Chancroid

• Causes, incidence, and risk factors

  Chancroid is 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
  • Is soft
  • 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. The swollen lymph nodes and abscesses are often referred to as buboes.

• Signs and tests

  Chancroid is diagnosed by looking at the ulcer(s) and checking for swollen lymph nodes. There are no blood tests for chancroid.

• 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.

• Expectations (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.

• 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.

• Calling your health care provider

  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. Avoiding all forms of sexual activity is the only absolute way to prevent a sexually transmitted disease.

  However, safe sex behaviors may reduce your risk. The proper use of condoms, either the male or female type, greatly decreases the risk of catching a sexually transmitted disease. You need to wear the condom from the beginning to the end of each sexual activity.

• References

  Murphy TF. Haemophilus infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 222.

  Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

  Centers for Disease Control and Prevention, Workowski KA, Berman SM. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep. 2006 Aug 4;55(RR-11):14-30.

Review Date: 7/29/2009

Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.