Molle ulcer A57.x0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Chancrelle; Chancre mou; Chancroéde; Chancroid; Ducrey-Unna disease; Schankroid; Soft chancre; soft sore

History
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Ducrey, 1889; Unna, 1892; Krefting, 1892

Definition
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Sexually transmitted infectious disease (STI) caused by Haemophilus ducreyi, which is rare in industrialised countries and no longer subject to compulsory notification.

Pathogen
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Haemophilus Ducrey.

Etiopathogenesis
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Transmission of H. ducreyi by sexual intercourse or smear infection after contact with skin lesions in already infected persons.

Localization
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Especially the genital region, but also the portio, perineum or anus are affected.

Clinical features
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Incubation period: 2-5 days. Rapidly disintegrating papules, formation of soft, greasy coated, painful ulcers with undermined margins. Some ulcers heal spontaneously after several weeks, even untreated. In case of progression, development of unilateral, highly painful regional lymphadenitis. There is a tendency to purulent melting of the lymph nodes. Fistulas often follow.

Further inoculation of the ulcers on adjacent skin areas (autoinoculation) is possible.

Special forms:

Diagnosis
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Microscopic (Gram- or Unna-Pappenheim staining: reddish rods in a fish-like arrangement) and cultural (GC-HgS medium or Mueller-Hinton HB agar) pathogen detection.

Notice! Repeated control of syphilisserology!

Differential diagnosis
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External therapy
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Indicated are disinfecting sitz baths or compresses with e.g. polyvidon-iodine solution (e.g. Betaisodona solution), potassium permanganate (light pink) or 0.1-0.2% polihexanide solution (e.g. Serasept, Prontoderm). In addition, apply dressings with disinfecting ointments, e.g. polyvidon-iodine ointment (e.g. Betaisodona, Braunovidon) or fusidic acid cream(e.g. Fucidine) with gauze grid. In case of firmly adhering coatings, additionally perform enzymatic wound cleaning (e.g. Iruxol Ointment N). See also Wound treatment.

Notice! Surgical lymph node incision is usually not necessary!

Internal therapy
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Systemic Antibiosis, see Table 1 / p.a. p. 17 of the current guidelines of the STI Society

Remember! Control and if necessary treatment of the sexual partner is necessary, even if he or she does not show any symptoms!

Progression/forecast
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Untreated chronic course with numerous fistulations and fistula scars. With timely therapy, healing occurs with scarring.

Tables
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Antibiotic therapy of the ulcer molle

Active substance

Example preparations

Dosage

Medium 1st choice

Azithromycin

Zithromax

Single dose: 1000 mg p.o.

Erythromycin

Erythrocin Filmtbl., Eryhexal Kps., Erythromycin Wolff Filmtbl.

4 times 500 mg/day p.o. over 7 days

Alternatively

Ceftriaxone

Rocephin

0,25 g i.m. as single dose

With simultaneous HIV infection

Ciprofloxacin

Ciprobay Filmtbl.

2 times 500 mg/day p.o. over 3-5 days

Amoxicillin/Clavulanic acid

Augmentan Filmtbl.

500/125 mg/day p.o. over 3-5 days

Literature
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  1. Dt. Gesellschaft zur Bekämpfung der Geschlechtskrankheiten (1992) Guidelines for the diagnosis and treatment of sexually transmitted diseases.
  2. Ducrey A (1889) Il virus dell'ulcera venerea. Gazz Internaz Med Chir (Naples) 11: 44
  3. Ducrey A (1889) Experimental studies of the soft chancre and the bubons Monthly practical Dermatol 9: 387-405
  4. Kaur C et al (2002) Erythema nodosum induced by chancroid. Sex Transm Infect 78: 388-389
  5. Korting HC et al (1989) Diagnosis and therapy of the ulcer molle today. dermatologist 40: 418-422
  6. Krefting R (1892) About the microbe specific for ulcus molle. Arch Dermatol Syphil (Berlin) 2nd supplement: 41-62
  7. Kyriakis KP et al (2003) Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece. Int J Dermatol 42: 876-881
  8. Lewis DA (2003) Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect 79: 68-71
  9. Steen R (2001) Eradicating chancroid. Bull World Health Organ 79: 818-826

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020