Elsevier

Medicine

Volume 42, Issue 6, June 2014, Pages 341-346
Medicine

Tropical stis
Tropical sexually transmitted infections (excluding lymphogranuloma venereum)

https://doi.org/10.1016/j.mpmed.2014.03.007Get rights and content

Abstract

Chancroid and donovanosis are causes of genital ulceration found mainly in tropical areas. Chancroid ulcers are painful with a ragged edge and whitish base. Donovanosis ulcers are classically beefy-red and bleed to the touch. Chancroid was identified early on as a risk factor for HIV transmission amongst heterosexuals and this led to a renewed interest in genital ulcers. The incidence of both conditions has recently decreased significantly, while the incidence of genital herpes has increased. Improved control of all causes of genital ulceration should be a priority in countries where HIV and genital ulcers are prevalent. The non-venereal treponemal diseases include yaws, endemic syphilis and pinta. All three have similarities with venereal syphilis. A global eradication programme in the 1950s and 1960s was successful at the time but there appears to have been a recent resurgence of yaws and endemic syphilis in some isolated communities. A new yaws eradication programme using mass treatment with azithromycin has been launched recently by WHO.

Section snippets

Chancroid

Chancroid is an STI causing painful genital sores. Inguinal lymphadenopathy is common. The causative organism is a Gram-negative bacterium, Haemophilus ducreyi.

Donovanosis (granuloma inguinale)

Donovanosis is a chronic, progressive bacterial infection that usually involves the genital region. The causative organism has been reclassified as Klebsiella granulomatis comb nov based on phylogenetic analysis,1 though there is debate about this; some authorities consider the original nomenclature, Calymmatobacterium granulomatis, to be more appropriate.2

Syndromic management

Syndromic management involves the identification of a syndrome (e.g. genital ulceration, inguinal bubo) comprising symptoms and signs that are associated with several infections. A clinical flow chart (Figure 4) is used to facilitate step-by-step management. Treatment is usually prescribed for the most likely causes of the syndrome.

Syndromic management is suitable for resource-poor settings and enables treatment to be given at the first attendance without the need for specialized skills or

Endemic non-venereal treponematoses

Yaws, pinta and endemic syphilis are non-venereal treponemal infections with many similarities to sexually transmitted syphilis (Figure 5).6 Immune responses are similar, making the interpretation of serological tests difficult. However, PCR and whole genome fingerprinting techniques have been able to differentiate between the different treponemal strains but these tests have limited availability. There is no congenital transmission.

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