Molle ulcer A57.x0

Sexually transmitted infectious disease (STI) caused by Haemophilus ducreyi, which is rare in industrialized countries and no longer subject to compulsory reporting, with distribution mainly in tropical subtropical areas and major European cities and ports.

In tropical countries, non-venereal ulcerative Haemophilus ducreyi infections also occur (see Fig.).

Haemophilus ducreyi is a gram-negative, coccoid, non-motile, non-spore-forming bacterium of the genus Haemophilus to which another 15 human pathogens (e.g. Haemophilus influenzae) belong.

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

Venereal transmitted Haemophilus ducreyi infection (ulcus molle):

Incubation period: 2-5 days. The initial kinetic lesions are rapidly disintegrating papules, with the formation of soft, slimy, painful ulcers with undermined margins. Some of the ulcers heal spontaneously after several weeks without treatment. In the case of progression, a unilateral, highly painful regional lymphadenitis develops. There is a tendency to purulent melting of the lymph nodes. Not infrequently, fistula formation also follows. Further inoculation of the ulcers to adjacent skin areas (autoinoculation) is possible.

Non-venereally transmitted Haemophilus ducreyi infection (ulcus molle): Haemophilus ducreyi infections of the skin also occur in tropical countries as non-sexually transmitted painful, chronic ulcers. Apparently, children are more frequently affected than adults (van Hattem JM et al. 2018; see Fign).

Special forms:

• Molle follicular ulcer
• Molle elevatum ulcer
• Molle gangrenosum ulcer
• Molle ulcer serpiginosum
• Transient molle ulcer.

Microscopic (Gram or Unna-Pappenheim stain: reddish rods in fish train-like arrangement) and cultural (GC-HgS medium or Mueller-Hinton HB agar) pathogen detection. PCR detection!

Reminder. Repeated control of syphilis serology!

Ulcus durum; Ulcus mixtum; Lymphogranuloma inguinale; Granuloma inguinale; Herpes genitalis.

In non-venereal Haemophilus ducreyi infections of the skin, numerous chroic ulcers of other etiologies may be considered.

Notice! Surgical lymph node incision is usually not necessary!

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

Azithromycin 1.5 - 2 g p.o. once (therapy failure in HIV+ and HSV- concomitant infection with azithromycin 1.0 g three times more frequently)

Alternative: Ceftriaxone 500 mg i.m. once only

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

Antibiotic therapy of the ulcer molle

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