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Chancroid. Medical Symptoms and Signs of Chancroid

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


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


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


  • 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


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


Associated Conditions

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

Age-Related Factors


Pediatric: N/A

Geriatric: N/A

Others: HIV disease may affect treatment response


Maternal to infant transmission has not been reported


  • Soft chancre

• Ulcus molle

International Classification of Diseases

099.0 Chancroid

See Also


Other Notes

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

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