Chancroid

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Rosacea Free Forever Cure By Laura Taylor

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Chancroid is a sexually transmitted disease caused by inoculation of Haemophilus ducreyi through genital breaks in the skin. Chancroid is rare in the United States but common in Africa and some parts of Asia. It is more common in men than in women and associated with lower socioeconomic groups. Chancroid is commonly associated with coexisting syphilis or HIV.

Within four to seven days after exposure, a tender papule arises. Within another one to two days, the lesion becomes pustular or ulcerates (Fig. 8). The ulcer is extremely painful and surrounded by erythema, and it is often foul smelling. Lesions can be solitary or by autoinoculation form multiple lesions that can coalesce into "kissing" lesions or giant ulcers. Within one or two weeks, inguinal lymphade-nopathy develops in approximately 50% of patients and is usually unilateral. The lymphadenitis may become suppurative and rupture. If untreated, extensive ulceration, necrosis, genital and perineal edema, and rectovaginal fistulae can result.

The differential diagnosis includes all sexually transmitted ulcerative diseases, including HSV infection in an immunocompromised patient, as well as aphthae, Crohn's disease, and hidradenitis suppurativa. The diagnosis of chancroid is likely if the patient has one or more painful genital ulcers and the presence of painful regional lymphadenopathy and there is no evidence of T. pallidum or HIV in the ulcer exudate. The diagnosis is difficult to confirm because the appropriate culture media for H. ducreyi is generally not available. Even in the best circumstances, H. ducreyi isolation has a sensitivity no more than 80%. Gram-stain evaluation classically shows coccobacilli in groups, described as "schools offish,'' or in parallel, described as "railroad tracks.''

Antimicrobial resistance is becoming more prominent with H. ducreyi. Antibiotic therapies include azithromycin 1 g orally or ceftriaxone 250 mg IM once, ciprofoxacillin 500 mg b.i.d. for three days, erythromycin 500 mg t.i.d. for seven days, or amoxicillin/clavulanic acid 500/125 t.i.d. for seven days (Table 8) (26).

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Figure 8 (See color insert) Despite the careful descriptions of differing morphologies of ulcers in the various ulcerative sexually transmitted diseases, the ulcers often appear discoura-gingly similar. This lesion of chancroid cannot be diagnosed on morphology alone, but rather on clinical suspicion and laboratory investigation.

Vulvovaginal Infections

83

Table 8 Chancroid

Clinical

Differential

Diagnosis Symptoms

appearance

diagnosis

Therapy

Chancroid Painful genital ulcers

Genital ulcer,

Genital herpes,

Azithromycin or

and painful regional

with surroun-

primary syph-

ceftriaxone,

lymphadenopathy

ding erythema

ilis, lympho-

ciprofloxacin,

and ery-

granuloma

or

thematous,

venereum,

erythromycin

suppurative

granuloma

base

buboes

inguinale,

trauma

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