CHANCROID

Definition:

 Chancroid is an infectious, painful, ragged venereal ulcer at the site of

infection by Haemophilus ducreyi, beginning after an incubation period
of 3-7 days; seen more commonly in men; Gram-negative streptobacilli
may be identified by staining material from the ulcer. SYN: soft chancre,
soft sore, soft ulcer, venereal sore, venereal ulcer
 Chancroid is a sexually transmitted disease caused by the organism
Haemophilus ducreyi.
 The illness is characterized by painful genital ulcers and tender inguinal
adenopathy that may suppurate.
 Also known as "soft chancre," venereal sore, chancroid is one of the three
major causes of genital ulcer disease; the other major causes are genital
herpes and syphilis.

Etiology:

 Haemophilus ducreyi appears microscopically as a pleomorphic gram-

negative rod

Signs and symptoms

 Typically, the first lesion noted is a small inflammatory papule

surrounded by a zone of erythema.
 Within 2 or 3 days a pustule forms that soon ruptures, leaving a sharply
circumscribed ulcer with ragged undermined edges without induration.
 The base of the ulcer usually has a granular appearance and is always
painful.
 In males, the most common sites for the ulcers are on the distal prepuce,
the mucosal surface of the prepuce on the frenulum, or in the coronal
sulcus.
 In females, the majority of lesions are at the entrance to the vagina.
 Painful tender inguinal adenopathy is present in as many as 50% of
patients and is usually unilateral.
 The involved lymph nodes may rapidly become fluctuant and rupture,
with the formation of inguinal ulcers.
 The combination of a painful ulcer with tender inguinal adenopathy is
suggestive of chancroid, and when accompanied by suppurative inguinal
adenopathy is almost pathognomonic

Diagnosis

 Gram stain of purulent material may reveal gram-negative rods in the

characteristic "school-of-fish" pattern, but this appearance is probably
more characteristic of in vitro propagated organisms.

Treatment

 Successful antimicrobial treatment of genital ulcers caused by

Haemophilus ducreyi cures infection, resolves clinical symptoms, and
prevents transmission to others.
 The Centers for Disease Control and Prevention currently recommend
one of four antibiotic regimens for treatment of chancroid:
a) Azithromycin: 1 g orally in a single dose;
b) Ceftriaxone: 250 mg intramuscularly in a single dose;
c) Ciprofloxacin: 500 mg orally twice a day for 3 days; or
d) Erythromycin base: 500 mg orally 4 times a day for 7 days.
 All four regimens are effective for treatment of chancroid in patients with
HIV infection.
 A successful response to therapy is usually evident within 48 to 72 hours,
as evidenced by decreased ulcer tenderness and pain.
 Complete healing of ulcers may take up to 28 days, but is often achieved
in 7 to 14 days.
 Healing of fluctuant adenopathy is slower than that of the ulcers and may
require needle aspiration through adjacent intact skin even during
successful therapy.