Genital Ulcer Disease (GUD)

Clinical Description

Common Causes

• Genital herpes, Chancroid and Syphilis may be present concurrently.
• Genital herpes is the most prevalent amongst the three.
• Treat patients with GUD for the above three infections

Signs and Symptoms

• Genital ulcer (painful or painless)
• Urethral discharge
• Inguinal swelling (lymphadenopathy)

Investigations

• VDRL
• TPHA

Non-pharmacological

• Keep lesions dry and clean

Pharmacological

• Treatment Give Ciprofloxacin 500mg PO 12 hourly for 3 days and
• Give Benzathine penicillin 2.4 MU IM STAT
• Give Acyclovir 400mg 8 hourly for 7 - 10 days
• Tell patient to return for follow-up care in 7-10 days, see below
• If bubo present, use Azithromycin 1g orally STAT and 1g after 1 week

Note: Acyclovir is indicated only in symptomatic GUD clients. If genital herpes infection is suspected and this is the first episode, treat with acyclovir for 7-10 days. If it is a recurrent genital herpes infection, lower the dose frequency to twice a day and treat for a shorter duration – 3 days. Offer analgesia if indicated, particularly in GUD with pain.

If patient allergic to penicillin/Ciprofloxacin and pregnant or lactating:

• Give Erythromycin 500mg 6 hourly for 15 days’ plus
• Give Acyclovir 400 mg 8 hourly for 7 –10days

Infants born to mothers treated for GUD with Erythromycin alone:

• Give Benzathine Penicillin 500,000 IU/kg as a single dose
• Follow-up care of GUD
• Inform the patient to return 7-10 days after starting treatment.
• If the ulcers have not healed or are getting worse, repeat GUD treatment if there is evidence of noncompliance.
• If the client complied fully and there is no improvement:
• Give Azithromycin 2g STAT.
• Review in further 7-10 days
• If no improvement after 14 days, refer for specialist opinion (patient may need a tissue biopsy)
• If improved, follow patient's progress until completely healed
• No further antibiotics are required at this time
• If the ulcers have improved but not completely healed:
• Repeat chancroid treatment

Ciprofloxacin 500mg single dose

• Review in further 7-10 days
• Subsequent action as above
• If the ulcers have completely healed:
• Reinforce counselling and patient education
• Promote/provide condoms