DOC in chancroid is
C i.e. Erythromycin Distinguishing Features of Genital Ulcers Features Syphilis (1degchancre) Chancroid (soft chancre) Lymphogranuloma Venereum Donovanosis Granuloma venerum/inguinale) Herpes genitalis Causative agent Treponema Haemophilus Chlamydia Calymmatobacterium Herpes simplex pallidiumQ ducreyiQ trachomatisQ granulomatisQ virus type HQ (LI,L2,L3) (rarely type I) Incubation period 9 - 90 daysQ 1 - 7 days rarely > 10 days 3 days - 6 weeks 1-4 weeks (upto 6 months) 2-7 days No. of attacks Only one (1) 1 or 2 Only one (1) Only one (1) Reccurent No. of lesions Usually 1 Usually multipleQ may coalesce Usually 1 Variable MultipleQ, may coalesce Early 1deg lesion Papule Pustule Papule, pustule Papule VesicleQ Diameter 5-15 mm Variable 2-10 mm Variable 1-2 mm Depth Superficial or deep Excavated Superficial or deep Elevated Superficial Edges Sharply demarcated, elevated, round or oval Undermined, ragged, sloughedQ irregular Elevated, round or oval Elevated, irregular serpiginous Erythematous Base Smooth, non- purulent, non- vascula,Q (relatively) Purulent, bleeds easily Variable, nonvascular Red & velvety (beefy red), bleeds easily with exuberant granulation tissueQ Serous, erythematous, nonvascular. Induration FirmQ SoftQ (mostly) Occasionly firm Firm None Pain UncommonQ Usually very tender Variable Uncommon Frequenctly tenderQ Lymphadenopathy Firm, non tender, shotty, bilateralQ Tender, may suppurate, loculated, usually unilateral (Bubo) Tender, may suppurate, loculated, usually unilateral (Bubo) No lymphadenopathy pseudobuboesQ (subcutaneous nodules in inguinal region, may ulcerate) Firm, tender, often bilateral Diagnosis - Dark field - Clinical features - Demonstration of - On tissue smear & - Multinucleate microscopyQ - Serologicaltests - Gram staining (gram -ve cocco- baccili with rail road appearance) LGV as elementary & inclusion bodies - Frie's testQ - Hyper gamma- globulinemia - Complement fixation +ve histopathological microscopy using Giemsa, Wrights or Silver stain or Leishman Stain 1. Gram negative C. granulomatis may be seen within characteristic large mono nuclear cell as d giant cell on Tzank smear - Culture is confirmatory Donovan bodies 2. Donovan bodies are seen in vacuolated cytoplasm of large mono nuclear cells as bipolar inclusionsQ (safety pin or telephone handle appearance) measuring 1 to 2 um x 0.5 to 0.7 um. Drug - Benzathine/procaine - Azithro/ - Doxy / tetra DoxycyclineW tetracycline AcyclovirQ Penicillin in all erythromycin cyclineQ Azithromycin / except neurosyph- ilis & congenital syphilis in which crystalline penicillin - Ciftriaxone . - Ciprofloxacin - Erythromycin erythromycin (in pregnancy) (aqueous benzyl penicillin) is used - In penicillin sensitive patient, Tetracycline or erythromycin is used
Tetracycline
Doxycycline
Erythromycin
Streptomycin