Chancroid (also known as soft chancre) is a sexually transmitted disease (STD) characterized by painful genital ulcers and inguinal adenitis. Chancroidal lesions may heal spontaneously and usually respond well to treatment in the absence of secondary infections. A high rate of human immunodeficiency virus (HIV) infection has been reported among patients with chancroid.
Chancroid results from Haemophilus ducreyi, a gram-negative Streptobacillus, and is transmitted through sexual contact. Poor hygiene may predispose males — especially those who are uncircumcised — to this disease.
This infection occurs worldwide but is particularly common in tropical countries; it affects more males than females.
After a 3- to 5-day incubation period, a small papule appears at the entry site, usually the groin or inner thigh; in the male, it may appear on the penis; in the female, on the vulva, vagina, or cervix. (See Chancroidal lesion.) Occasionally, this papule may erupt on the tongue, lip, breast, or navel. The papule rapidly ulcerates, becoming painful, soft, and malodorous; it bleeds easily and produces pus. It’s gray and shallow, with irregular edges, and measures up to 2.5 cm in diameter. Within 2 to 3 weeks, inguinal adenitis develops, creating suppurated, inflamed nodes that may rupture into large ulcers or buboes. Headache and malaise occur in 50% of patients. During the healing stage, phimosis may develop.
Gram stain smears of ulcer exudate or bubo aspirate are 50% reliable; blood agar cultures are 75% reliable. Biopsy confirms the diagnosis but is reserved for resistant cases or cases in which cancer is suspected. Dark-field examination and serologic testing rule out other STDs that cause similar ulcers. Testing for HIV infection should be done at the time of diagnosis.
The treatment of choice is azithromycin, erythromycin, ceftriaxone, or ciprofloxacin. The safety of azithromycin for pregnant or lactating women hasn’t been established. Aspiration of fluid-filled nodes may be indicated as well.
❑ Make sure the patient isn’t allergic to any drug before giving the first dose.
❑ Instruct the patient not to apply lotions, creams, or oils on or near the genitalia or on other lesion sites.
❑ Tell the patient to abstain from sexual contact until healing is complete (usually about 2 weeks after treatment begins) and to wash the genitalia daily with soap and water. Instruct uncircumcised males to retract the foreskin for thorough cleaning.
❑ To prevent chancroid, advise the patient to avoid sexual contact with infected people, to use condoms during sexual activity, and to wash the genitalia with soap and water after sexual activity. Tell the patient that abstinence is the only sure way to prevent chancroid.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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