Chancroid

Globally, the agents of curable STDs - gonorrhea, chlamydial infections, syphilis, chancroid, and trichomoniasis - caused ~350 million new infections annually in the mid-1990s. Bacterial vaginosis (arguably acquired sexually) occurs in up to 50% of women of reproductive age in developing countries. Thus, there are probably close to 1 billion cases of these curable infections annually, all six of which are associated with increased risk of HIV transmission or acquisition.

Ofloxacin (300 mg orally bid for 10 days) is an optimal agent for syndrome-based treatment of epididymitis because of its effectiveness against N. gonorrhoeae, C. trachomatis, and Enterobacteriaceae. Alternatively, ceftriaxone (250 mg intramuscularly) followed by doxycycline (100 mg orally bid for 10 days) is effective for epididymitis caused by N. gonorrhoeae or C. trachomatis.

In Asia and Africa, chancroid was once considered the most common type of genital ulcer, followed by primary syphilis and then genital herpes. With increased efforts to control chancroid and syphilis, together with more frequent recurrences or persistence of genital herpes attributable to the growing numbers of immunosuppressed persons with HIV infection, PCR testing of genital ulcers now clearly implicates genital herpes as the most common cause of genital ulceration in some developing countries. Lymphogranuloma venereum and donovanosis continue to cause genital ulceration in developing countries but rarely occur today in North America or Europe. Other causes of genital ulcer include

(1) candidiasis and traumatized genital warts both readily recognized;

(2) lesions due to genital involvement of more widespread dermatoses; and

(3) cutaneous manifestations of systemic diseases, such as genital mucosal ulceration in Stevens-Johnson syndrome