Ulcus molle

Last Updated: 2021-10-15

Author(s): -

  • Ducrey 1889
  • Unna 1892
  • Krefting 1892

Soft chancre, Chancroid. 

Venereal disease caused by Haemophilus ducreyi, which is commonly called soft chancre and occurs mainly in tropical-subtropical areas.

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

The transmission is caused by a smear infection.

Up to 5 days after infection, soft papules ulcerating in the genital region, portio, perineum or anus. Unilateral lymphadenitis occurs, which can lead to melting and fistula formation after 2-3 weeks.

  • Medical history 
    • Unprotected sex?

  • Bacterial smear.
  • Microscopic and cultural pathogen detection
  • NAAT (high sensitivity and specificity)
  • In the diagnosis of ulcer molle, HIV and syphilis serologies should be performed at the beginning of the therapy and 6 weeks thereafter.

Men: frenulum, foreskin
Women: vulva, cervix, perianal

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

Ulcus molle lymphangitis with development of abscesses. Without therapy, fistulations occur after lymph node cedation. Risk of further infections (other STI) is greatly increased.

Always also treat the partner! (including STI screening)

 

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

Systemic therapy

  • Ceftriaxone 250mg i.m. once only
  • Azithromycin p.o. 1g 1x single dose.
  • Ciprofloxacin 2-, 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.