Ulcus molle

• Ducrey 1889
• Unna 1892
• Krefting 1892

Soft chancre, Chancroid.

Sexual disease caused by Haemophilus ducreyi, which is popularly known as soft chancre and occurs mainly in tropical-subtropical areas.

Significant decline in numbers in recent years. Endemic in the countries of tropical Africa and Southeast Asia, on the Indian subcontinent and in South America.

Transmission occurs through smear infection.

Up to 5 days after infection, ulcerating soft papules occur in the genital region, the portio, the perineum or the anus. Unilateral lymphadenitis occurs, and after 2-3 weeks there may be fusion with fistula formation.

• Anamnesis
  • Unprotected sexual intercourse?
• Bact. smear
• Microscopic and cultural pathogen detection
• NAAT (high sensitivity and specificity)
• When ulcer molle is diagnosed, HIV and syphilis serologies should be performed at the beginning of therapy and 6 weeks afterwards.

Men: frenulum, prepuce

Women: Vulva, cervix, perianal

In a biopsy from the base of the ulcer, Giemsa staining can be used to visualise the organism in the granulation tissue inside and outside macrophages.

Ulcus molle lymphangitis with formation of abscesses. Without therapy, fistulation follows lymph node abscessation. Risk of further infections (other STI) greatly increased.

Always include therapy for the partner! (incl. STI screening)

• Iodine povidone - wound ointment, solution, ointment gauze
• Fusidic acid - ointment, gauze

Systemic therapy

• Ceftriaxone 250mg i.m. once
• Azithromycin p.o. 1g 1x single dose.
• Ciprofloxacin 2-,al 500mg for 3 days
• Erythromycin p.o. 500 mg 4x daily for 7 days

1. Al-Tawfiq JA, Spinola SM. Haemophilus ducreyi: clinical disease and pathogenesis. Current Opinion in Infectious Diseases 2002;15:43-7.
2. Janowicz DM, Li W, Bauer ME. Host–pathogen interplay of Haemophilus ducreyi. Current Opinion in Infectious Diseases 2010;23:64-9.
3. Stümpke G. Ulcus molle. Symptomatologie, Diagnose, Prognose, Therapie, Epidemiologie.  Ulcus Molle und Andere Krankheiten der Urogenitalorgane: Springer Science + Business Media; 1927:75-144.