Genital ulcer disease (GUD)

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CLINICAL DESCRIPTION

Common Causes

  • Genital herpes, Chancroid and Syphilis may be present concurrently.
  • Genital herpes is the most prevalent amongst the three.
  • Treat patients with GUD for the above three infections

CLINICAL FEATURES

SIGNS AND SYMPTOMS
  • Genital ulcer (painful or painless)
  • Urethral discharge
  • Inguinal swelling (lymphadenopathy)
INVESTIGATIONS
  • VDRL
  • TPHA

TREATMENT

NON-PHARMACOLOGICAL 
  • Keep lesions dry and clean
PHARMACOLOGICAL
  • Treatment Give Ciprofloxacin 500mg PO 12 hourly for 3 days  and
  • Give Benzathine penicillin 2.4 MU IM STAT
  • Give Acyclovir 400mg 8 hourly for 7 - 10 days
  • Tell patient to return for follow-up care in 7-10 days, see below
  • If bubo present, use Azithromycin 1g orally STAT and 1g after 1 week

Note: Acyclovir is indicated only in symptomatic GUD clients. If genital herpes infection is suspected and this is the first episode, treat with acyclovir for 7-10 days. If it is a recurrent genital herpes infection, lower the dose frequency to twice a day and treat for a shorter duration – 3 days. Offer analgesia if indicated, particularly in GUD with pain.

If patient allergic to penicillin/Ciprofloxacin and pregnant or lactating:

  • Give Erythromycin 500mg 6 hourly for 15 days plus
  • Give Acyclovir 400 mg 8 hourly for 7 – 10 days

Infants born to mothers treated for GUD with Erythromycin alone:

  • Give Benzathine Penicillin 500,000 IU/kg as a single dose

 

Follow-up care of GUD

  • Inform the patient to return 7-10 days after starting treatment.
  • If the ulcers have not healed or are getting worse, repeat GUD treatment if there is evidence of noncompliance.
  • If the client complied fully and there is no improvement:
    • Give Azithromycin 2g STAT.
    • Review in further 7-10 days
    • If no improvement after 14 days, refer for specialist opinion (patient may need a tissue biopsy)
    • If improved, follow patient's progress until completely healed
    • No further antibiotics are required at this time
  • If the ulcers have improved but not completely healed:
    • Repeat chancroid treatment
  • Ciprofloxacin 500mg single dose
    • Review in further 7-10 days
    • Subsequent action as above
  • If the ulcers have completely healed:
    • Reinforce counselling and patient education
    • Promote/provide condoms