Chancroid

Definition
Chancroid is a disease known to be spread solely through sexual contact.

Causes, incidence, and risk factors

Chancroid is a bacterial infection caused by the organism Haemophilus ducreyi. It is a disease found primarily in developing and third world countries.

Only a few hundred cases a year are diagnosed in the United States. The majority of individuals in the U.S. diagnosed with chancroid have traveled outside the country to areas where the disease is known to occur frequently.

Uncircumcised men are at 3 times the risk of circumcised men for contracting chancroid from an infected partner. Chancroid is a risk factor for contracting the HIV virus.

Symptoms

After an incubation period of 1 day to 2 weeks, chancroid begins with a small bump that becomes an ulcer within a day of its appearance. The ulcer characteristically:

     
  • Ranges in size dramatically (from 1/8 inch to 2 inches across)  
  • Is painful  
  • Has sharply defined borders  
  • Has irregular or ragged borders  
  • Has a base that is covered with a grey or yellowish-grey material  
  • Has a base that bleeds easily if traumatized or scraped

About half of infected men have only a single ulcer. Women frequently have 4 or more ulcers. The ulcers appear in specific locations.

Common locations in men (most common to least common) are:

     
  • Foreskin (prepuce)  
  • Groove behind the head of the penis (coronal sulcus)  
  • Shaft of the penis  
  • Head of the penis (glans)  
  • Opening of the penis (urethral meatus)  
  • Scrotum

In women the most common location for ulcers is the labia majora. “Kissing ulcers” may develop. These are ulcers that occur on opposing surfaces of the labia. Other areas such as the labia minora, perianal area, and inner thighs may also be involved. The most common symptoms in women are pain with urination and pain with intercourse.

The initial ulcer may be mistaken as a chancre, the typical sore of primary syphilis.

Approximately half of the infected individuals will develop enlargements of the inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen.

Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin producing draining abscesses. The swollen lymph nodes and abscesses are often referred to as buboes.

Signs and tests
Diagnosis is made by evaluating the ulcer(s) and presence of swollen lymph nodes, and by obtaining a culture from the base of the ulcers. There are no serological tests for chancroid such as those available for syphilis.

Treatment
The infection is treated with appropriate antibiotics. Effective antibiotics include azithromycin, ceftriaxone, ciprofloxacin, and erythromycin. Large lymph node swellings need drainage either by needle or local surgery.

Expectations (prognosis)
Chancroid can resolve spontaneously. However, some people may experience months of painful ulceration and draining. Antibiotic treatment usually results in rapid clearing of lesions with a minimal to small amount of scarring.

Complications

     
  • Urethral fistulas  
  • Phimosis in uncircumcised males (scars on the foreskin of the penis)  
  • Patients with chancroid should also be checked for syphilis, HIV, and genital herpes  
  • Patients with HIV may take much longer to heal

Calling your health care provider
Call for an appointment with your health care provider if you have symptoms suggestive of chancroid. Also call if you have had sexual contact with a person known to have any STD, or if you have engaged in high-risk sexual practices.

Prevention

Chancroid is a bacterial infection that is spread by sexual contact with other infected individuals. Although abstinence is the only sure prevention, safe sex practices are helpful in preventing the spread of chancroid.

Monogamous sexual relations with a known disease-free partner is the safest and most practical “safe sex” method. Condoms provide very good protection from the spread of most sexually transmitted diseases when used properly and consistently.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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