Molle ulcer A57.x0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 28.03.2021

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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 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.).

Pathogen
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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.

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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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:

Diagnosis
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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!

Differential diagnosis
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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.

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

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!

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) Richtlinien zur Diagnostik und Therapie von sexuell übertragbaren Krankheiten.
  2. Ducrey A (1889) Il virus dell'ulcera venerea. Gazz Internaz Med Chir (Naples) 11: 44.
  3. Ducrey A (1889) Experimental investigations on the infectious agent of soft chancre and on the bubones. Monatsh prakt Dermatol 9: 387-405
  4. González-Beiras C et al.(2016) Epidemiology of Haemophilus ducreyi infections. Emerg Infect Dis 22:1-8.
  5. Kaur C et al (2002) Erythema nodosum induced by chancroid. Sex Transm Infect 78: 388-389.
  6. Korting HC et al (1989) Diagnosis and therapy of molle's ulcer today. Dermatologist 40: 418-422
  7. Krefting R (1892) Ueber die für ulcus molle specifische Mikrobe. Arch Dermatol Syphil (Berlin) 2nd supplement: 41-62
  8. 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
  9. Lewis DA (2003) Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect 79: 68-71
  10. Steen R (2001) Eradicating chancroid. Bull World Health Organ 79: 818-826
  11. van Hattem JM et al (2018) Haemophilus ducreyi cutaneous ulcer contracted at Seram Island, Indonesia, presented in the Netherlands. PLoS Negl Trop Dis 12:e0006273.

Disclaimer

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

Authors

Last updated on: 28.03.2021