Clinical management of Genital Ulcer Disease Syndrome in Uganda
Uganda Clinical Guidelines 2023 · all from source →
General Adult
Diagnosis
Clinical Features
Primary syphilis: painless genital ulcer with clean base and indurated margins. Secondary syphilis: multiple, painless ulcers. Genital Herpes: small, multiple, usually painful blisters, vesicles, or ulcers (often recurrent). Granuloma inguinale: irregular ulcer increasing in size. Chancroid: multiple, large, irregular ulcers with enlarged painful suppurating lymph nodes.
Differential Diagnosis
Cancer of the penis in elderly men. Cancer of the vulva in women >50 years.
Investigations
Swab: for microscopy. Blood: for VDRL/TPR.
Treatment
Multiple painful blisters/vesicles (likely herpes)
Aciclovir 400 mg every 6 hours for 7 days. If RPR positive add Benzathine penicillin 2.4 MU IM single dose (half in each buttock). If lesions persist, repeat acyclovir for 7 days.
All other cases
Ciprofloxacin 500 mg every 12 hours for 3 days PLUS Benzathine penicillin 2.4 MU IM single dose. In penicillin allergy, give Erythromycin 500 mg every 6 hours for 14 days. Avoid Ciprofloxacin in pregnancy.
Ulcer persists >10 days and partner treated
Add Erythromycin 500 mg every 6 hours for 7 days. If ulcer still persists, refer.
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