Chancroid: Difference between revisions

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==Background==
==Background==
*Causative agent: Haemophilus ducreyi
*Caused by ''Haemophilus ducreyi''
*Sexually transmitted
*Rare in western countries (leads to frequent misdiagnosis in these locations)


[[File:Chancroidmale.jpg|thumb|Chancroid (male)]] [[File:Chancroidfemale.jpg|thumb|Chancroid (female)]]
[[File:Chancroidmale.jpg|thumb|Chancroid (male)]]  
[[File:Chancroidfemale.jpg|thumb|Chancroid (female)]]


==Clinical Features==
==Clinical Features==
*Multiple '''painful''' lesions
*Incubation period 3-7 days<ref name="Basta">Basta-Juzbašić A, Čeović R. Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum contagiosum. Clin Dermatol. 2014 Mar-Apr;32(2):290-8. doi: 10.1016/j.clindermatol.2013.08.013.</ref>
*Painful inguinal lymphadenopathy (buboes) that may become an abscess and rupture
*Lesions begin as soft chancre/papule → '''painful''' ulceration with ragged margins<ref name="Basta" />
*Within days to weeks, unilateral painful inguinal lymphadenopathy (buboes) forms
**These may become abscessed and rupture


==Differential Diagnosis==
==Differential Diagnosis==
*[[Ulcerative STDs]]
*[[Ulcerative STDs]]


==Diagnosis==
==Diagnostic Evaluation==
*Generally clinical diagnosis
*Generally clinical diagnosis
*PCR can be used for indeterminate cases<ref name="Basta" />


==Management==
==Management==
*clean area with soap and water
*Clean area with soap and water
*I&D any fluctuant buboes
*I&D any fluctuant buboes
*treat for other [[STDs]] as well
*Treat for other [[STDs]] as well
*Antibiotics:
*Antibiotics<ref name="Basta" />:
**[[Azithromycin]] 1g PO x1 '''OR'''
**[[Azithromycin]] 1g PO x1 '''OR'''
**[[Ceftriaxone]] 250 mg IM x1 with Erythromycin 500 mg PO QID x7 days '''OR'''
**[[Ceftriaxone]] 250 mg IM x1 '''OR'''
**[[Erythromycin]] 500 mg PO QID x7 days '''OR'''
**[[Ciprofloxacin]] 500mg PO BID x3 days
**[[Ciprofloxacin]] 500mg PO BID x3 days
===[[Antibiotic Sensitivities]]<ref>Sanford Guide 2014</ref>===
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Category'''
| align="center" style="background:#f0f0f0;"|'''Antibiotic'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| [[Penicillins]]||[[Penicillin G]]||'''S'''
|-
| ||[[Penicillin V]]||X1
|-
| Anti-Staphylocccal [[Penicillins]]||[[Methicillin]]||X1
|-
| ||[[Nafcillin]]/[[Oxacillin]]||X1
|-
| ||[[Cloxacillin]]/[[Diclox.]]||X1
|-
| Amino-[[Penicillins]]||[[AMP]]/[[Amox]]||R
|-
| ||[[Amox-Clav]]||'''S'''
|-
| ||[[AMP-Sulb]]||'''S'''
|-
| Anti-Pseudomonal [[Penicillins]]||[[Ticarcillin]]||X1
|-
| ||[[Ticar-Clav]]||X1
|-
| ||[[Pip-Tazo]]||X1
|-
| ||[[Piperacillin]]||X1
|-
| [[Carbapenems]]||[[Doripenem]]||X1
|-
| ||[[Ertapenem]]||X1
|-
| ||[[Imipenem]]||X1
|-
| ||[[Meropenem]]||X1
|-
| ||[[Aztreonam]]||X1
|-
| [[Fluroquinolones]]||[[Ciprofloxacin]]||X1
|-
| ||[[Ofloxacin]]||X1
|-
| ||[[Pefloxacin]]||X1
|-
| ||[[Levofloxacin]]||X1
|-
| ||[[Moxifloxacin]]||X1
|-
| ||[[Gemifloxacin]]||X1
|-
| ||[[Gatifloxacin]]||X1
|-
| 1st G [[Cephalo]]||[[Cefazolin]]||X1
|-
| 2nd G. [[Cephalo]]||[[Cefotetan]]||X1
|-
| ||[[Cefoxitin]]||'''S'''
|-
| ||[[Cefuroxime]]||X1
|-
| 3rd/4th G. [[Cephalo]]||[[Cefotaxime]]||'''S'''
|-
| ||[[Cefizoxime]]||'''S'''
|-
| ||[[CefTRIAXone]]||'''S'''
|-
| ||[[Ceftaroline]]||X1
|-
| ||[[CefTAZidime]]||'''S'''
|-
| ||[[Cefepime]]||X1
|-
| Oral 1st G. [[Cephalo]]||[[Cefadroxil]]||X1
|-
| ||[[Cephalexin]]||X1
|-
| Oral 2nd G. [[Cephalo]]||[[Cefaclor]]/[[Loracarbef]]||X1
|-
| ||[[Cefproxil]]||X1
|-
| ||[[Cefuroxime axetil]]||X1
|-
| Oral 3rd G. [[Cephalo]]||[[Cefixime]]||'''S'''
|-
| ||[[Ceftibuten]]||X1
|-
| ||[[Cefpodox]]/[[Cefdinir]]/[[Cefditoren]]||X1
|-
| [[Aminoglycosides]]||[[Gentamicin]]||X1
|-
| ||[[Tobramycin]]||X1
|-
| ||[[Amikacin]]||X1
|-
| ||[[Chloramphenicol]]||X2
|-
| ||[[Clindamycin]]||X2
|-
| [[Macrolides]]||[[Erythromycin]]||'''S'''
|-
| ||[[Azithromycin]]||'''S'''
|-
| ||[[Clarithromycin]]||X1
|-
| Ketolide||[[Telithromycin]]||X1
|-
| Tetracyclines||[[Doxycycline]]||R
|-
| ||[[Minocycline]]||R
|-
| Glycylcycline||[[Tigecycline]]||X1
|-
| ||[[Daptomycin]]||R
|-
| Glyco/Lipoclycopeptides||[[Vancomycin]]||R
|-
| ||[[Teicoplanin]]||X1
|-
| ||[[Telavancin]]||X1
|-
| ||[[Fusidic Acid]]||X1
|-
| ||[[Trimethoprim]]||R
|-
| ||[[TMP-SMX]]||I
|-
| Urinary Agents||[[Nitrofurantoin]]||X1
|-
| ||[[Fosfomycin]]||X1
|-
| Other||[[Rifampin]]||X1
|-
| ||[[Metronidazole]]||R
|-
| ||[[Quinupristin dalfoppristin]]||X1
|-
| ||[[Linezolid]]||X1
|-
| ||[[Colistimethate]]||X1
|}


==Disposition==
==Disposition==

Revision as of 04:51, 7 September 2015

Background

  • Caused by Haemophilus ducreyi
  • Sexually transmitted
  • Rare in western countries (leads to frequent misdiagnosis in these locations)
Chancroid (male)
Chancroid (female)

Clinical Features

  • Incubation period 3-7 days[1]
  • Lesions begin as soft chancre/papule → painful ulceration with ragged margins[1]
  • Within days to weeks, unilateral painful inguinal lymphadenopathy (buboes) forms
    • These may become abscessed and rupture

Differential Diagnosis

Diagnostic Evaluation

  • Generally clinical diagnosis
  • PCR can be used for indeterminate cases[1]

Management

Disposition

  • Discharge

See Also

References

  1. ↑ 1.0 1.1 1.2 1.3 Basta-Juzbašić A, Čeović R. Chancroid, lymphogranuloma venereum, granuloma inguinale, genital herpes simplex infection, and molluscum contagiosum. Clin Dermatol. 2014 Mar-Apr;32(2):290-8. doi: 10.1016/j.clindermatol.2013.08.013.
Gram Positives
Cocci
Clusters
Pairs/Chains
Other
Rods
Gram Negatives
Cocci
Rods
Lactose Fermenters
Lactose Non-Fermenters
Other
Rods/Cocci
Anaerobes
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