A randomized, double-blind, placebo-controlled trial of single-dose ciprofloxacin versus erythromycin for the treatment of chancroid in Nairobi, Kenya

A randomized, double-blind, placebo-controlled clinical trial was conducted in Nairobi, Kenya, to compare single-dose ciprofloxacin with a 7-day cours e of erythromycin for the treatment of chancroid. In all, 208 men and 37 wo men presenting with genital ulcers clinically compatible with chancroid wer e enrolled. Ulcer etiology was determined using culture techniques for chan croid, serology for syphilis, and a multiplex polymerase chain reaction for chancroid, syphilis, and herpes simplex virus (HSV). Ulcer etiology was 31 % unmixed chancroid, 23% unmixed syphilis, 16% unmixed HSV, 15% mixed etiol ogy, and 15% unknown. For 111 participants with chancroid, cure rates were 92% with ciprofloxacin and 91% with erythromycin. For all study participant s, the treatment failure rate was 15%, mostly related to ulcer etiologies o f HSV infection or syphilis, and treatment failure was 3 times more frequen t in human immunodeficiency virus-infected subjects than in others, mostly owing to HSV infection. Ciprofloxacin is an effective single-dose treatment for chancroid, but current recommendations for empiric therapy of genital ulcers may result in high treatment failure due to HSV infection.