An infectious disease caused by Haemophilus ducreyi, a small gram-negative bacillus.
Common in the tropics, especially in Africa, the Far East, and the Caribbean.
Persons may present with chancroid outside endemic regions sporadic outbreaks of infection occur in Europe and North America.
Incubation period is about 3-7 days.
Begins as a small, tender papule, changing into a pustule which rapidly progresses to a painful ulcer with a brighted areola.
Neither the edge nor base of the ulcer is indurated (unlike syphilis).
The ulcer feels soft, hence the name soft sore (ulcus molle)
with superimposed bacterial infection it often feels indurated.
The ulcers may be multiple due to auto-inoculation sites of predilection in men are the prepuce, frenulum, glans or shaft of the penis.
In women the labia, fourchette, vestibule, clitoris, cervix, or perineum are favored sites.
Lesions may cause dyspareunia, pain on voiding or defaecation and vaginal discharge.
Women may be asymptomatic carries about 7 -14 days after the appearance of the ulcer, a bubo appears.
A mass of glands matted together often adherent to the overlying skin.
The glands above the inguinal ligament are usually affected and often there is a unilateral enlargement.
Central softening is often found and if u untreated the bubo may rupture and discharge through a fistula.
The combination of a painful genital ulcer and suppurative inguinal adenopathy is almost pathognomonic of chancroid.
Patient may present with bubo, the initial ulcer having healed.
A typical lesion have been reported in HIV-infected individuals.
More extensive, or multiple lesions sometimes accompanied by systemic manifestations such as fever and chills.
Progressive ulceration and amputation of the phallus, particularly in HIV patients.
Other causes of genital ulcers:
- Granuloma inguinale
- Lymphogranuloma venereum
- Fixed drug eruption
- Erythema multiforme
- Behcet’s disease
- Tuberculous chancre
Microscopy, culture and sensitivity of discharge from ulcer.
Serological tests e.g complement fixation (CF);
Microimmuno fluorescence (MIF) test, PCR
Same as for Gonorrhoea
500 mg orally every 12 hours for 3 days
Erythromycin 500mg orally every 6 hours for 7 days
Azithromycin 1 g orally as a single dose
Cerftriaxone, 250 mg by intramuscular injection, as a single dose
Keep ulcerative lesions clean.
Aspirate fluctuant lymph nodes through the surrounding healthy skin, preferably from a superior approach to prevent persistent dripping and sinus formation.
Incision and drainage, or excision of nodes may delay healing and is not recommended.
All patients should be followed up until there is clear evidence of improvement or cure.
In patients infected with HIV, treatment may appear to be less effective, but this may be a result of co-infection with genital herpes or syphilis.
Chancroid and HIV infection are closely association and therapeutic failure is likely to be seen with increasing frequency.
Patients should therefore be followed up weekly until there is clear evidence of improvement.
Notable adverse drug reactions, caution and contraindications
Ciprofloxacin and ceftriaxone (see gonorrhea)
Erythromycin and azithromycin (see Chlamydia)
- Condom use
- Contact treatment.