Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda.

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)

Tuberculous chancre in the partner of an intravenous drug abuser.

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.

Consideraciones sobre chancro atípico en un paciente inmunodeprimido / Atypical scabiotic chancre in an immunodepressed patient

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

Consideraciones sobre chancro atípico en un paciente inmunodeprimido / Atypical scabiotic chancre in an immunodepressed patient

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

Chancro blando a proposito de un brote epidemico en la ciudad de La Paz / Soft chancre: a pulpose of one germ epidemiological in the city of La Paz

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