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Sexually transmitted infections

Chancroid Treatment STD

Treatment

The World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the United Kingdom's Clinical Effectiveness Group recommends several different antibiotic regimens. Comparable cure rates for both single dose ciprofloxacin (500 mg) and a 1 week course of erythromycin (500 mg three times daily for seven days) have been demonstrated. Pregnant women should be treated with either erythromycin or ceftriaxone (250 mg, single dose, IM). Patients with HIV infection should be followed because reduced healing of genital ulcers and persistence of H ducreyi in the lesions has been reported. There is also an increased likelihood of treatment failure in uncircumcised individuals with chancroid. Undiagnosed co-existing HSV infection, particularly in immunosuppressed HIV seropositive patients, may account for some of the observed cases where treatment has failed to cure chancroid.

Based on the emergence of resistant strains in Rwanda, the WHO has recommended that chancroid is not treated with trimethoprim/sulfamethoxazole based regimens unless the antimicrobial susceptibility profiles of local H ducreyi isolates are known.

Fluctuant buboes are aspirated to provide symptomatic relief and to avoid spontaneous rupture. Incision and drainage of fluctuant buboes, with subsequent packing of the wound, has also been recommended as an effective management strategy for chancroid and avoids the need for frequent bubo re-aspirations.

Serological screening for both syphilis and HIV infection should be offered at the time of genital ulcer presentation and again after 3 months at the end of the window period for both diseases.