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DipGUM > Chancroid > Flashcards

Chancroid Flashcards

1
Q

What is the most common cause of genital ulceration in ALL countries?

A

HSV-2

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2
Q

What organism causes chancroid?

A

Haemophilus ducreyi

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3
Q

What type of organism is Haemophilus ducreyi?

A

gram negative
facultative
anaerobic
cocco-bacillus

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4
Q

What is a facultative organism?

A

makes ATP if oxygen present but can switch to fermentation, anaerobic respiration if no oxygen

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5
Q

What family of bacteria is Haemophilus ducreyi part of?

A

Pasteurellacae

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6
Q

How common is Chancroid as a cause of genital ulceration?

A

Decreasing markedly
38% Asia
56% Africa

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7
Q

Why has chancroid as a cause of genital ulcer reduced?

A

GUD was identified as an important risk factor for female-to-male HIV
transmission in the late 1980s
more attention was paid to GUD control as a means of limiting the spread of HIV

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8
Q

What specific changes occurred following focus on control of genital ulcer disease?

A

Change in antibiotics used
- previous resistance to tetracycline and co-trimoxazole
-erythromycin reduced H ducreyi
Behaviour change
- increased condom use
Widespread testing and treatment for syphilis

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9
Q

What is the clinical presentation of chancroid?

A

Ano-genital ulceration
Lymphadenitis
Bubo formation

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10
Q

How does sexual transmission of chancroid occur?

A

Sexual transmission through a break in the skin

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11
Q

What is the incubation period chancroid?

A

4-7 days

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12
Q

Describe the progression of the ulcer in chancroid?

A

tender papule into a pustule and then ulcer or soft sore
ragged undermined edge with grey or yellow base
contact bleed
painful
single or multiple

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13
Q

Where do chancroid ulcers occur on men?

A

Prepuce
Coronal sulcus
frenulum
glans

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14
Q

Where do chancroid ulcers occur on women?

A

Labia MINORA

fourchette

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15
Q

How common are extragenital ulcers in chancroid? Where do they occur?

A

RARE
Fingers
Breasts
Inner thighs

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16
Q

What proportion of people get painful lymphadenopathy in chancroid?

A

50% men

less in women

17
Q

If buboes occur how should they be managed in chancroid?

A

Aspiration

NOT incision and drainage

18
Q

What complications may occur from chancroid?

A

Phimosis
Partial loss of tissue, esp glans
tissue contraction from healed ulcers
mucosal breaks and bleeding

19
Q

Chancroid - how to diagnose?

A 
DNA PCR (no commercial, research/private lab only)
Culture from ulcer base or edge or bubo aspirate
20
Q

To increase sensitivity of culture for chancroid, what should be performed?

A

culture on more than one medium

21
Q

What is identified on microscopy of an ulcer/pus from chancroid?

A

gram negative coccobacilli

characteristic chaining

22
Q

How sensitive is culture for chancroid if more than one medium is used?

A

60 - 80% (endemic areas)

23
Q

How sensitive is PCR for chancroid diagnosis?

A

95%

24
Q

What is the CDC diagnostic criteria of a ‘probable diagnosis’ chancroid?

A 
1 or more painful ulcer
no evidence T pallidum
OR
clinical presentation, appearance of ulcers and lymphadenopathy typical of chancroid AND
HSV swab negative
25
Q

What are the treatment options for Chancroid (4)?

A

Azithromycin 1gram STAT
Ceftriaxone 250mg IM STAT
Ciprofloxacin 500mg twice daily THREE days
Erythromycin 500mg four times a day SEVEN days

26
Q

When there is chancroid and HIV co-infection which regimens are advised?

A

NOT single therapy
Ciprofloxacin OR
erythromycin

27
Q

What is the cure rate of chancroid with erythromycin?

A

93%

28
Q

What are the limitations to use of erythromycin for chancroid?

A

Side effects

Poor compliance

29
Q

Why is aspiration preferred over incision and drainage for management of chancroid buboes?

A

Less risk of sinus formation

30
Q

When do ulcers resolve following treatment for chancroid?

A

3 days symptomatic improvement

7 days re-epithelisation

31
Q

How far back should contact tracing be performed for chancroid?

A

sexual contact within the 10 days before onset of

the patient’s symptoms

DipGUM (39 decks)

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