Sandbox g44

• 1. Chancroid

• Preferred regimen: Azithromycin 1 g PO as a single dose OR Ceftriaxone 250 mg IM as a single dose OR Ciprofloxacin 500 mg PO bid for 3 days OR Erythromycin base 500 mg PO tid for 7 days

Note: The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. For both clinical and surveillance purposes, a probable diagnosis of chancroid can be made if all of the following criteria are met: 1) the patient has one or more painful genital ulcers; 2) the clinical presentation, appearance of genital ulcers and, if present, regional lymphadenopathy are typical for chancroid; 3) the patient has no evidence of T. pallidum infection by darkfield examination of ulcer exudate or by a serologic test for syphilis performed at least 7 days after onset of ulcers; and 4) an HSV PCR test or HSV culture performed on the ulcer exudate is negative.

• 1.1 Specific considerations

• Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.

• 1. Urethritis and cervicitis

• Preferred regimen (macrolide-susceptible strains): Azithromycin 1 g PO as a single dose OR Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
• Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days

• 2. Pelvic inflammatory disease (PID)

• Preferred regimen: Moxifloxacin 400 mg PO qd for 14 days

• 3. Specific considerations

• 3.1 Management of sex partners

• Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.

• 3.2 HIV infection

• Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.