Treating chancroid: summary of studies in southern Africa.

Recent studies undertaken in southern Africa and elsewhere indicate that many short or single dose treatments are available to treat chancroid. Erythromycin 500 mg three times a day for five days, ciprofloxacin 500 mg, sulphamethopyrazine 800 mg and trimethoprim 1000 mg or sulphametrole 3200 mg and trimethoprim 640 mg as single oral doses, or ceftriaxone 250 mg as a single intramuscular injection are all effective in treating the disease. The widespread use of these regimens largely depends on the accuracy of diagnosis, susceptibilities of local Haemophilus ducreyi isolates to antimicrobials, and financial considerations.

Problems in the management of sexually transmitted diseases in South Africa.

On the subcontinent sexually transmitted diseases present considerable diagnostic and therapeutic problems. With the recognition of vast numbers of non-gonococcal and chancroid infections, penicillin therapy is no longer adequate. This article outlines an approach to the management of urethritis and genital ulcer disease, giving suitable guidelines for the treatment of these 'disease syndromes'. The management of sexually transmitted vaginal discharges is also discussed, and the relevance of the rapidly performed 'wet mount' in the diagnosis of those discharges arising from the vaginal wall is stressed.

Treatment of chancroid with erythromycin. A clinical and microbiological appraisal.

One hundred and thirty seven patients presenting with genital ulcerations from which Haemophilus ducreyi was isolated were treated with erythromycin stearate 500 mg every six hours for seven days. Of these, 91 (66%) had associated inguinal lymphadenopathy. Only two of the 100 patients who returned after one week showed no clinical improvement. Despite decrease in size H ducreyi was reisolated from the ulcers of three patients, two of whom had not complied with treatment. The patients were treated for a further week either with erythromycin or with a placebo preparation and on day 14 no discernible difference in clinical response was evident. H ducreyi was not reisolated from any lesion. In contrast, the natural course of development of associated lymphadenopathy was not modified by treatment. H ducreyi was not, however, isolated from any gland after the start of treatment. Side effects attributable to erythromycin were minimal and treatment had to be discontinued in only two patients. This study clearly indicates that treatment with erythromycin for one week results in rapid healing of lesions and the elimination of H ducreyi from both ulcers and associated lymph glands.

Antimicrobial susceptibility of 103 strains of Haemophilus ducreyi isolated in Johannesburg.

Of 103 strains of Haemophilus ducreyi isolated in Johannesburg, 96 produced beta-lactamase and were resistant to penicillin and ampicillin. Most strains showed resistance to tetracycline, sulfisoxazole, and sulfamethoxazole. All isolates were susceptible to rifampin, erythromycin, and cefoxitin, moderately susceptible to trimethoprim-sulfamethoxazole (1:19) and minocycline, and somewhat less susceptible to doxycycline.

Training the primary health care nurse. The Baragwanath experience.

The extended role of the nurse has received much attention recently. A training programme for nurses who are to provide primary health care is offered at Baragwanath Hospital, Johannesburg. This article describes the training of nurses who care for adult patients. Fifty-one nurses had successfully completed their training by January 1980, and four clinics for adult are now staffed by primary health care nurses and general practitioners. Between March 1977 and December 1979, 212,611 patients had been seen by these nurses. The implications of the new role of the nurse are discussed.