Chancroid

Causes and Risks:
Chancroid is a bacterial infection caused by the organism Haemophilus ducreyi. It is a disease found primarily in developing and third world countries, but cases are continuously diagnosed in the United States. The majority of individuals in the U.S. diagnosed with chancroid have traveled in endemic areas outside the country (areas where the disease is known to occur frequently).

Chancroid begins with a small bump ( papule ) that becomes an ulcer within a day of its appearance. The ulcer characteristically:
  • ranges in size dramatically (from 1/8 inch to 2 inches across)
  • is painful
  • has sharply defined borders (sharply demarcated)
  • has irregular or ragged borders
  • has a base that is covered with a grey or yellowish-grey material ( exudate )
  • has a base that bleeds easily if traumatized or scraped

About half of infected men have only a single ulcer. Women frequently have 4 or more ulcers . The ulcers appear in specific locations.

Common locations in men (most common to least common) are:

  • foreskin (prepuce)
  • groove behind the head of the penis (coronal sulcus)
  • shaft of the penis
  • head of the penis (glans)
  • opening of the penis (urethral meatus)
  • scrotum

In women the most common location is the labia majora. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the labia. Other areas such as the labia minora, perianal area, and inner thighs may also be involved.

The initial ulcer may be mistaken as a chancre , the typical sore of primary syphilis .

Approximately half of the infected individuals will develop enlargement of the inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen. Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin producing draining abscesses . The swollen lymph nodes and abscesses are often referred to as bubos.

Uncircumcised men are at 3 times the risk of circumcised men for contracting chancroid from an infected partner. Chancroid may also be a risk factor for contracting the HIV virus.

Prevention:
Chancroid is a bacterial infection that is spread by sexual contact with other infected individuals. Although abstinence is the only sure prevention, safe sex practices are helpful in preventing the spread of chancroid. Monogamous sexual relations with a known disease-free partner is the safest and most practical "safe sex" method. Condoms provide very good protection from the spread of most sexually transmitted diseases when used properly and consistently.

Symptoms:

  • painful genital ulcer or ulcers
  • swollen inguinal lymph nodes
  • draining inguinal lymph nodes



Signs and Tests:
There are no serological tests for chancroid such as those available for syphilis . Diagnosis is made by using a sterile cotton swab to obtain a sample from the base of the ulcers . The material from the swab is then cultured.

Treatment:
The infection is treated with appropriate antibiotics. Effective antibiotics include:

  • sulfonamides - oral
  • tetracyclines - oral
  • streptomycin
  • kanamycin-oral
  • chloramphenicol
  • trimethoprim and sulfa mixtures
  • ceftriaxone, 250 mg (milligrams), injected into a muscle
  • Ciprofloxacin - oral, 500 mg, twice a day for 3 days
  • erythromycins - oral, 500 mg, four times a day for 7 days



Prognosis:
Chancroid can resolve spontaneously. However, some people may experience months of painful ulceration and draining. Antibiotic treatment usually results in rapid clearing of lesions with a minimal to small amount of scarring.

Complications:

  • urethral fistulas
  • phimosis in uncircumcised males (scars on the foreskin of the penis )



Call Your Healthcare Provider:
Call for an appointment with your health care provider if you have symptoms suggestive of chancroid. Also call if you have had sexual contact with a person known to have any STD, or if you have engaged in high-risk sexual practices.


This is a chancroid erosion on the shaft of the penis. Chancroid is a sexually transmitted disease (STD) that produces a painful ulcer at the site of initial infection. The ulcer can be mistaken for the primary ulcer of syphilis. Specific lab studies should be done to differentiate between the two.



A chancre on the penis caused by primary syphilis. The "chancre", a painless ulceration at the site of infection, is the classical presenting skin finding of syphilis. Chancres are highly visible in males but may go undetected in females.



Chancroid is a highly infectious sexually transmitted disease that produces ulceration of the skin, seen here on the head of the penis. Multiple ulcers may be present. Following contact, the incubation period is approximately 3 to 5 days.



Chancroid erosion on the glans of the penis: Chancroid is a highly infectious sexually transmitted disease that produces ulceration of the skin. Multiple ulcers may be present. Following contact the incubation period is approximately 3-5 days. The ulcers often have sharp edges and a yellowish base. They may ooze purulent (pus) material.