Chancroid: Diagnosis and Therapy

by John Fisher, MD

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    00:01 You make a diagnosis of definite chancroid by detecting antigens of Haemophilus ducreyi by PCR.

    00:14 that’s the way to make them.

    00:16 Gram stain is not that sensitive.

    00:22 It’s probable chancroid if a patient presents with one or more genital ulcers that are painful, and you’ve ruled out syphilis – no evidence of Treponema pallidum either by dark field, or their serology is negative.

    00:39 Or if they have a typical clinical presentation, and you’ve also thought about herpes simplex and you’ve tested for that, and the test for herpes simplex is negative – that would be examples of probable chancroid.

    00:57 Now in terms of treatment, azithromycin in a single dose is very effective.

    01:07 Alternatives include ceftriaxone, a single intramuscular dose, and remember that this is a Gram-negative pleomorphic rod, and like ceftriaxone works with Haemophilus influenzae.

    01:24 You wouldn’t be surprised that it also works for Haemophilus ducreyi.

    01:29 Ditto ciprofloxacin and erythromycin given for 7 days.

    01:37 And what you would expect in a patient is that they would be better in 3-7 days.

    01:43 If they’re not better, then perhaps the diagnosis is not correct.

    01:48 So what do we do about a patient who you thought had chancroid but you weren’t able to prove it and they didn’t get any better? Well the main thing that you want to rule out is the painful genital infection due to herpes simplex, and also an atypical presentation of primary syphilis.

    02:13 So you would want to rule those 2 things out.

    02:16 Now in terms of treating the contacts of the patients – someone who’s had sex with a patient within 10 days before the onset of symptoms – they need to be identified and treated.

    02:31 Even asymptomatic contacts of people you thought had chancroid should be treated, and the treatment is simple with 1 gram of azithromycin in a single dose.

    02:45 Lastly let's have a view on fluctuant lymph nodes. They should be aspirated, or if they are very large or infected, an incision and drainage maybe needed.

    About the Lecture

    The lecture Chancroid: Diagnosis and Therapy by John Fisher, MD is from the course Genital and Sexually Transmitted Infections.

    Included Quiz Questions

    1. Detection of antigens of the pathogen by PCR of a swab of the ulcer
    2. Culture of the pathogen from a swab of the ulcer
    3. Blood culture
    4. Serological detection of antibodies
    5. Clinical diagnosis only
    1. Single dose of azithromycin 1g orally
    2. Azithromycin 500mg twice a day for 7 days
    3. Clindamycin 900mg twice a day for 7 days
    4. Ceftriaxone 250mg intravenously daily for 10–14 days
    5. Single dose of ciprofloxicin 250mg intramuscularly
    1. Rule out genital herpes and primary syphilis
    2. Empiricalyl treat for missed syphilis with penicillin
    3. Treat with a longer course of Azithromycin (500mg twice a day for 7 days)
    4. Alternative treatment with ceftriaxone 250mg intramuscularly once
    5. Repeat treatment with azithromycin and treat all sexual contacts within the past 10 days

    Author of lecture Chancroid: Diagnosis and Therapy

     John Fisher, MD

    John Fisher, MD

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