Infectious Disease Book



Aka: Chancroid, Soft Chancre, Hemophilus ducreyi
  1. See Also
    1. Sexually Transmitted Infection
    2. Bubo
  2. 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)
  3. Pathophysiology
    1. Sexually Transmitted Infection with Haemophilus ducreyi, a Gram Negative Rod (bacillus)
    2. Incubation: under 1 week
  4. Symptoms
    1. Malaise
    2. Headache
    3. Anorexia
    4. Extremely painful Genital Ulcers
  5. 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
  6. 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
  7. 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
  8. Differential Diagnosis
    1. See Genital Ulcers
    2. Herpes Simplex Virus also causes painful Genital Ulcers
  9. Associated Conditions: Common - over 10% (especially when Chancroid acquired outside the United States)
    1. Herpes Simplex Virus Coinfection
    2. Syphilis Coninfection
  10. 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
  11. Complications
    1. Phimosis
    2. Bacterial superinfection
  12. 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]

Chancroids (C0007947)

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, ナンセイゲカンキンカンセン, ナンセイゲカン
Swedish Schanker, mjuk
Finnish Pehmeä sankkeri
Czech Infekce Haemophilus ducreyi, Chancroid vyvolaný Haemophilus ducreyi, Chancroid, ulcus molle, vřed měkký, měkký vřed
Korean 무른궤양(연성하감)
Polish Wrzód weneryczny, Wrzód miękki, Zakażenie Haemophilus ducreyi
Hungarian chancroid, Haemophilus ducreyi fertőzés, Haemophilus ducreyi chancroid
Norwegian Ulcus molle, Bløt sjanker
Derived from the NIH UMLS (Unified Medical Language System)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

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