Doxycycline 100 mg twice daily orally should be given for 21 days according to tolerance. If disease persists, the course should be repeated. An alternative regimen is erythromycin 500 mg orally 4 times daily for 21 days. Large lymph nodes should be aspirated to avoid chronic drainage. Surgical excision of scarred areas may be necessary.
(CDC) Recommended regimen—(a) azithromycin 1 g orally once; (b) ceftriaxone 250 mg intramuscularly (IM) as a single dose; (c) erythromycin base 500 mg orally 3 times daily for 7 days; and (d) ciprofloxacin 500 mg orally twice daily for 3 days. Fluctuant lymph nodes may need to be aspirated through normal adjacent skin. Incision and drainage of the nodes is not recommended because it will delay healing. Chancroid is a reportable disease. NB LGV is also reportable
The disease is almost nonexistent in the United States. It is most common in India, Brazil, the West Indies, some South Pacific islands, and parts of Australia, China, and Africa. The causative organism is Calymmatobacteriumgranulomatis (Donovan body). Donovan bodies are bacteria encapsulated in mononuclear leukocytes. Transmission is via coitus, and the incubation period is 8–12 weeks. NB IP for genital ulcer in LGV and chancroid is 2-5 days. Syphilis 3wks. Note for LGV buboes occur after 2to 3wks. Healing is very slow, and satellite ulcers may unite to form a large lesion. When smears are negative, a biopsy specimen should be taken. Biopsy of the lesion generally shows granulation tissue infiltrated by plasma cells and scattered large macrophages with rod-shaped cytoplasmic inclusion bodies (Mikulicz cells). Pseudoepitheliomatous hyperplasia often is seen at the margin of the ulcer.
Seminar on inguinal bubo syndrome.yih
Seminar on inguinal bubo syndrome By Yihienew Mequanint (clinical II student) Adama science and technology university Asella, Arsi, Ethiopia 1,13,2004E.C
Inguinal Bubo• Swelling of inguinal lymph nodes as a result of STIs• a painful, often fluctuant, swelling of the lymph nodes in the inguinal region (groin)• The common sexually transmitted pathogens that are associated with inguinal bubo include – C. trachomatis (serovar L1, L2 and L3): LGV: – H. ducreyi: Chancroid – K.Granulomatis (Calymmatobacterium granulomatis): Granuloma ingunale – T.pallidum: syphilis• Rarely systemic symptoms except LGV 4
Lymphogranuloma Venereum• 3 stages – Primary stage(genital ulcer) – Secondary satge(lymphadenitis and lymphangitis) – Third stage(fibrosis and edema-genital elephantiasis)
Lymphogranuloma Venereum• Early in the course of the disease, a vesicopustular eruption may go undetected. This transient, primary, painless genital or anorectal ulcer develops after 2-5 days.• Multiple, large, confluent inguinal nodes develop 2 to 3 weeks later and eventually suppurate. Acute infection may cause generalized systemic symptoms• With inguinal (and genital) ulceration, lymphedema, and secondary bilateral invasion, excruciating conditions arise. Sitting or walking may cause pain• During the inguinal bubo phase, the groin is exquisitely tender• LGV responds to 3-week regimens of doxycycline or erythromycin in the usual doses
Chancroid (Soft Chancre)• suppurative inguinal adenopathy with painful ulcers is pathognomonic• Culture positive for H ducreyi• The early chancroid lesion is a vesicopustule• Later, it degenerates into a saucer-shaped ragged ulcer circumscribed by an inflammatory wheal• Typically, the lesion is very tender and produces a heavy, foul discharge that is contagious
Granuloma Inguinale (Donovanosis)• Essentials of Diagnosis; – chronic ulcerative granulomatous disease that usually develops in the perineum and inguinal regions – Donovan bodies revealed by Wrights or Giemsas stain a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue. The painless genital ulcers can be mistaken for syphilis. In contrast to syphilitic genital ulcers, inguinal lymphadenopathy is generally absent
Syphilis• Sometimes T. pallidum can be a cause of inguinal lymphadenopthy – unlike the other causes, it doesnt generally produce necrosis and abscess collection in the lymph nodes. – In conditions where the clinical examination doesnt reveal a fluctuant bubo, syphilis should be additionally considered and treated accordingly – Surgical incisions are contraindicated and the pus should only be aspirated using a hypodermic needle – NB hard chancre is painless, non-exudative, hard (indurated) edge, unlike soft chancre 12
Inguinal Bubo Flow Chart• Men affected more than females• Common predisposing factor for the spread of HIV• Complications: – Abscess formation and PID – Lymphatic obstruction – Stenosis and Infertility 14
complains of inguinal swelling Take history and Examine Educate on RR Inguinal/femoral No No Offer HCT Other bubo(s) present? STIs Condom use Yes Yes Ulcer(s) present? Yes Use appropriate flowchart NoRx LGV, chancroid, GI•Educate on RR Use GU•Provide condoms flowchart•Partner management•Offer HIV testing 15•Advise to return in 7days
Recommended treatmentCiprofloxacin 500 mg bid orally for 3 days PlusDoxycycline 100mg bid orally for 14 days Or Erythromycin 500 mg po qid for 14 days 16