Chancroid. Medical Symptoms and Signs of Chancroid - Sexually Transmitted Diseases

Description of Medical Condition

A sexually transmitted disease characterized by painful genital ulcerations and inflammatory inguinal adenopathy. It is uncommon in the United States but found worldwide. Chancroid is endemic in developing countries and a cofactor for HIV transmission.

System(s) affected: Reproductive, Skin/Exocrine

Genetics: N/A

Incidence/Prevalence in USA: Fewer than 100 cases reported to the CDC in 2000-2002. Actual numbers felt to be greater due to underreporting of cases.

Predominant age: Teenagers and adults

Predominant sex: Male > Female

Medical Symptoms and Signs of Disease

Tender genital papule that ulcerates after 24 hours
Irregular edged, painful ulcer(s)
Ulcers may be 1 mm to 5 cm in size
Ulcers may occur on the shaft of the penis, glans and meatus in men
Ulcers in women most commonly occur in labia majora but also seen in labia minora, perineum, thigh, and cervix
Painful inguinal adenopathy with abscess (bubo) formation in 30% of patients
Atypical presentations include folliculitis and foreskin abscess

What Causes Disease?

Haemophilus ducreyi (gram negative bacterium)

Risk Factors

Multiple sexual partners
Uncircumcised males
Prostitutes often are carriers

Diagnosis of Disease

Differential Diagnosis

Syphilis
Herpes simplex virus (HSV1 and 2)
Lymphogranuloma venereum (LGV)
Granuloma inguinale

Laboratory

Serologic testing for antibody with ELISA technique. Gram stain; culture of organism on Mueller-Hinton agarwith incorporated vancomycin. Polymerase chain reaction (PCR) where available.

Drugs that may alter lab results: Previous antibiotics

Disorders that may alter lab results: None expected

Pathological Findings

“School of fish” pattern on gram stain

Diagnostic Procedures

Gram stain and culture of ulcer exudate
Aspiration of inguinal bubo (lymph node)
PCR testing of ulcer exudate for H. Ducreyi DNA
Dark-field examinations of exudate to rule out Trepo-nema pallidum
Culture or PCR testing for HSV

Treatment (Medical Therapy)

Appropriate Health Care

Outpatient treatment

General Measures

Saline or Burow’s solution soaks to ulcers
Aspiration of buboes if greater than 5 cm; done through adjacent uninvolved skin

Activity

Refrain from sexual intercourse until genital lesions fully resolved

Patient Education

Sexual counseling
Use of condoms
Local wound care
Treatment of all sexual partners with same regimen as index case
HIV testing

Medications (Drugs, Medicines)

Drug(s) of Choice

Azithromycin 1 gm po single dose (more expensive than other treatments)
Ceftriaxone 250 mg IM single dose
Ciprofloxacin 500 mg po bid for 3 days or other quino-lone
Erythromycin base 500 mg qid x 7 days

Contraindications:

Allergy to the medication
Ciprofloxacin in pregnancy and lactation, and patients less than age 18

Precautions: Refer to manufacturer’s profile of each drug

Significant possible interactions: Refer to manufacturer’s profile of each drug

Alternative Drugs

N/A

Patient Monitoring

Patient followed until all clinical signs of infection resolved
Should see symptomatic improvement within 3 days and objective improvement by day 7
Baseline syphilis serology and at 3 months
HIV testing at baseline and at 3 months post-treatment

Prevention / Avoidance

Avoidance of sexual activity until ulcers resolved

Possible Complications

Phimosis
Balanoposthitis
Rupture of buboes with fistula formation and scarring

Expected Course / Prognosis

Full clinical resolution with appropriate treatment
5% relapse after treatment
Primary infection is not believed to provide immunity

Miscellaneous

Associated Conditions

Syphilis — concurrently in 10% of patients (per new CDC data)
HSV or HIV infection

Age-Related Factors

N/A

Pediatric: N/A

Geriatric: N/A

Others: HIV disease may affect treatment response

Pregnancy

Maternal to infant transmission has not been reported

Synonyms

Soft chancre

• Ulcus molle

International Classification of Diseases

099.0 Chancroid

Other Notes

Chancroid has been shown to be an established risk factor for acquisition of HIV infection