Chanchroid is caused by?
Ans. c (Hemophilus ducreyi). (Ref. Harrison's 17th/ Table 124-7; Anantanarayan Micro, 6th /311)CLINICAL FEATURES OF GENITAL ULCERSFeatureSyphilisHerpesChancroidLymphogranuloma VenereumDonovanosis (granuloma inguinale)Causative organismT. pallidumHerpes simplexHemophilus - ducreyiChlamydia trachomatis (Serovars LI, L2, and L3)Calymmatobacterium granulomatisIncubation period9-90 days2-7 days1-14 days3 days-6 weeks1-4 weeks (up to 6 months)Early primary lesionsPapuleVesiclePustulePapule, pustule, or vesiclePapuleNo. of lesionsUsually oneMultipleUsually multiple, may coalesceUsually one; often notdetected, despite lymphadenopathyVariableDiameter5-15 mm1-2 mmVariable2-10 mmVariableEdgesSharply demarcated, elevated, round, or ovalErythematousUndermined, ragged, irregularElevated, round, or ovalElevated, irregularDepthSuperficial or deepSuperficialExcavatedSuperficial or deepElevatedBaseSmooth, non- purulent, relatively nonvascularSerous, erythematous, nonvascularPurulent, bleeds easilyVariable, nonvascularRed and velvety, bleeds readilyIndurationFirmNoneSoftOccasionally firmFirmPainUncommonFrequently tenderUsually very tenderVariableUncommonLymphade nopathyFirm, non- tender, bilateralFirm, tender, often bilateral with initial episodeTender, may suppurate, loculated, usually unilateralTender, may suppurate, loculated, usually unilateralNone; pseudobuboesInvesti- gationCulture, Dark-field exam, direct for T. pallidum; FA, or PCR RPR testdirect FA, ELISA, or PCR for HSVIn chancroid- Endemic area: PCR or culture for H. ducreyiIsolation of LGV strain from node or rectum, occasionally from urethra or cervix; LGV CF titer, >1:64; micro-IF titer, >1:512Preferred is demonstration of typical intracellular Donovan bodies within large mono nuclear cells visualized in smears prepared from lesions or biopsy specimens.Giemsa, Leishman's, or Wright's stains used.TreatmentBenzathine penicillin 2.4 million unitsIM once to patient, recent (e.g., within 3 months) seronegative partner(s), and all seropositive partners.Rx for genital herpes with acyclovir, valacyclovir, or famci clovir.Ciprofloxacin 500 mg PO as single dose or Ceftriaxone 250 mg IM as single dose or Azithromycin 1 g PO as single dose.Azithromycin, lg PO;or Doxycycline,100 mg bid for 7 days.Azithromycin1 g weekly or 500 mg/dErythromycinTetracyclineDoxycyclineTrimetho- prim-sulfa- methoxa- zole Chloram- phenicol500 mg qid500 mg qid100 mg bid1 double- strength tablet bid 500 mg tidDIAGNOSTIC FEATURES AND MANAGEMENT OF VAGINAL INFECTIONFeatureNormal Vaginal ExaminationVulvovaginal CandidiasisTrichomonal VaginitisBacterial VaginosisEtiologyUninfected; lacto bacilli predominantCandida albicansTrichomonas vaginalisAssociated withGardnerella vaginalis, various anaerobic and/ or noncultured bacteria, and mycoplasmasTypical symptomsNoneVulvar itching and/ or irritationProfuse purulent discharge; vulvar itchingMalodorous, slightly increased dischargeDischargeAmountVariable; usually scantScantOften profuseModerateColor"Clear or slightly WhitewhiteWhite or yellowWhite or grayConsistencyNonhomogeneous, floccularClumped; adherent plaquesHomogeneousHomogeneous, low viscosity; uniformly coats vaginal wallsinflammation of vulvar or vaginal epitheliumNoneErythema of vaginal epithelium, introitus; vulvar dermatitis, fissures commonErythema of vaginal and vulvar epithelium; colpitis macularisNonepH of vaginal fluid"Usualy 4.5Usualy 4.5Usualy 5.0Usualy >4.5Amine ("fishy") odor with 10%' KOHNoneNoneMay be presentPresentMicroscopy*Normal epithelial cells; lactobacilli predominantLeukocytes, epithelial cells; mycelia or pseudomycelia in up to 80% of C. albicans culture- positive persons with typical symptomsLeukocytes; motile trichomonads seen in 80--90% of symptomatic patients, less often in the absence of symptomsClue cells; few leukocytes; no lactobacilli or only a few outnumbered by profuse mixed flora, nearly always including G. vaginalis plus anaerobic species on Gram's stain (Nugent's score =7)Other laboratory findings Isolation of Candida spp.Isolation of T. vaginalis or positive NAATd Usual treatmentNoneAzole cream, tablet, or suppository--e.g., miconazole 100-mg vaginal suppository or clotrimazole 100-mg vaginal tablet, once daily for 7 daysFluconazole, 150 mg orally (single dose)Metronidazole or tinidazole, 2 g orally (single dose)Metronidazole, 500 mg PO bid for 7 daysMetronidazole, 500 mgPO bid for 7 daysClindamycin, 2% cream one full applicator vaginally each night for 7 daysUsual management of sexual partnerNoneNone; topical treatment if candida dermatitis of penis is detectedExamination for STD; treatment with metronidazole, 2 g PO (single dose)Examination for STD; no treatment if normal
Treponema pallidum
Leishmania donovanii
Hemophilus ducreyi
Donovania granulomatis
Haemophilus