Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid.

GOAL OF THIS STUDY: To compare outcomes of incision and drainage with packing to needle aspiration of purulent buboes in patients with presumed chancroid. The safety and efficacy of incision and drainage were compared with that of needle aspiration.

STUDY DESIGN AND METHODS: The study was a prospective randomized, nonblinded clinical trial carried out from April 1992, to January 1994 in an inner city emergency department. A consecutive sample of 27 adults with fluctuant inguinal buboes presumed or proven to be chancroid or lymphogranuloma venereum were eligible for inclusion. Patients were excluded if they were believed to have buboes secondary to disease other than chancroid. After informed consent was obtained, patients had buboes drained by needle aspiration or by incision and drainage with packing according to a random numbers table.

RESULTS: Twenty-seven patients were included in the study (22 men and 5 women), with 12 randomized to incision and drainage and 15 to aspiration. The mean age was 35.7 +/- 13 years. Genital ulcer or bubo pus cultures for Haemophilus ducreyi were positive in seven patients, negative in 15 patients, and not done in five patients. Follow-up was obtained for 23 (85%) patients, 11 of whom had incision and drainage and 12 of whom had aspirations. No adverse effects were reported in either group.

CONCLUSION: Incision and drainage is an effective method for treating fluctuant buboes and may be preferable to traditional needle aspiration considering the frequency of required re-aspirations in the study patients. Limitations of this study include lack of complete laboratory testing and lack of follow-up of all patients.