BU — Key Facts & Diagnosis

Clinical description

• Main symptoms: single or multiple enlarged lymph nodes in groin, often painful, sometimes fluid-filled. ± genital ulcers/sores, ± genital discharge.
• STI causes: chancroid (H. ducreyi), HSV-2, syphilis, LGV (C. trachomatis L1–L3), granuloma inguinale.
• Non-STI causes: TB, Kaposi sarcoma, lymphoma, leg infection.
• Avoid spontaneous rupture of buboes (causes slow-healing fistulas). Avoid surgical incision & drainage (delays healing).

Treatment

If genital ulcers/sores present: treat as GUD. If ulcers absent: treat for presumed chancroid or LGV.

Standard treatment (bubo without ulcers)

• Ciprofloxacin 500 mg oral BD for 3 days.
• Doxycycline 100 mg oral BD for 14 days.
• Aspirate fluid-filled buboes through adjacent healthy skin with 18/19-gauge needle. Never through inflamed skin.

Review after 3–7 days. Repeat aspiration if needed. Investigate for TB if no improvement (Xpert on aspirate).

Partner treatment

Partner treatment (asymptomatic, no ulcers)

• Ciprofloxacin 500 mg oral BD for 3 days + doxycycline 100 mg oral BD for 14 days.
• With ulcers: treat as GUD partner treatment.

At every visit

HIV & ART status

• Ascertain HIV + ART status from health passport or self-report.
• Offer new HIV test for all unless previously diagnosed. Do not use coercion.
• New positive: active referral for ART initiation.
• New negative: refer/offer PrEP, VMMC, consistent condom use.
• Known positive: reinforce ART adherence or refer for re-initiation.

Hepatitis B

• Offer HBV rapid test for all patients born before 2002.
• HBsAg negative: refer for HBV vaccination unless previously completed 3 doses.
• HBsAg positive: refer for clinical and treatment assessment.

Syphilis screening

• Offer syphilis rapid test for concurrent asymptomatic syphilis (except in GUD/ARI where it does not influence treatment decisions).

Risk reduction & condoms

• Risk reduction counselling. Promote and dispense condoms.
• Promote VMMC for all non-circumcised men. Schedule appointment in 2 weeks.