A58
Buboes that persist despite appropriate syndromic management should be investigated. Referral letter from PHC should include all relevant information (i.e. HIV status, treatment history and partner notification and management).
INVESTIGATIONS
- All NHLS standard laboratory forms must include the following information:
- Name and contact details (cellphone number + email address) of requesting healthcare worker.
- Genital specimen collection and test requests:
- Materials: One Dacron swab (wire shaft); 21-gauge sterile needle and syringe; two sterile universal containers or tubes (all obtained from local NHLS laboratory).
- If genital ulcer is present:
- Dacron swab: Collect material from base of ulcer lesion; place swab in sterile universal container or tube and cut off wire shaft. Close container.
- Test request: Transport Dacron swab on ice to NICD STI reference laboratory as soon as possible for PCR for chancroid and LGV.
2. If genital ulcer is absent:
- After topical disinfection, insert 21-gauge needle into bubo and aspirate pus into syringe. Transport pus in two sterile tubes/ containers to laboratory.
- Test request: send one tube on ice to NICD STI reference laboratory as soon as possible for PCR for chancroid and Lymphogranuloma Venereum (LGV).
- Test request: send one tube to local NHLS laboratory for bacterial M/C/S.
- Presumptive diagnosis: Persistent bubo unresponsive to syndromic management.
MEDICINE TREATMENT
- Doxycyline 100 mg, oral 12 hourly for 21 days.
Note: Follow-up until there is complete resolution of symptoms. Fluctuant buboes may require frequent needle aspiration to prevent rupture – review every 72 hours, as necessary.
For laboratory-confirmed diagnosis of LGV:
- Doxycycline 100 mg, oral 12 hourly for more than 21 days may be required for complete resolution of disease.