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American Family Physician Mar 2020Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Herpes simplex virus is the most common cause... (Review)
Review
Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Herpes simplex virus is the most common cause of genital ulcers in the United States. A diagnosis of genital herpes simplex virus infection is made through physical examination and observation of genital lesions. The 2015 Centers for Disease Control and Prevention sexually transmitted disease guidelines provide strategies for the management of patients with genital ulcer disease. Specific testing includes a polymerase chain reaction test for herpes simplex virus; syphilis serology and darkfield microscopy or a direct fluorescent antibody test for Treponema pallidum; and/or culture for Haemophilus ducreyi in settings where chancroid is highly prevalent. Rarely, cases of Epstein-Barr virus may present with genital ulcers. Syphilis and chancroid cause genital ulcers and are mandatory reportable diseases to the local health department. In some cases, no pathogen is identified. It is important to consider noninfectious etiologies such as sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions. Genital ulcers are symptomatic by definition, and the U.S. Preventive Services Task Force recommends screening for syphilis infection for those at risk, early screening for syphilis infection in all pregnant women, and against routine serologic screening for genital herpes simplex virus infection in asymptomatic adolescents and adults, including those who are pregnant.
Topics: Diagnosis, Differential; Disease Management; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Ulcer
PubMed: 32163252
DOI: No ID Found -
The Pan African Medical Journal 2019Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by...
Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1 g per os in a single dose) or ceftriaxone (250 mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome.
PubMed: 31565145
DOI: 10.11604/pamj.2019.33.185.16187 -
The Pan African Medical Journal 2019Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by...
Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1g per os in a single dose) or ceftriaxone (250mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome.
PubMed: 31692707
DOI: 10.11604/pamj.2019.33.190.15989 -
Journal of Family Medicine and Primary... Aug 2022Genital ulcer disease (GUD) continues to be an important cause of morbidity and mortality worldwide. It is an important risk factor for the acquisition of HIV. GUD is... (Review)
Review
Genital ulcer disease (GUD) continues to be an important cause of morbidity and mortality worldwide. It is an important risk factor for the acquisition of HIV. GUD is mainly caused by five sexually transmitted infections. Three pathogens most frequently associated with GUD are herpes simplex virus 2 (HSV-2), , . Although their prevalence varies among different geographical regions, HSV-2 is the leading cause of this syndrome globally. In recent years, there has been an epidemiological transition of HSV-1 with a growing role of this virus as a causative agent of GUD. GUD may present with unique features depending on the etiological agent that can help clinicians identify the etiology and start treatment. However, owing to atypical presentations and co-infections, an accurate clinical diagnosis is often a challenge without confirmatory laboratory tests. Standard methods used to detect the causative pathogens of GUD have limitations. Molecular methods can provide a more sensitive and rapid microbiological diagnosis, with detection of the pathogen from the clinical sample directly. In situations where no laboratory support is available, the syndromic approach for management should be followed. The current scenario, clinical presentation (typical and atypical), laboratory diagnosis, and management of GUD will be discussed in this review. We searched PubMed literature and Google search engine using the terms "genital ulcer disease," "epidemiology of genital ulcer disease," and "clinical features of genital ulcer disease and atypical presentations" and relevant literature was selected to provide current perspectives of GUD.
PubMed: 36352984
DOI: 10.4103/jfmpc.jfmpc_2111_21 -
Clinical Microbiology Reviews Apr 1989Haemophilus ducreyi is the causative agent of chancroid, one of the genital ulcerative diseases. H. ducreyi is the major cause of genital ulcer disease in Africa and... (Review)
Review
Haemophilus ducreyi is the causative agent of chancroid, one of the genital ulcerative diseases. H. ducreyi is the major cause of genital ulcer disease in Africa and Southeast Asia and is of increasing concern in the United States. Definitive diagnosis of chancroid requires the isolation and identification of H. ducreyi, but isolation of this organism is difficult and the available medium is not optimal for all strains. Fluorescent antibody and serologic tests are of limited value. In general, our knowledge of this organism is rather limited, and indeed, recent studies have questioned the placement of H. ducreyi in the genus Haemophilus. H. ducreyi has relatively few biochemical activities, and epidemiologic studies are limited because there are limited phenotypic markers available for strain typing. Specific virulence factors of H. ducreyi have yet to be identified. Antimicrobial resistance in H. ducreyi is of special concern, as this organism has acquired both gram-negative and gram-positive resistance determinants. In addition, some of these determinants can be mobilized and transferred to other Haemophilus species or to Neisseria gonorrhoeae.
Topics: Amino Acid Sequence; Aminopeptidases; Animals; Chancroid; Drug Resistance, Microbial; Haemophilus ducreyi; Humans; Molecular Sequence Data; Serologic Tests; Virulence
PubMed: 2650859
DOI: 10.1128/CMR.2.2.137 -
Bulletin of the World Health... 2001Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18...
Genital ulcers are important cofactors of HIV transmission in the countries most severely affected by HIV/AIDS. Chancroid is a common cause of genital ulcer in all 18 countries where adult HIV prevalence surpasses 8% and is rare in countries with low-level HIV epidemics. Haemophilus ducreyi, the causative organism of chancroid, is biologically vulnerable and occupies a precarious epidemiological niche. Both simple, topical hygiene and male circumcision greatly reduce risk of infection and several classes of antibiotics--some of which can be administered in single-dose treatment regimens--provide rapid cure. H. ducreyi depends on sexual networks with high rates of partner change for its survival, thriving in environments characterized by male mobility and intensive commercial sex activity. Elimination of H. ducreyi infection from vulnerable groups results in disappearance of chancroid from the larger community. Once endemic in Europe and North America, chancroid began a steady decline early in the twentieth century, well before the discovery of antibiotics. Social changes--resulting in changing patterns of commercial sex--probably disrupted the conditions needed to sustain chancroid as an endemic disease. Sporadic outbreaks are now easily controlled when effective curative and preventive services are made available to sex workers and their clients. More recently, chancroid prevalence has declined markedly in countries such as the Philippines. Senegal, and Thailand, a development that may contribute to stabilization of the HIV epidemics in these countries. Eradication of chancroid is a feasible public health objective. Protecting sex workers and their clients from exposure to sexually transmitted diseases (STDs) and improving curative services for STDs are among the proven strategies that could be employed.
Topics: Africa South of the Sahara; Asia; Chancroid; Developing Countries; Europe; Female; HIV Infections; HIV Seroprevalence; Humans; Male; North America; Sex Work
PubMed: 11584729
DOI: No ID Found -
Toxins Jul 2016Cytolethal distending toxin (CDT) is found in Gram-negative bacteria, especially in certain Proteobacteria such as the Pasteurellaceae family, including Haemophilus... (Review)
Review
Cytolethal distending toxin (CDT) is found in Gram-negative bacteria, especially in certain Proteobacteria such as the Pasteurellaceae family, including Haemophilus ducreyi and Aggregatibacter (Actinobacillus) actinomycetemcomitans, in the Enterobacteriaceae family and the Campylobacterales order, including the Campylobacter and Helicobacter species. In vitro and in vivo studies have clearly shown that this toxin has a strong effect on cellular physiology (inflammation, immune response modulation, tissue damage). Some works even suggest a potential involvement of CDT in cancers. In this review, we will discuss these different aspects.
Topics: Animals; Bacterial Proteins; Bacterial Toxins; Cell Transformation, Neoplastic; DNA Damage; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Host-Pathogen Interactions; Humans; Inflammation; Inflammation Mediators; Neoplasms; Risk Factors
PubMed: 27429000
DOI: 10.3390/toxins8070220 -
Microbiological Reviews Dec 1989The etiological agent of the sexually transmitted genital ulcer disease chancroid was first described in 1889 by Auguste Ducrey following repeated autoinoculation of... (Review)
Review
The etiological agent of the sexually transmitted genital ulcer disease chancroid was first described in 1889 by Auguste Ducrey following repeated autoinoculation of purulent ulcer material from a series of patients. The organism was isolated on artificial media a decade later but has remained difficult to isolate consistently, resulting in controversy over its characteristics and role as the causative agent of chancroid. Because of its fastidious growth requirements, including unknown components in blood, the organism was included in the original description of the genus Haemophilus. Requirement for exogenous hemin and limited phenotypic characteristics, including structural and antigenic properties, suggested that Haemophilus ducreyi was a valid member of the genus Haemophilus. Recent studies of respiratory quinones, deoxyribonucleic acid hybridization, and competition for homologous transformation of the type species, H. influenzae, suggest that H. ducreyi is unrelated to any of the present species of the family Pasteurellaceae, which includes members of the genera Haemophilus, Actinobacillus, and Pasteurella. This review summarizes the early studies with H. ducreyi and our current knowledge of the microbiology of this important human pathogen.
Topics: Chancroid; Haemophilus ducreyi; Humans; Microscopy, Electron
PubMed: 2687678
DOI: 10.1128/mr.53.4.377-389.1989 -
Current Opinion in Infectious Diseases Feb 2010Haemophilus ducreyi, the causative agent of the sexually transmitted infection chancroid, is primarily a pathogen of human skin. During infection, H. ducreyi thrives... (Review)
Review
PURPOSE OF REVIEW
Haemophilus ducreyi, the causative agent of the sexually transmitted infection chancroid, is primarily a pathogen of human skin. During infection, H. ducreyi thrives extracellularly in a milieu of professional phagocytes and other antibacterial components of the innate and adaptive immune responses. This review summarizes our understanding of the interplay between this pathogen and its host that leads to development and persistence of disease.
RECENT FINDINGS
H. ducreyi expresses key virulence mechanisms to resist host defenses. The secreted LspA proteins are tyrosine-phosphorylated by host kinases, which may contribute to their antiphagocytic effector function. The serum resistance and adherence functions of DsrA map to separate domains of this multifunctional virulence factor. An influx transporter protects H. ducreyi from killing by the antimicrobial peptide LL37. Regulatory genes have been identified that may coordinate virulence factor expression during disease. Dendritic cells and natural killer cells respond to H. ducreyi and may be involved in determining the differential outcomes of infection observed in humans.
SUMMARY
A human model of H. ducreyi infection has provided insights into virulence mechanisms that allow this human-specific pathogen to survive immune pressures. Components of the human innate immune system may also determine the ultimate fate of H. ducreyi infection by driving either clearance of the organism or an ineffective response that allows disease progression.
Topics: Chancroid; Haemophilus ducreyi; Host-Pathogen Interactions; Humans
PubMed: 19918177
DOI: 10.1097/QCO.0b013e328334c0cb