary in developing countries. :Physicians paid little attention to chancroid and its causative agent Hemophilus ducreyi until the late 1970s and early 1980s. Therefore diagnoses are insufficient. In addition, physicians do not manage chancroid well and public health officials cannot control its spread. Chancroid is endemic in developing countries, but periodically chancroid epidemics do occur in developed countries. Gram positive cocci which also flourish in chancroid ulcers often overgrow H. ducreyi (a gram negative rod) making it hard to diagnose infection. Besides, for optimal chance of H. ducreyi isolation, a health worker must directly inoculate pus from the ulcer onto either gonococcal or Mueller-Hinton agar in the Petri dish. To further complicate diagnosis, clinical and epidemiological characteristics of patients who are H. ducreyi culture negative are like those of patients who are H. ducreyi culture positive. Moreover genital ulceration varies like it does with Treponema pallidum or herpes simplex virus. In fact, only about 40% of men and 29% of women have an ulcer. Nevertheless a chancroid lesion starts out as papule that soon turns into an ulcer. Around 33% of all patients experience lymphadenopathy. If chancroid is not treated, the lymph nodes swell and exude pus. They eventually burst and drain chronically. Prostitutes and other sexually active females with ulcers tend to be reservoirs of H. ducreyi. As of late 1990, researchers could not culture H. ducreyi from asymptomatic males. Another exacerbation of the problems with chancroid is that H. ducreyi is resistant to most antibiotics. Yet erythromycin, ceftriaxone, and cefotaxime treatment yield positive results. A study in Kenya shows that treatments with 1000 mg, 500 mg, and 250 mg ceftriaxone cured 97% of men with genital ulcer disease. Since diagnosis is difficult; anyone with chancroid and his/her contacts should be treated immediately.

journal_name

Sex Transm Dis

journal_title

Sexually transmitted diseases

authors

D'Costa LJ,Bowmer I,Nsanze H,Dylewski J,Fransen L,Plummer FA,Piot P,Ronald AR

doi

10.1097/00007435-198607000-00019

subject

Has Abstract

pub_date

1986-07-01 00:00:00

pages

189-91

issue

3 Suppl

eissn

0148-5717

issn

1537-4521

journal_volume

pub_type

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Advances in the diagnosis and management of chancroid.