Recommended antibiotic regimens

• Azithromycin 1 g orally, single dose
• Ceftriaxone 250 mg IM, single dose
• Ciprofloxacin 500 mg orally twice daily for 3 days
• Erythromycin base 500 mg orally three times daily for 7 days

Additional management

• Test for HIV, syphilis, and usually HSV, since genital ulcers may be mixed or misdiagnosed.
• Review in 3 to 7 days. Symptomatic improvement should occur within 3 days, and ulcers usually improve objectively within 7 days. Complete healing can take more than 2 weeks for large ulcers.
• Aspirate or drain a fluctuant suppurative inguinal bubo if needed for symptom relief. Avoid extensive incision where possible because it may delay healing.
• Test and treat sexual partners who had contact during the 10 days before symptom onset, even if asymptomatic.
• Avoid sexual contact until ulcers have healed and partners have been evaluated/treated.
• In people with HIV, response may be slower and treatment failure is more likely. Close follow-up is needed, and repeated or longer therapy may be necessary.
• Avoid ciprofloxacin in pregnancy or breastfeeding. Use an appropriate alternative with specialist or STI-clinic guidance.