CLINICAL FEATURES

PROBABLE DIAGNOSIS & CAUSE

• Single, painless, relatively clean ulcers without pus
• Incubation period up to 3 weeks
• Painless lymphadenopathy

Primary syphilis chancre
T. pallidum

• Multiple, soft, deep, tender ulcers with profuse pus
• Incubation period 1 week
• Very painful lymphadenopathy which can be fluctuant
• Disfiguration of the genitalia
• Secondary infection

Chancroid
H. ducreyi

• Multiple shallow and tender ulcers
• May start as vesicles grouped together. Itchy
• Incubation period 1 week
• Tender lymphadenopathy, may be recurrent, rarely suppurative

Herpes genitalis
H. simplex

• Single, small and transient ulcers
• Incubation period 1 -2 weeks
• Lymphadenopathy; several glands may be matted together
• fistula and stricture formation

Lymphogranuloma
(LGV)
C. trachomatis

• Large and beefy ulcers
• Variable incubation period
• None or rarely lymphadenopathy

Granuloma inguinale
Calymmatobacterium granulomatis (Donovan Bacilli)

DIAGNOSIS

FIRST LINE TREATMENT

SECOND LINE TREATMENT

CHANCROID

Adults

Trimethoprim 160 mg/sulphamethoxazole 800 mg 4 tablets once a day × 2 days.
OR
Cotrimoxazole 8 tablets daily × 2 days.
Buboes if present, should be aspirated and not incised and drained (80/400)

Erythromycin 500 mg orally QDS × 7 days.
OR Ceftriaxone 250 mg IM STAT.
OR Ciprofloxacin 500 mg BD × 3 days.

Pregnancy Allergy

Erythromycin 500 mg orally QDS × 7 days.
OR Ceftriaxone 250 mg IM STAT.
OR Ciprofloxacin 500 mg BD × 3 days.

EARLY SYPHILIS

Early syphilis (less than 1 year duration)
Benzathine penicillin 2.4 m.u weekly × 2 weeks.
OR Procaine penicillin (PAM) 600,000 units IM OD x 10 days.

In penicillin allergy use:
Tetracycline capsules 500 mg QDS × 15 days.
OR Erythromycin 500 mg QDS × 15 days.
OR Doxycycline 100 mg OD × 15 days.

LATE SYPHILIS *(more than 1 year)

Procaine penicillin (PAM) 600,000 units IM OD × 14 days.
OR Benzathine penicillin 2.4 m.u. weekly x 4 to 5 doses.

Pregnancy

Use either one of the penicillin preparations or erythromycin (see above). If erythromycin is used, the neonate should be treated soon after birth.

CONGENITAL SYPHILIS

Aqueous crystalline penicillin G 25,000 units/kg IM, twice a day for a minimum of 10 days. OR
Aqueous procaine penicillin G 50,000 units/kg/day IM OD for a minimum of 10 days.

HERPES GENITALIS

Lesions should be kept clean by washing the affected sites with soap and water and careful drying.
Acyclovir 200 mg orally 5 times daily for 7-10 days only reduces the symptoms and their duration and does not prevent recurrences. It is expensive.

LYMPHOGRANULOMA VENEREUM

Tetracycline 500 mg QDS × 14 days.
OR Erythromycin 500 mg QDS × 14 days.
OR Doxycycline capsules 100 mg BD × 14 days.
OR Sulphamethoxazole 1 g orally BD x 14 days.

GRANULOMA INGUINALE

Tetracycline capsules 500 mg QDS × 10 days.
OR Erythromycin 500 mg QDS × 10 days.
OR Cotrimoxazole 2 tablets twice daily × 10 days.
OR Streptomycin 750 mg daily x 10 days.