Chancroid
Chancroid: Excerpt from The 5-Minute Pediatric Consult
Christine S. Cho, MD, MPH
Chancroid - BASICS
Chancroid - description
Infection with the Gram-negative coccobacillus Haemophilus ducreyi, resulting in necrotizing, purulent, painful genital ulcers that may be associated with regional lymphadenitis.
Chancroid - general prevention
- Condom use
- Treatment of partners whether or not they have symptoms
- Evaluation for the presence of other sexually transmitted diseases
Chancroid - epidemiology
- Probably underrecognized and underreported
- In underdeveloped countries, it is a major cause of genital ulcer syndrome.
- Importantly, it is a major cofactor in the transmission of HIV. Transmission occurs via sexual contact with an individual with an ulcer.
- Seen more commonly in males; females are more likely to be asymptomatic.
Chancroid - incidence
From 1996–2000 the incidence has declined from 388 to 82 reported cases per year in the US.
Chancroid - risk factors
Increased association with individuals involved in drug use and prostitution
Chancroid - pathophysiology
- Trauma and abrasion allow the organism to penetrate the epidermis.
- 3–10 days later, an erythematous, tender papule develops and progresses to a pustule.
- The pustule ruptures after 2–3 days, leaving a shallow ulcer with a painful, necrotic base with undermined edges.
- Single or multiple ulcers may be present
Chancroid - etiology
The most common causes of genital ulcer syndrome include syphilis, HSV, and chancroid.
Chancroid - associated conditions
- Associated with HIV transmission and infection
- Coinfection with syphilis and human herpesvirus may occur (10%).
Chancroid - DIAGNOSIS
Chancroid - signs & symptoms
Chancroid - history
- Males usually present with symptoms referable to an ulcer.
- Females may be asymptomatic or present with nonspecific symptoms (dysuria, vaginal discharge, pain with stooling or sexual intercourse, rectal pain, or bleeding).
Chancroid - physical exam
Classic findings:
- Extremely painful ulcer with an irregular, undermined border and a gray, necrotic center:
- In males: Found on prepuce or coronal sulcus
- In females: Found on the vulva, cervix, or perianal area
- Inguinal lymphadenopathy in 50%: May spontaneously drain (bubo)
- Extragenital sites are rare and include the inner thigh area, breasts, fingers, mouth
Chancroid - tests
Diagnosis is made by clinical findings and exclusion of other causes of genital ulcers.
Chancroid - lab
- Gram stain from the base of the ulcer: May show short gram-negative coccobacilli in parallel “school of fish” arrangement. This finding does not compare favorably with culture-proven or clinically diagnosed cases, so routine use is not helpful.
- Cultures from the ulcer:
- H. ducreyi is a fastidious organism and requires specialized media and technique for successful isolation.
- Compared with newer amplification techniques, has been proven to be 75% sensitive
- Helpful in the face of treatment failure and useful for following trends in antimicrobial resistance
- Currently the only method routinely available for the diagnosis of chancroid
- DNA amplification:
- A genital ulcer multiplex polymerase chain reaction (GUM) test has been developed for simultaneous amplification of DNA targets from H. ducreyi, T. pallidum, and HSV types 1 and 2; offers improved sensitivity when compared with culture
- This technology is not routinely available but offers the advantage of evaluating the patient for the major causes of genital ulcer syndrome simultaneously.
- Monoclonal antibody:
- Monoclonal antibody against the outer membrane protein of H. ducreyi using immunofluorescent antibody has also proven to be more sensitive than culture.
- Could provide easy, rapid, inexpensive, sensitive testing, but not available currently
- Culture for HSV, rapid plasma reagent: Evaluation for the common causes of genital ulcer syndrome should be done routinely.
- HIV test: Genital ulcers are a significant cofactor for HIV infection.
Chancroid - differencial diagnosis
- Chancroid must be distinguished from the other causes of genital ulcers, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum, and granuloma inguinale. More than one of these pathogens may be present in individual cases.
- Uncommon etiologies include:
- Trauma
- Fixed drug eruptions
- Lymphogranuloma venereum
- Inflammatory bowel disease
- Behcçet syndrome
Chancroid - TREATMENT
Chancroid - medication
- Azithromycin 1 g PO
- Ceftriaxone 250 mg IM
- Ciprofloxacin 500 mg b.i.d. for 3 days (patients >18 years)
- Erythromycin 500 mg q.i.d. for 7 days
Chancroid - FOLLOW UP
- Symptoms improve within 3–7 days.
- Ulcers heal between 1 and 4 weeks.
- Lymphadenopathy may take longer to regress; may progress to fluctuance in spite of adequate therapy.
- Patients should be followed weekly until symptoms resolve.
- For patients who do not follow the typical course, consider other causes of genital ulcers; noncompliance; presence of a coexisting sexually transmitted disease, especially HIV infection; and, rarely, presence of a resistant organism.
- Recent sexual partners (within the preceding 10 days) should be treated.
Chancroid - complications
- Draining bubo
- Coinfection with syphilis and HSV
- HIV infection
Chancroid - bibliography
Centers for Disease Control. STD Surveillance 2000. Available at: http://www.cdc.gov/std/stats00/Tables/2000Table42.htm. Accessed December 1, 2006.
American Academy of Pediatrics. Chancroid. In: Pickering LK, ed. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006.
- Laskaris G. Oral manifestations of oral genital bacterial infections. Oral Dis. 2006;12(S1):2–3.
- Mackay IM, Harnett G, Jeoffreys N, et al. Detection and discrimination of herpes simplex viruses, Haemophilus ducreyi, Treponema pallidum, and Calymmatobacterium (Klebsiella) granulomatis from genital ulcers. Clin Infect Dis. 2006;42(10):1431–1438.
Chancroid - ADDITIONAL READING
Lewis DA. Chancroid: Clinical manifestations, diagnosis and management. J Sex Health HIV. 2003;79:68–71.
Lewis DA. Diagnostic tests for chancroid. J Sex Health HIV. 2000;76:137–141.
Chancroid - CODES
Chancroid - icd9
099.0 Chancroid
Chancroid - PATIENT TEACHING-MED
Chancroid - prevent
Condom use with all sexual activity.
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Chancroid
More Medical Textbooks Online about Chancroid
Review other book chapters online related to Chancroid:
Medical Books Excerpts
- Chancroid
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
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