trimethoprim--sulfamethoxazole-drug-combination and Chancroid

Chancroid, as the name implies, is like a chancre. Unlike the painless chancre of syphilis, it is painful, darkfield negative, and does not respond to penicillin therapy. The number of cases have continued to rise in recent years. Because it can cause irreversible anatomical destruction, making the correct diagnosis is important and can prevent chronic morbidity.

Topics: Adult; Chancroid; Diagnosis, Differential; Erythromycin; Female; Haemophilus ducreyi; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Cotrimoxazole has traditionally been used as first drug for treatment of chancroid in India. With reports of increasing resistance to the drug, this study was conducted to compare treatment response of clinical chancroid between ciprofloxacin, 500 mg twice daily for 3 days, erythromycin, 500 mg four times daily for 7 days, and double-strength cotrimoxazole (trimethoprim 160 mg + sulfamethoxazole 800 mg), twice daily for 7 days.. Forty-six patients with a clinical diagnosis of chancroid were randomly divided into 3 groups. Sixteen patients received ciprofloxacin, whereas 15 each received erythromycin and cotrimoxazole. Patients were seen on day 7, 14, and if needed day 21. Clinical response was noted in terms of cure, improvement, or failure.. Excellent response was observed to both ciprofloxacin and erythromycin therapy with cure rates of 93.7% and 93.3%, respectively. Improvement was observed in 6.7% cases in both groups. There were no failures with either ciprofloxacin or erythromycin. Poor response to cotrimoxazole therapy was observed with 53.3% cure rates and a high failure rate of 46.7%.. Ciprofloxacin and erythromycin are equally effective in chancroid. Ciprofloxacin is better in terms of dosage schedule, duration of treatment, and low cost. Cotrimoxazole should be discontinued as drug of choice because of high failure rates.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Urinary; Chancroid; Ciprofloxacin; Erythromycin; Female; Humans; Male; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Chancroid; Humans; Male; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

A comparative open study was performed to evaluate the efficacy of single doses of ciprofloxacin (500 mg) and trimethoprim-sulfamethoxazole (TMP-SMZ; 640 mg/3,200 mg) for the treatment of culture-proven chancroid. Clinical cure or improvement was observed 7 days after treatment in 32 (76.2%) of the 42 patients who received ciprofloxacin and 21 (52.5%) of the 40 patients who received TMP-SMZ (P = .04). Cultures for one (4.5%) of 22 patients not cured with ciprofloxacin and 16 (59.3%) of 27 patients not cured with TMP-SMZ were still positive for Haemophilus ducreyi 7 days after treatment (P < .001). Although 77 (71.3%) of the 108 patients tested were seropositive for HIV-1 antibody, HIV infection and the degree of CD4+ lymphocyte depletion had no effect on clinical and bacteriologic outcome. All isolates of H. ducreyi were highly susceptible to ciprofloxacin (MIC, 0.004-0.06 mg/L). In contrast, resistance to TMP-SMZ (MIC, > or = 4/76 micrograms/mL) was observed in 48.9% of isolates (22 of 45) and was significantly associated with treatment failure. Therefore, the administration of TMP-SMZ, in single or multiple doses, is no longer indicated for the treatment of chancroid in Rwanda.

Topics: Adult; CD4 Lymphocyte Count; Chancroid; Ciprofloxacin; Drug Resistance, Microbial; Female; Follow-Up Studies; Haemophilus ducreyi; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Rwanda; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Chancroid is linked to the spread of human immunodeficiency virus type 1 (HIV-1) in East Africa. Effective, easily administered therapy is a priority for the control of Haemophilus ducreyi. The efficacy of a single oral dose of fleroxacin, 400 mg, was compared to a 3-day oral course of trimethoprim-sulfamethoxazole (TMP-SMZ), 160/800 mg, twice daily for the treatment of chancroid in 98 HIV-1-seronegative men in Nairobi, Kenya. No differences were noted between the two groups with respect to demographic characteristics, sexual behavior, and clinical characteristics. Culture-proven failure occurred in 1 (3%) of 36 fleroxacin-treated patients and in 11 (30%) of 37 TMP-SMZ-treated patients (P = .005). Fleroxacin, as a single oral dose, is an effective treatment for culture-proven chancroid in patients who are HIV-1 seronegative. TMP-SMZ is no longer predictably effective due to the recent emergence of resistance to both sulfonamides and to trimethoprim.

Topics: Administration, Oral; Adult; Chancroid; Double-Blind Method; Fleroxacin; Follow-Up Studies; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Chancroid is a major sexually transmitted disease in many developing countries. Although single-dose and short-course treatment of chancroid have been described, the increasing resistance of Hemophilus ducreyi to antimicrobial agents requires continuing evaluation of new therapies. Ciprofloxacin is a new quinolone antimicrobial agent with excellent in vitro efficacy against H. ducreyi. A double-blind, randomized clinical trial was conducted comparing a single-dose ciprofloxacin regimen (500 mg) and a three-day regimen of ciprofloxacin (500 mg twice daily) with a three-day regimen of trimethoprim-sulfamethoxazole (160 and 800 mg, respectively, twice daily) for the treatment of chancroid. The three-day ciprofloxacin regimen successfully eradicated H. ducreyi, and resulted in rapid clinical improvement in all 40 patients followed, with no failures. The other two regimens were also effective, but bacteriologic and clinical failure occurred in two and three patients following treatment with single-dose ciprofloxacin and three days of trimethoprim-sulfamethoxazole, respectively. All patients with buboes had resolution of lesions. There were no significant adverse effects associated with ciprofloxacin or trimethoprim-sulfamethoxazole. All three regimens are effective therapy for chancroid and H. ducreyi infections. If resistance to trimethoprim-sulfamethoxazole becomes widespread, ciprofloxacin may become a first-line therapy for chancroid. This study also demonstrates the efficacy of ciprofloxacin in soft tissue infection.

Topics: Adolescent; Adult; Chancroid; Ciprofloxacin; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Resistance, Microbial; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Chancroid; Clinical Trials as Topic; Drug Combinations; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Chancroid; Clinical Trials as Topic; Doxycycline; Drug Combinations; Female; Humans; Male; Random Allocation; South Africa; Sulfamethoxazole; Tablets; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We describe the first case of chancroid seen in the Czech Republic, diagnosed in a 40-year-old heterosexual HIV-positive man. Despite genital localization of the ulcer, the transmission of Haemophilus ducreyi infection in our patient remains unclear, as he denied having sexual intercourse and he did not travel outside the Czech Republic for several months before the ulcer appeared. The correct diagnosis has been revealed by a multiplex nucleic acid amplification test. Physicians in countries in the eastern and central Europe region should be aware that chancroid can occur in their patients.

Topics: Adult; Azithromycin; Chancroid; Haemophilus ducreyi; HIV Seropositivity; Humans; Lymphadenopathy; Male; Methicillin-Resistant Staphylococcus aureus; Multiplex Polymerase Chain Reaction; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Ulcer

Absent for several decades, the chancroid reappeared in Algeria in 1988. In the unique department of Dermatology and Venereology of the University Hospital of the country of Tlemcen (more than 700,000 inhabitants), we wanted to know the state of this STD seven years after the report of the first cases. The file of the consulting patients were examined. We looked for the principal characteristics of this STD: age, sex, incubation period, place infection contact, type of relation, clinical presentation, evolution without and with treatment, other associated STD (syphilis, HIV). From August 1988 (1st case) to December 1995, 144 cases of chancroid were collected = 1988: 6, 1989: 5, 1990: 7, 1991: 18, 1992: 11, 1993: 33, 1994: 48, 1995: 16. The presentation is quite stereotyped; it concerns males only, singles in must cases, having had sexual relations with prostitutes. The incubation period is short (less than 10 days), the characteristic ulceration presents, very often, some adenopathies. The treatment by cotrimoxazole is efficient. They are no concomitant syphilis or HIV infection. The chancroid is the first cause of genital ulceration in the world. Since 1991, it is the principal STD in our department. It spreads within a male population, young singles associated with prostitutes. It is well installed in Algeria, and its role, although minor, in the transmission of the HIV infection, should not be neglected.

Topics: Adolescent; Adult; Age Factors; Algeria; Anti-Infective Agents; Chancroid; Genital Diseases, Male; HIV Infections; Humans; Lymph Nodes; Male; Marital Status; Middle Aged; Penile Diseases; Retrospective Studies; Scrotum; Sex Factors; Sex Work; Sexual Partners; Sexually Transmitted Diseases, Bacterial; Skin Ulcer; Syphilis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Chancroid; Ciprofloxacin; HIV Infections; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

In Yaoundé, chancroid occurs frequently among adolescents and young men (95 p. 100 of the cases) who have sexual contacts regularly with prostitutes. Apart of classical clinical forms complicated in 2/3 of cases by inguinal adenopathies, we have observed furuncular chancroid which is quite characteristic of the disease. Giemsa stain represents for us a simple and reliable diagnostic method for this disease because in 1/3 of smears, typical cultural aspects of Haemophilus ducreyi were seen.

Topics: Adolescent; Adult; Cameroon; Chancroid; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

The in vitro susceptibilities of 112 clinical isolates of Haemophilus ducreyi to six antimicrobial agents were determined. These isolates were obtained in Kigali, Rwanda, during three studies on genital ulcer disease performed in 1986 (18 isolates), 1988 (23 isolates), and 1991 (71 isolates). All H. ducreyi isolates were susceptible to azithromycin, ceftriaxone, ciprofloxacin, and erythromycin; all isolates obtained in 1986 were also susceptible to trimethoprim and to the combination trimethoprim-sulfamethoxazole. In contrast, 39 and 9% of the isolates obtained in 1988 and 59 and 48% of the isolates obtained in 1991 were resistant to trimethoprim (MIC, > or = 4.0 mg/liter) and trimethoprim-sulfamethoxazole (MIC, < or = 4.0/76 mg/liter), respectively. These data indicate that trimethoprim-sulfamethoxazole can no longer be recommended for use in the treatment of chancroid in Rwanda, and possibly elsewhere in Africa.

Topics: Anti-Bacterial Agents; Chancroid; Drug Resistance, Microbial; Haemophilus ducreyi; Humans; Microbial Sensitivity Tests; Rwanda; Trimethoprim, Sulfamethoxazole Drug Combination

From June to November 1987 an outbreak of chancroid occurred in Winnipeg, the first in more than 10 years; 14 people (9 men, 5 women) were involved. Nine of the cases were confirmed through culture. A control strategy was implemented in November 1987 that included presumptive treatment of genital ulcer disease with single-dose antimicrobial therapy, intensive tracing of contacts and treatment of asymptomatic sexual contacts. The origin of the outbreak was not determined, and an epidemiologic link between all the patients could not be demonstrated. The isolates were found to contain the same plasmid; this suggested that a single clone of Haemophilus ducreyi was responsible for the outbreak.

Topics: Adult; Aged; Canada; Ceftriaxone; Chancroid; Disease Outbreaks; Female; Haemophilus ducreyi; Humans; Male; Manitoba; Middle Aged; Plasmids; Sex Work; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Boston; Chancroid; Disease Outbreaks; Drug Combinations; Erythromycin; Female; Genital Diseases, Female; Humans; Male; Penile Diseases; Serologic Tests; Sex Work; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ulcer

A single dose of ceftriaxone (250 mg) administered intramuscularly was compared with trimethoprim-sulfamethoxazole (TMP-SMZ; 160/800 mg) administered orally twice daily for seven days or with a single dose of TMP-SMZ (640/3,200 mg) administered orally for the treatment of chancroid in men in Thailand. Haemophilus ducreyi was isolated from 79 (48%) of 164 men with a clinical diagnosis of chancroid. For men with ulcers that were culture positive for H. ducreyi, rates of cure were 100% in 25 men treated with ceftriaxone, 87% in 23 men given TMP-SMZ for seven days, and 55% in 31 men given TMP-SMZ in a single dose. For men with ulcers that were culture negative for H. ducreyi, rates of cure were 100% in 29 men treated with ceftriaxone, 66% in 32 men given TMP-SMZ for seven days, and 63% in 24 men given TMP-SMZ in a single dose. The MIC50 of the three antibiotics for 94 isolates of H. ducreyi were as follows: 0.004 micrograms/ml for ceftriaxone, 16 micrograms/ml for trimethoprim, and greater than 512 micrograms/ml for sulfamethoxazole. Our study indicates that ceftriaxone in a single dose of 250 mg is effective, but that TMP-SMZ, even when given in a standard seven-day regimen, is not effective treatment for chancroid in Thailand.

Topics: Administration, Oral; Adult; Ceftriaxone; Chancroid; Drug Combinations; Drug Resistance, Microbial; Haemophilus ducreyi; Humans; Injections, Intramuscular; Male; Sulfamethoxazole; Thailand; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Boston; Chancroid; Disease Outbreaks; Drug Combinations; Erythromycin; Female; Genital Diseases, Female; Humans; Male; Penile Diseases; Serologic Tests; Sex Work; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Ulcer

A case of Hemophilus ducreyi infection clinically resembling granuloma inguinale is reported. Culture of the causative organism permitted a definitive diagnosis to be made. Combined treatment with tetracycline and sulphamethizole/trimethoprim rapidly cleared the infection.

Topics: Adult; Chancroid; Diagnosis, Differential; Drug Combinations; Drug Therapy, Combination; Granuloma Inguinale; Humans; Male; Skin Ulcer; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

A 39-year-old Norwegian seaman developed penile ulcerations after sexual contact overseas. The diagnosis of syphilitic chancre and of chancroid was confirmed. The ulcers healed after combined treatment with benzathine penicillin and trimethoprim-sulfamethoxazole.

Topics: Adult; Chancre; Chancroid; Drug Combinations; Haemophilus ducreyi; Humans; Male; Penicillin G Benzathine; Penile Diseases; Sulfamethoxazole; Syphilis; Syphilis Serodiagnosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Auto-inoculation from a genital ulcer suspected of being ulcus molle gave redness after 24 hours and after 48 hours vesicles and pustules appeared. Cultivation from the auto-inoculation after the 48 hours was positive for herpes simplex virus type 2. Our observation underlines two points: auto-inoculation for the diagnosing of Haemophilus ducreyi infection may be mimicked by herpes simplex infection, and the incubation period of herpes simplex can be shorter than the 4-5 days usually given.

Topics: Adult; Autoantibodies; Chancroid; Diagnosis, Differential; Drug Combinations; Female; Haemophilus ducreyi; Herpes Genitalis; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination