Chancroid
Basics
Chancroid is a sexually transmitted disease characterized by genital sores and swollen glands. Chancroid is one of several sexually transmitted diseases characterized by genital sores. Chancroid is very uncommon in the U.S. Syphillis and herpes also cause genital sores. Because chancroid is difficult to recognize, many people probably have it unknowingly. In areas of Africa and Asia, chancroid is a significant public health problem.
Causes
Chancroid is caused by Hemophilus ducreyi bacteria. Chancroid is spread through direct contact with open sores that contain contagious H. ducreyi bacteria. After direct contact, the bacteria multiply, causing skin lesions and infection within lymph nodes. The open sores of chancroid make the patient more vulnerable to other infections spread by direct contact, including syphilis and HIV.
Symptoms
Chancroid causes painful sores on the genitals Table 01. Two to five days after infection with chancroid, a small pimplelike sore appears (usually on the external genitalia, but possibly on the anal region, depending on sexual activity). The small pimple becomes filled with pus, and then opens and enlarges. This open sore, also known as an ulcer, has irregular, ragged, soft edges. More sores may develop, and may join together to form a larger sore. Sores may become infected with other bacteria, and emit a foul-smelling discharge.
Tender, swollen glands are common in chancroid. About half of patients with chancroid develop swollen and tender glands in the area of the sore within one to three weeks after infection, usually on one side of the body. The overlying skin may become red and warm, indicating that the gland is infected, filled with pus, and has formed an abscess. In some cases, the infection opens through the skin, draining the abscess.
Some people feel mildly ill. A moderate fever and malaise sometimes occur with chancroid.
Table 1. Symptoms of Chancroid
| Sores on the genitals or in the anal region (closed pimple, then open sore) |
| Tender, swollen glands, especially in the groin, that may open through the skin |
| Fever and malaise |
Other sexually transmitted diseases cause genital sores.. Possible causes of these sores include chancroid, genital herpes, or syphilis. These diseases are present in the population at different rates throughout the country, but in most areas genital herpes is most common.
Risk Factors
Engaging in unprotected sexual activity places you at increased risk for contracting sexually transmitted diseases such as chancroid.
Having sexual relations with multiple partners or sex workers increases your risk for chancroid. Chancroid is more common in certain tropical countries than in the U.S. Engaging in sexual activity without condoms, with multiple partners, or with people who have multiple partners increases your risk of acquiring any sexually transmitted disease.
Diagnosis
Chancroid is a sexually transmitted disease characterized by genital sores and swollen glands. Chancroid is one of several sexually transmitted diseases characterized by genital sores. Chancroid is very uncommon in the U.S. Syphillis and herpes also cause genital sores. Because chancroid is difficult to recognize, many people probably have it unknowingly. In areas of Africa and Asia, chancroid is a significant public health problem.
Chancroid is caused by Hemophilus ducreyi bacteria. Chancroid is spread through direct contact with open sores that contain contagious H. ducreyi bacteria. After direct contact, the bacteria multiply, causing skin lesions and infection within lymph nodes. The open sores of chancroid make the patient more vulnerable to other infections spread by direct contact, including syphilis and HIV.
Chancroid causes painful sores on the genitals Table 01. Two to five days after infection with chancroid, a small pimplelike sore appears (usually on the external genitalia, but possibly on the anal region, depending on sexual activity). The small pimple becomes filled with pus, and then opens and enlarges. This open sore, also known as an ulcer, has irregular, ragged, soft edges. More sores may develop, and may join together to form a larger sore. Sores may become infected with other bacteria, and emit a foul-smelling discharge.
Tender, swollen glands are common in chancroid. About half of patients with chancroid develop swollen and tender glands in the area of the sore within one to three weeks after infection, usually on one side of the body. The overlying skin may become red and warm, indicating that the gland is infected, filled with pus, and has formed an abscess. In some cases, the infection opens through the skin, draining the abscess.
Some people feel mildly ill. A moderate fever and malaise sometimes occur with chancroid.
Table 1. Symptoms of Chancroid
| Sores on the genitals or in the anal region (closed pimple, then open sore) |
| Tender, swollen glands, especially in the groin, that may open through the skin |
| Fever and malaise |
Other sexually transmitted diseases cause genital sores.. Possible causes of these sores include chancroid, genital herpes, or syphilis. These diseases are present in the population at different rates throughout the country, but in most areas genital herpes is most common.
Engaging in unprotected sexual activity places you at increased risk for contracting sexually transmitted diseases such as chancroid.
Having sexual relations with multiple partners or sex workers increases your risk for chancroid. Chancroid is more common in certain tropical countries than in the U.S. Engaging in sexual activity without condoms, with multiple partners, or with people who have multiple partners increases your risk of acquiring any sexually transmitted disease.
Your doctor will examine you for genital sores. If you have an open sore on your genitals, your doctor will suspect that you have chancroid, herpes, or syphilis. Your doctor will have to investigate further to determine which illness is responsible for your sores. Your doctor will be more likely to suspect chancroid if you live in or have recently traveled in a region where chancroid is known to occur, if the sore is painful with soft edges, or if you also have swollen and tender lymph nodes.
Laboratory tests can help determine if you have chancroid. Usually a clinical diagnosis is made on the basis of physical symptoms along with various laboratory tests that will rule out syphilis, herpes, and other diseases.
Sometimes fluid from a sore can be examined under a microscope to look for the bacteria that cause chancroid. The fluid should also be examined for the organisms that cause syphilis.
Often no definitive diagnosis can be made. In about one out of four patients with a genital sore, the diagnosis is uncertain despite a complete evaluation. In such cases, many experts recommend treating for chancroid with antibiotics..
Avoid sexual relations with people who have multiple partners, or with people whose sexual health history you do not know.
Avoid having sexual relations while under the influence of alcohol and drugs. Using alcohol can impair your judgment and ability to practice safer sexual practices, thus increasing your chances of acquiring a sexually transmitted disease.
In the U.S., chancroid has been associated with prostitution in certain urban areas. Chancroid is also common in some areas of Africa and Asia.
Regular condom use can significantly reduce the transmission of STDs. Use condoms consistently and correctly to reduce the likelihood of disease transmission.
The U.S. government's Centers for Disease Control and Prevention recommend the following:
Prevention and Screening
Avoid sexual relations with people who have multiple partners, or with people whose sexual health history you do not know.
Avoid having sexual relations while under the influence of alcohol and drugs. Using alcohol can impair your judgment and ability to practice safer sexual practices, thus increasing your chances of acquiring a sexually transmitted disease.
In the U.S., chancroid has been associated with prostitution in certain urban areas. Chancroid is also common in some areas of Africa and Asia.
Regular condom use can significantly reduce the transmission of STDs. Use condoms consistently and correctly to reduce the likelihood of disease transmission.
The U.S. government's Centers for Disease Control and Prevention recommend the following:
Treatment
See your doctor if you have a sore on the genital or anal region. Although genital sores may resolve without treatment, it is essential to see a doctor to determine the cause. The syphilis lesion, for example, will disappear on its own. If untreated, the disease can recur years later with devastating symptoms.
All sexual contacts starting from 10 days prior to the onset of symptoms should be notified that they have been exposed to chancroid, and should be treated regardless of whether or not symptoms are present.
Experts recommend HIV testing for patients with genital lesions because of the higher risk of transmitting this infection when open sores are present.
Use light saline compresses or Burow's solution to relieve pain. Cool saline or Burow's solution, both available over-the-counter at pharmacies, can be applied to sores three times a day.
Your doctor is the best source of information on the drug treatment choices available to you.
Infected lymph nodes may require drainage or surgery. Your physician may need to drain pus from infected lymph nodes that lie below the skin. In rare cases, surgery is needed for persistent infection in a lymph node, or to correct extensive scar formation.
HIV-infected individuals and uncircumcised men may need more extensive treatment. Uncircumcised men and individuals infected with HIV often do not respond quickly to antibiotic treatment, and need to be monitored closely. These individuals may require longer courses of treatment. In addition, treatment failures have been reported using conventional therapy in HIV-infected patients.
With antibiotic treatment, the sore should feel better within a few days and look better within a week. Complete healing may take more than two weeks if the sore is large. Healing also may take longer in HIV-positive individuals, and in uncircumcised men who have sores under the foreskin.
Affected lymph nodes may take longer to heal. In some cases, they need to be drained with a needle or opened surgically to remove pus.
Sometimes infections persist and need more aggressive treatment. In a few cases, scars may remain. Some sores may become secondarily infected with other bacteria, requiring additional antibiotic treatment. Such sores may also enlarge rapidly and destroy nearby tissue. Scars may remain after a severe infection.
Patients should follow up with a doctor within a week after starting antibiotic therapy to be sure that treatment is working. The sore should feel better within three days of starting antibiotics, and should look better by one week. If not, the doctor must determine if the bacteria is resistant to the prescribed antibiotic, and if an alternative medication should be used. If the sores still haven't healed after an alternative medication is used, your doctor will consider the possibility that you have a different disease.
Sexual contacts need to be notified. All sexual contacts starting from 10 days prior to the onset of symptoms should be notified that they have been exposed to chancroid, and be treated regardless of whether or not symptoms are present.
Patients with chancroid should be tested for HIV and syphilis. The open sore of chancroid makes transmission of other diseases more likely to occur. Some experts estimate that 10% of individuals with chancroid are also infected with HIV or syphilis. All patients should be tested at the time chancroid is diagnosed. If the results are negative, they should be retested three months later, as both syphilis and HIV tests detect an immune response that may take several weeks to develop.