Chancroid

Definition

Chancroid is a bacterial disease that is spread only through sexual contact.

Causes

Chancroid is a sexually-transmitted infection caused by a type of bacteria called Haemophilus ducreyi.

The disease is found mainly in developing and third world countries. Only a small number of cases are diagnosed in the United States each year. Most people 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 much higher risk than circumcised men for getting chancroid from an infected partner. Chancroid is a risk factor for the HIV virus.

Symptoms

Within 1 day - 2 weeks after getting chancroid, a person will get a small bump in the genitals. The bump becomes an ulcer within a day of its appearance. The ulcer:

• Ranges in size 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 banged or scraped

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

Common locations in men 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 for ulcers is the outer lips of the vagina (labia majora). "Kissing ulcers" may develop. These are ulcers that occur on opposite surfaces of the labia. Other areas such as the inner vagina lips (labia minora), the area between the genitals and the anus (perineal area), and inner thighs may also be involved. The most common symptoms in women are pain with urination and intercourse.

The ulcer may look like a chancre, the typical sore of primary syphilis.

Approximately half of the people infected with a chancroid will develop enlarged inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen.

Half of those who have swelling of the inguinal lymph nodes will progress to a point where the nodes break through the skin, producing draining abscesses

Exams and Tests

Chancroid is diagnosed by looking at the ulcer(s) and checking for swollen lymph nodes, as well as by getting a culture from the base of the ulcers. There are no lab tests for chancroid as there are for syphilis.

Treatment

The infection is treated with antibiotics, including azithromycin, ceftriaxone, ciprofloxacin, and erythromycin. Large lymph node swellings need to be drained, either with a needle or local surgery.

Outlook (Prognosis)

Chancroid can get better on its own. However, some people may have months of painful ulcers and draining. Antibiotic treatment usually clears up the lesions quickly with very little scarring.

Possible Complications

Complications include urethral fistulas and scars on the foreskin of the penis in uncircumcised males. Patients with chancroid should also be checked for syphilis, HIV, and genital herpes.

Chancroids in persons with HIV may take much longer to heal.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you have symptoms 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.

Prevention

Chancroid is a bacterial infection that is spread by sexual contact with an infected person. Although not having sex is the only sure prevention, safe sex practices are helpful for preventing the spread of chancroid.

Having sexual relations with only one partner who you know to be disease-free 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.

Annan NT, Lewis DA. Treatment of chancroid in resource-poor countries. Expert Rev Anti Infect Ther. 2005 Apr;3(2):295-306.

Lewis DA. Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect. 2003 Feb;79(1):68-71.