Granulating Ulcers Without Buboes

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These are most likely to be lesions of granuloma inguinale, a condition also known as Donovanosis and caused by Calymmatobacterium granulomatis. It should be remembered that persons who are immunosuppressed may not develop a bubo and occasionally persistent genital ulcers without bubo formation may occur as a result of chancroid in persons with immunosuppression and HIV infection.

First line:

	Medicine	Adult dose	Frequency	Duration
	benzathine penicillin im	2.4MU (1.44g)	one dose only	-
and	azithromycin po	1g	once only followed by 500mg daily until ulcer healed*
or	doxycycline po	100mg	twice a day	until ulcer is healed
Or in penicillin allergy:
	erythromycin po	500mg	4 times a day	for 14 days

                                               

* review patients on a weekly basis

Second line:

Medicine	Adult dose	Frequency	Duration
Cotrimoxazole	960mg	twice a day	until ulcer is healed