II. Epidemiology
- Haemophilus ducreyi
- Causative organism for Chancroid
- Facultative Anaerobic Gram Negative Rod
- Chancroid is very common in developing countries (e.g. Africa)
- Responsible for 50-70% of Genital Ulcers in third world
- Replaces Genital Herpes (rare in third world) as the most common Genital Ulcer cause in third world
- Chancroid is rare in United States (except possibly urban centers)
- Outbreak in L.A. 1987
- Only 28 cases were reported to the State Health Departments in 2009, 7 cases in 2017
- Reportable disease
- Coinfection with HSV and Syphilis is common (see Associated Conditions below)
III. Pathophysiology
- Sexually Transmitted Infection with Haemophilus ducreyi, a Gram Negative Rod (Bacillus)
- Incubation: under 1 week
IV. Symptoms
- Malaise
- Headache
- Anorexia
- Extremely painful Genital Ulcers
V. Signs
- Fever
- Small Red Papules begin on genitalia or adjacent skin
- Lesions suppurate into soft painful Genital Ulcers
- Deep, Undermined edges
- Irregular, serpiginous borders
- Purulent, friable base
- Multiple lesions in two thirds of patients
- Causes chronic non-genital Skin Ulcerations in children in developing countries
- Regional tender unilateral inguinal Lymphadenitis
- Occurs in 30-50% of patients
-
Inguinal Buboes
- Develops from swollen Lymph Nodes
- Fluctuant lesions may rupture
VI. Labs
- Sexually Transmitted Disease screening (see associated conditions below regarding coinfections)
- Haemophilus ducreyi bacilli in smear
- Gram Negative slender rods or coccobacilli
- May appear as "school of fish" pattern under microscopy
- Haemophilus ducreyi culture positive
- Requires special culture media
- Test Sensitivity: 80%
- Haemophilus ducreyi PCR
- No FDA approved tests available in the United States (although proprietary lab testing may be available)
VII. Diagnosis
- See labs above
- Presumptive diagnosis is reasonable approach in United States where testing may not be definitive
- Painful Genital Ulcers with or without Regional Lymphadenopathy and
- No evidence of Syphilis at least 7 days after ulcer onset and
- Negative HSV Testing
VIII. Differential Diagnosis
- See Sexually Transmitted Infection
- Painful Genital Ulcers
- See Genital Ulcers
- Herpes Simplex Virus (also causes painful Genital Ulcers)
-
Inguinal Lymphadenopathy
- Lymphogranuloma venereum (slow development of painless matted suppurative nodes)
- Syphilis (bilateral painless adenopathy)
IX. Associated Conditions: Common - over 10% (especially when Chancroid acquired outside the United States)
- Herpes Simplex Virus Coinfection
- Syphilis Coninfection
X. Management
-
General
- Needle aspiration or Incision and Drainage of fluctuant buboes
- All sexual partners in prior 60 days should undergo exam and treatment
- First-Line Agents
- Azithromycin 1 gram orally for 1 dose
- Ceftriaxone 500 mg IM for 1 dose
- Alternative Agents
- Ciprofloxacin 500 mg orally twice daily for 3 days
- Erythromycin 500 mg orally four times daily for 7 days
XI. Complications
- Phimosis
- Bacterial superinfection
- HIV Coinfection
- Genital Ulcerations increase risk of HIV Transmission
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Related Studies
| Definition (MSH) | Acute, localized autoinoculable infectious disease usually acquired through sexual contact. Caused by HAEMOPHILUS DUCREYI, it occurs endemically almost worldwide, especially in tropical and subtropical countries and more commonly in seaports and urban areas than in rural areas. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D002602 |
| ICD9 | 099.0 |
| ICD10 | A57 |
| SnomedCT | 186945008, 154391003, 87429008, 266213004, 266143009 |
| LNC | LA10441-6 |
| English | Chancroid, Haemophilus ducreyi chancroid, Hemophilus ducreyi chancroid, Haemophilus ducreyi infection, Hemophilus ducreyi infection, Ulcus molle, Chancroid [Disease/Finding], ulcus molle, soft chancre, sexually transmitted disease chancroid, chancroid, chancroid (diagnosis), (Chancroid [& bubo]) or (Ducrey's chancre), (Chancroid [& bubo]) or (Ducrey's chancre) (disorder), Chancroidal bubo, Ducrey's chancre, Soft chancre - chancroid, Soft sore - chancroid, Chancroid (disorder), Haemophilus ducreyi, Hemophilus ducreyi, bubo; Haemophilus ducreyi, bubo; Hemophilus ducreyi, bubo; chancroidal, bubo; soft chancre, bubo; virulent, chancroid; bubo, Bacillus; Ducrey, molle; ulcer, ulcer; molle, virulent; bubo, Soft chancre, Ducrey's disease, Bubo due to Haemophilus ducreyi, Simple chancre, Chancroid (disorder) [Ambiguous], Chancroids, chancroidal; bubo, Bubo chancroidal, Bubo due to Hemophilus ducreyi, Ducrey's simple soft chancre, Ulcus molle, cutis, Ulcus molle, skin |
| Dutch | Haemophilus ducreyi-infectie, Haemophilus ducreyi-venerische zweer, Bacillus; Ducrey, bubo; Haemophilus ducreyi, bubo; chancroidalis, bubo; virulent, bubo; zachte sjanker, chancroïd; bubo, molle; ulcus, ulcus; molle, virulent; bubo, chancroïd, chancroïd; bubo chancroidalis, Chancroïd |
| French | Infection à Haemophilus ducreyi, Chancre mou à Haemophilus ducreyi, Chancre simple, Chancrelle, Chancre mou, Chancroïde |
| German | Haemophilus ducreyi-Infektion, Haemophilus ducreyi-Chancroid, Ulcus molle (venereum), Chancroid, Schanker, weicher, Ulcus molle |
| Italian | Infezione da Haemophilus ducreyi, Ulcera molle da Haemophilus ducreyi, Ulcera venerea |
| Portuguese | Infecção por Haemophilus ducrey, Cancro mole por Haemophilus ducrey, Cancro mole por Haemophilus ducreyi, Cancroide, Cancro mole |
| Spanish | Chancroide por Haemophilus ducreyi, Chancroide por Hemophilus ducreyi, Infección por Hemophilus ducreyi, chancro (trastorno), enfermedad de Ducrey, bubón chancroide, bubón por Haemophilus ducreyi, chancro simple, chancro, bubón virulento, chancro (concepto no activo), chancro blando, chancro de Ducrey, chancroide (trastorno), chancroide, Chancroide |
| Japanese | 軟性下疳, 軟性下疳菌感染, ﾅﾝｾｲｹﾞｶﾝｷﾝｶﾝｾﾝ, ﾅﾝｾｲｹﾞｶﾝ |
| Swedish | Schanker, mjuk |
| Finnish | Pehmeä sankkeri |
| Russian | MIAGKII SHANKR, МЯГКИЙ ШАНКР |
| Czech | Infekce Haemophilus ducreyi, Chancroid vyvolaný Haemophilus ducreyi, Chancroid, ulcus molle, vřed měkký, měkký vřed |
| Korean | 무른궤양(연성하감) |
| Croatian | ČANKIR, MEKI |
| Polish | Wrzód weneryczny, Wrzód miękki, Zakażenie Haemophilus ducreyi |
| Hungarian | chancroid, Haemophilus ducreyi fertőzés, Haemophilus ducreyi chancroid |
| Norwegian | Ulcus molle, Bløt sjanker |
Ontology: Hemophilus ducreyi (C0018481)
| Definition (MSH) | A species of HAEMOPHILUS that appears to be the pathogen or causative agent of the sexually transmitted disease, CHANCROID. |
| Definition (CSP) | species of Haemophilus that appears to be the pathogen or causative agent of the sexually transmitted disease, chancroid. |
| Concepts | Bacterium (T007) |
| MSH | D006191 |
| SnomedCT | 64889004 |
| LNC | LP15183-4, MTHU001855 |
| English | Haemophilus ducreyi, ducreyi haemophilus, haemophilus ducreyi, hemophilus ducreyi, Haemophilus ducreyi (Neveu-Lemaire 1921) Bergey et al. 1923, Bacillus ulceris cancrosi, Coccobacillus ducreyi, Haemophilus ducreyi (organism), Hemophilus ducreyi |
| French | Hemophilus ducreyi, Haemophilus ducreyi |
| Swedish | Haemophilus ducreyi |
| Czech | Haemophilus ducreyi |
| Spanish | Haemophilus ducreyi, Hemophilus ducreyi, Haemophilus ducreyi (organismo) |
| Finnish | Haemophilus ducreyi |
| Russian | MIAGKOGO SHANKRA BAKTERIIA, MIAGKOGO SHANKRA VOZBUDITEL', HAEMOPHILUS DUCREYI, МЯГКОГО ШАНКРА БАКТЕРИЯ, МЯГКОГО ШАНКРА ВОЗБУДИТЕЛЬ |
| Japanese | ヘモフイルス･デュクレイイ, ジュクレイ菌, 軟性下疳菌, デュクレー菌, ヘモフィルスジュクレイ |
| Italian | Hemophilus ducreyi, Haemophilus ducreyi |
| Polish | Pałeczki wrzodu miękkiego, Haemophilus ducreyi |
| Norwegian | Haemophilus ducreyi, Hemophilus ducreyi |
| German | Haemophilus ducreyi |
| Dutch | Haemophilus ducreyi, Hemophilus ducreyi |
| Portuguese | Haemophilus ducreyi, Hemophilus ducreyi |
