Warning:

This document is being maintained for historical purposes, but is now out of date. To view current guidelines please visit:

• STD Treatment Guidelines   at http://www.cdc.gov/STD/treatment

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1993 Sexually Transmitted Diseases Treatment Guidelines

09/24/1993

SUGGESTED CITATION
Centers for Disease Control and Prevention. 1993 Sexually
transmitted diseases treatment guidelines. MMWR 1993;42(No. RR-14):
{inclusive page numbers}.

CIO Responsible for this publication:
National Center for Prevention Services,
Division of Sexually Transmitted Diseases and HIV Prevention

Management of the Patient with Genital Ulcers
     
     In the United States, most patients with genital ulcers have
genital herpes, syphilis, or chancroid. The relative frequency of
each varies by geographic area and patient population, but in most
areas of the United States genital herpes is the most common of
these diseases. More than one of these diseases may be present
among at least 3%-10% of patients with genital ulcers. Each disease
has been associated with an increased risk for HIV infection.

     A diagnosis based only on history and physical examination is
often inaccurate. Therefore, evaluation of all persons with genital
ulcers should include a serologic test for syphilis and possibly
other tests. Although ideally all of these tests should be
conducted for each patient with a genital ulcer, use of such tests
(other than a serologic test for syphilis) may be based on test
availability and clinical or epidemiologic suspicion. Specific
tests for the evaluation of genital ulcers are listed below:

--   Darkfield examination or direct immunofluorescence test for
     Treponema pallidum,

--   Culture or antigen test for HSV, and

--   Culture for Haemophilus ducreyi.

     HIV testing should be considered in the management of patients
with genital ulcers, especially for those with syphilis or
chancroid.


     A health-care provider often must treat a patient before test
results are available (even after complete testing, at least one
quarter of patients with genital ulcers have no
laboratory-confirmed diagnosis). In that circumstance, the
clinician should treat for the diagnosis considered most likely.
Many experts recommend treatment for both chancroid and syphilis if
the diagnosis is unclear or if the patient resides in a community
in which chancroid morbidity is notable (especially when diagnostic
capabilities for chancroid and syphilis are not ideal).

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