Chancre , Chancroid , Herpes Genitalis , Lymphogranuloma Venereum , Acute Disease , Anti-Infective Agents/therapeutic use , Chancre/diagnosis , Chancre/therapy , Chancroid/diagnosis , Chancroid/therapy , Chronic Disease , Diagnosis, Differential , Herpes Genitalis/diagnosis , Herpes Genitalis/therapy , Humans , Lymphogranuloma Venereum/diagnosis , Lymphogranuloma Venereum/therapy , Medical History Taking , Microbiological Techniques , Physical Examination
Chancre , Syphilis, Cutaneous , Anti-Bacterial Agents/therapeutic use , Chancre/diagnosis , Chancre/epidemiology , Chancre/therapy , Diagnosis, Differential , Doxycycline/therapeutic use , Female , HIV Infections/complications , HIV Seropositivity/complications , Humans , Incidence , Injections, Intramuscular , Male , Neurosyphilis/diagnosis , Penicillin G/administration & dosage , Penicillin G Benzathine/administration & dosage , Penicillins/administration & dosage , Pregnancy , Pregnancy Complications, Infectious/drug therapy , Risk Factors , Syphilis Serodiagnosis , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/epidemiology , Syphilis, Cutaneous/therapy , Syphilis, Latent/diagnosis , Tetracycline/therapeutic use
Chancre/transmission , Infectious Disease Transmission, Vertical , Syphilis, Congenital , Adolescent , Adult , Age of Onset , Chancre/epidemiology , Chancre/therapy , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Latvia/epidemiology , Middle Aged , Risk Factors , Syphilis, Congenital/epidemiology , Syphilis, Congenital/prevention & control
A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care centre in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, we simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simple syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection.
PIP: A cross-sectional study was conducted among 395 patients presenting with genital ulcers at a primary health care center in Kigali, Rwanda. Using clinical data and the results of a rapid plasma reagin (RPR) test, the authors simulated the diagnostic outcome of two simple WHO flowcharts for the management of genital ulcers. These outcomes and a clinical diagnosis were then compared with the laboratory diagnosis based on culture for genital herpes and Haemophilus ducreyi and serology for syphilis. The prevalence of HIV infection was high (73%) but there was no difference between HIV-positive and HIV-negative patients in the clinical presentation and etiology of genital ulcer disease. The proportion of correctly managed chancroid and/or syphilis cases was 99% using a syndromic approach, 82.1% using a hierarchical algorithm including an RPR test, and 38.3% with a clinical diagnosis. In situations where no laboratory support is available, a simply syndromic approach is preferable to the clinical approach for the management of genital ulcer. If an RPR test can be included in the diagnostic strategy, patients with a reactive RPR test should be treated for both syphilis and chancroid infection. (author's)
Algorithms , Chancre/microbiology , Chancroid/microbiology , HIV Seropositivity/complications , Herpes Genitalis/microbiology , Chancre/therapy , Chancroid/therapy , Cross-Sectional Studies , Female , Herpes Genitalis/therapy , Humans , Male , Rwanda , Treatment Outcome
We report a 26-year-old housemaid whose partner was an intravenous drug abuser with undiagnosed pulmonary tuberculosis. The patient presented with a painless chin ulcer with an elevated irregular border and a firm, nontender submandibular adenopathy. The lesion had been present for 2 months and did not respond to antibiotic therapy. The tuberculin test was positive, and a biopsy and Löwenstein culture confirmed the diagnosis of cutaneous chancre. The patient was treated with rifampicin, isoniazid and pyrazinamide and, after 6 months of treatment, she developed scrofuloderma which had to be surgically removed. After 1 year of follow-up, the lesions had totally cleared.
Chancre/etiology , Facial Dermatoses/etiology , Sexual Partners , Substance Abuse, Intravenous , Tuberculosis, Cutaneous/etiology , Tuberculosis, Pulmonary , Adult , Chancre/pathology , Chancre/therapy , Facial Dermatoses/pathology , Facial Dermatoses/therapy , Female , Humans , Tuberculosis, Cutaneous/pathology , Tuberculosis, Cutaneous/therapy
Se presenta un paciente de 24 años de edad con lesiones exulceradas e induradas de pene, de 7 meses de evolución, con características totalmente inusuales por su número y expresión clínica, exudado abundante y resistencia a toda terapéutica. Se descartan múltiples patologías chancriformes. Al diagnóstico histopatológico, la lesión es compatible con chancro escabiótico atípico
Chancre/pathology , Hexachlorocyclohexane/therapeutic use , Penile Diseases/etiology , Scabies/complications , Chancre/complications , Chancre/therapy , Penile Diseases/diagnosis , Penile Diseases/pathology , Scabies/immunology , Scabies/therapy , Acquired Immunodeficiency Syndrome/complications , Substance-Related Disorders , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/immunology
Se presenta un paciente de 24 años de edad con lesiones exulceradas e induradas de pene, de 7 meses de evolución, con características totalmente inusuales por su número y expresión clínica, exudado abundante y resistencia a toda terapéutica. Se descartan múltiples patologías chancriformes. Al diagnóstico histopatológico, la lesión es compatible con chancro escabiótico atípico
Scabies/complications , Chancre/pathology , Penile Diseases/etiology , Hexachlorocyclohexane/therapeutic use , Tuberculosis, Pulmonary/immunology , Tuberculosis, Pulmonary/complications , Acquired Immunodeficiency Syndrome/complications , Scabies/immunology , Scabies/therapy , Chancre/complications , Chancre/therapy , Penile Diseases/diagnosis , Penile Diseases/pathology , Substance-Related Disorders
En el periodo comprendido de enero a diciembre de 1990 tuvimos la ocasion de observar por primera vez en nuestro hospital un brote epidemico de chancro blando en 55 pacientes incluidos entre otros 142 pacientes con diferentes sexualmente transmitibles. En 22 de ellos el diagnostico clinico fue confirmado por examen directo y cultivo de agar chocolate, 20 correspondian al sexo masculino y 2 al femenino. Las caracteristicas de todos los pacientes eran similares a los reportados en la literatura. En algunos casos observamos asociacion con otras enfermedades de transmision sexual. Este es el primer reporte de chancro blando observado en nuestro pais y aparecido con caracter epidemico coincidente con un aumento en la frecuencia de la enfermedad a nivel mundial. El tratamiento con eritromicina o co-trimoxozol resulto exitoso para la totalidad de los casos utilizados
Humans , Male , Female , Chancre/diagnosis , Chancre/therapy , Chancre/epidemiology , Tetracycline/therapeutic use , Bolivia , Sexually Transmitted Diseases/transmission
Blood Pressure , Prognosis , Abortion/therapy , Tropical Medicine , Communicable Diseases , Primary Prevention , Chancre/therapy , Transplantation , Implants, Experimental , Nutrition Disorders/complications , Gastroenteritis/etiology , Pediatrics , Labor, Induced , Auscultation , Percussion , Diagnostic Techniques and Procedures , Eczema , Infant Mortality , Argentina/epidemiology , Rheumatic Fever , Psychomotor Disorders , Whooping Cough/drug therapy
Abortion/therapy , Argentina/epidemiology , Auscultation , Chancre/therapy , Whooping Cough/drug therapy , Communicable Diseases , Eczema , Rheumatic Fever , Gastroenteritis/etiology , Implants, Experimental , Tropical Medicine , Infant Mortality , Pediatrics , Percussion , Blood Pressure , Primary Prevention , Prognosis , Labor, Induced , Transplantation , Nutrition Disorders/complications , Psychomotor Disorders , Diagnostic Techniques and Procedures
