Adapted from the US National Library of Medicine, National Institutes of Health by Marjorie Montemayor, MA November 2005
Causes, incidence, and risk factors
Chancroid is a sexually-transmitted infection caused by the Gram negative bacterium Haemophilus ducreyi. The main symptom is genital sores that rupture after a few days.
The disease is found primarily in developing and third world countries. Only a few hundred cases a year are diagnosed in the United States. The majority of individuals in the U.S. diagnosed with chancroid have traveled outside the country to areas where the disease is known to occur frequently.
Uncircumcised men are at a much higher risk than circumcised men for contracting chancroid from an infected partner. Chancroid is a risk factor for contracting the HIV virus.
Symptoms
After an incubation period of one day to two weeks, chancroid begins with a small bump 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,
- has irregular or ragged borders,
- has a base that is covered with a grey or yellowish-grey material,
- has a base that bleeds easily if traumatized or scraped.
About half of infected men have only a single ulcer. Women frequently have four or more ulcers. The ulcers appear in specific locations.
Common locations in men (most common to least common) are listed below:
- 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 for ulcers 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 most common symptoms in women are pain with urination and pain with intercourse.
The initial ulcer may be mistaken as a chancre, the typical sore of primary syphilis.
Approximately half of the infected individuals will develop enlargements 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 buboes.
Signs and tests
Diagnosis is made by evaluating the ulcer(s) and presence of swollen lymph nodes, and by obtaining a culture from the base of the ulcers. There are no lab tests for chancroid like there is for syphilis.
Treatment
The infection is treated with antibiotics including azithromycin, ceftriaxone, ciprofloxacin, and erythromycin. Large lymph node swellings need drainage either by needle or local surgery.
Expectations (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)
- Patients with chancroid should also be checked for syphilis, HIV, and genital herpes.
- Patients with HIV may take much longer to heal.
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.
Chancroid. US National Library of Medicine, National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000635.htm. Accessed November 3, 2005.
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