Chancroid

Definition

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

Causes

Chancroid is caused by a type of bacteria called Haemophilus ducreyi.

The infection is found mainly in developing and third world countries. Very few people are diagnosed in the United States each year with this infection. Most people in the U.S. who are diagnosed with chancroid have traveled outside the country to areas where the infection is more common.

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 a base that is covered with a grey or yellowish-grey material
  • Has a base that bleeds easily if it is banged or scraped

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

Common locations in men are:

  • Foreskin
  • Groove behind the head of the penis
  • Shaft of the penis
  • Head of the penis
  • Opening of the penis
  • 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 the 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.

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

In half of people who have swelling of the inguinal lymph nodes, the nodes will break through the skin and cause draining abscesses. The swollen lymph nodes and abscesses are often called buboes.

Exams 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.

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 other sexually transmitted infections, including 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
  • You have had sexual contact with a person who you know has a sexually transmitted infection (STI)
  • 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 species (including H. influenzae and chancroid). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 225.

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.

Workowski KA, Berman S: Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2010. MMWR Morb Mortal Wkly Rep. 2010 Dec 17;59:1-110.


Review Date: 8/14/2012
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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