Chancroid in Emergency Medicine Treatment & Management
- Author: Andrew D Nguyen, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
Emergency Department Care
Clean the local area with plain antibacterial soap and water or any other skin cleansing solution.
Incision and drainage of fluctuant buboes is preferable over needle aspiration, as repeat aspiration typically is required due to reaccumulation.
If syndromic management is used, patients should be treated for other STDs as well. In endemic areas, patients should be treated for granuloma inguinale. Therapy for lymphogranuloma venereum should be given if inguinal buboes are present.
Health education and safe sex practices should be encouraged.
Serologic testing for syphilis, HIV, and all other STDs should be performed, retesting 3 months later if test results are negative.
HIV-positive patients may fail single-dose therapy and, therefore, warrant close monitoring.
According to the CDC 2015 guidelines, antibiotic treatment includes azithromycin at 1 g orally as a single dose, ceftriaxone at 250 mg intramuscularly as single a dose, erythromycin at 500 mg orally thrice daily for 7 days, or ciprofloxacin at 500 mg orally twice daily bid for 3 days.
In patients with HIV infection, the same regimens may be used, but note that these patients are more likely to experience treatment failure, which may necessitate repeated or longer therapy.
Azithromycin and ceftriaxone can be given during pregnancy, while ciprofloxacin is potentially toxic during breastfeeding and should be avoided in breastfeeding patients.
Streptomycin and ceftriaxone have been shown to be synergistic in the treatment of chancroid.
Single-dose ciprofloxacin (92% cure rate) and azithromycin are effective. These treatment options also offer the advantage of directly observed, single-dose therapy. Several isolates have showed intermediate resistance to single-dose therapy. The prevalence of these isolates is not known at this time.
Treatment of partners is similar to the source patient. All sexual partners encountered 10 days preceding the onset of symptoms should be treated.
Patients should not engage in sexual activity until ulcers are healed and antibiotic therapy is complete.
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