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WikiDoc Infectious Disease Project — Pathogen-Based Infections

Pathogens of Public Health Significance

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Pathogens of Clinical Significance

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• 1. Chancroid

• Preferred regimen: Azithromycin 1 g PO as a single dose OR Ceftriaxone 250 mg IM as a single dose OR Ciprofloxacin 500 mg PO bid for 3 days OR Erythromycin base 500 mg PO tid for 7 days
• Note (1): The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. For both clinical and surveillance purposes, a probable diagnosis of chancroid can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for chancroid; 3) the patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers; and 4) an HSV PCR test or HSV culture performed on the ulcer exudate is negative.
• Note (2): Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
• Note (3): Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.

• 2. Specific considerations

• 2.1 Management of sex partners

• Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.

• 2.2 Pregnancy

• Ciprofloxacin may present a low risk to the fetus during pregnancy, with a potential for toxicity during breastfeeding. Alternative drugs should be used during pregnancy and lactation.

• 2.3 HIV infection

• Persons with HIV infection who have chancroid should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly. Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.

• 1. Urethritis and cervicitis

• Preferred regimen (macrolide-susceptible strains): Azithromycin 1 g PO as a single dose OR Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
• Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days

• 2. Pelvic inflammatory disease

• Preferred regimen: Moxifloxacin 400 mg PO qd for 14 days

• 3. Specific considerations

• 3.1 Management of sex partners

• Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.

• 3.2 HIV infection

• Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.