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Updated: Jan 13 2019

Haemophilus ducreyi

  • Snapshot
    • A 35-year-old woman presents to the urgent care clinic for genital ulcers. Her past medical history includes peptic ulcer disease and depression. She started having unprotected sexual intercourse with a new partner 1 month ago. She reports that he had not been tested for sexually transmitted diseases. She reports having a painful ulcer on her labia and wishes to be tested. On physical exam, there is a 1 cm ulcer with an erythematous base and irregular borders. When scraped, the ulcer easily bleeds.
  • Introduction
    • Classification
      • Haemophilus ducreyi
        • gram-negative facultative anaerobic coccobacillus
        • transmission
          • sexually, often through a break in the skin
        • causes
          • chancroids
    • Epidemiology
      • incidence
        • highest in Asia, Africa, and the Caribbean
      • location
        • genitals
      • risk factors
        • multiple sexual partners
        • unprotected sex
    • Associated conditions
      • often co-infection with herpes simplex virus
    • Prevention
      • protected sex
    • Prognosis
      • most heal within a week
  • Presentation
    • Symptoms
      • painful genital lesion
      • typically does not have systemic symptoms
    • Physical exam
      • genital papule that develops into an ulcer
        • has a grey-yellow base with irregular borders
        • may bleed when touched
        • often has an exudate
      • unilateral tender inguinal lymphadenopathy
  • Studies
    • Labs
      • detection of DNA with polymerase chain reaction
      • culture requires a special media (often using a mixed culture, i.e., gonoccocal agar with bovine hemoglobin and fetal calf serum) and may be difficult to grow
    • Making the diagnosis
      • based on clinical presentation and exclusion of other sexually transmitted diseases
  • Differential
    • Treponema pallidum primary infection
      • distinguishing factor
        • nonpainful ulcer (chancre)
    • Herpes
      • distinguishing factor
        • painful ulcer with systemic symptoms
  • Treatment
    • Medical
      • azithromycin or ceftriaxone
        • indication
          • first-line
          • requires only a single dose
  • Complications
    • Increased risk of HIV transmission
    • Secondary bacterial infections
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