Chancroid

Aka: Chancroid, Soft Chancre, Hemophilus ducreyi

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II. Epidemiology

  1. Chancroid is very common in third world (e.g. Africa)
    1. Responsible for 50-70% of Genital Ulcers in third world
    2. Replaces Genital Herpes (rare in third world) as the most common Genital Ulcer cause in third world
  2. Chancroid is rare in United States (except possibly urban centers)
    1. Outbreak in L.A. 1987
    2. Only 28 cases were reported to the State Health Departments in 2009, 7 cases in 2017
  3. Reportable disease
  4. Coinfection with HSV and Syphilis is common (see Associated Conditions below)

III. Pathophysiology

  1. Sexually Transmitted Infection with Haemophilus ducreyi, a Gram Negative Rod (bacillus)
  2. Incubation: under 1 week

IV. Symptoms

  1. Malaise
  2. Headache
  3. Anorexia
  4. Extremely painful Genital Ulcers

V. Signs

  1. Fever
  2. Small Red Papules begin on genitalia or adjacent skin
    1. Perineum (involved in women and homosexual men)
    2. Men
      1. Prepuce or frenulum
    3. Women
      1. Vulva or Cervix
    4. Extragenital lesions
      1. Rarely involve inner thighs and fingers
  3. Lesions suppurate into soft painful Genital Ulcers
    1. Deep, Undermined edges
    2. Irregular, serpiginous borders
    3. Purulent, friable base
    4. Multiple lesions in two thirds of patients
    5. Causes chronic non-genital Skin Ulcerations in children in developing countries
  4. Regional tender unilateral inguinal Lymphadenitis
    1. Occurs in 30-50% of patients
  5. Inguinal Buboes
    1. Develops from swollen Lymph Nodes
    2. Fluctuant lesions may rupture

VI. Labs

  1. Sexually Transmitted Disease screening (see associated conditions below regarding coinfections)
    1. Gonorrhea
    2. Chlamydia
    3. Herpes Simplex Virus
    4. Syphilis (RPR)
    5. HIV Infection
    6. Hepatitis B Infection
  2. Haemophilus ducreyi bacilli in smear
    1. Gram Negative slender rods or coccobacilli
    2. May appear as "school of fish" pattern under microscopy
  3. Haemophilus ducreyi culture positive
    1. Requires special culture media
    2. Test Sensitivity: 80%
  4. Haemophilus ducreyi PCR
    1. Not available in the United States

VII. Diagnosis

  1. See labs above
  2. Presumptive diagnosis is reasonable approach in United States where testing may not be definitive
    1. Painful Genital Ulcers with or without Regional Lymphadenopathy and
    2. No evidence of Syphilis at least 7 days after ulcer onset and
    3. Negative HSV Testing

VIII. Differential Diagnosis

  1. See Genital Ulcers
  2. Herpes Simplex Virus also causes painful Genital Ulcers

IX. Associated Conditions: Common - over 10% (especially when Chancroid acquired outside the United States)

  1. Herpes Simplex Virus Coinfection
  2. Syphilis Coninfection

X. Management

  1. General
    1. Needle aspiration or Incision and Drainage of fluctuant buboes
    2. All sexual partners in prior 60 days should undergo exam and treatment
  2. First-Line Agents
    1. Azithromycin 1 gram orally for 1 dose
    2. Ceftriaxone 500 mg IM for 1 dose
  3. Alternative Agents
    1. Ciprofloxacin 500 mg orally twice daily for 3 days
    2. Erythromycin 500 mg orally four times daily for 7 days

XI. Complications

  1. Phimosis
  2. Bacterial superinfection

XII. References

  1. Lewis (2003) Sex Transm Infect 79(1): 68-71 [PubMed]
  2. Lewis (2014) Expert Rev Anti Infect Ther 12(6):687-96 +PMID:24597521 [PubMed]
  3. González-Beiras (2016) Emerg Infect Dis. 2016 Jan; 22(1): 1–8 +PMID: 26694983 [PubMed]
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4696685/

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