Chancroid is an acute bacterial infection localized in the genital area and characterized clinically by single or multiple painful, necrotizing ulcers at the site of infection, frequently accompanied by painful swelling and suppuration of regional lymph nodes. Minimally symptomatic lesions may occur on the vaginal wall or cervix. Asymptomatic lesions may occur in women, but are probably uncommon.
Chancroid ulcers, like other genital ulcers, are associated with increased risk of HIV infection. Since many pathogens can cause genital ulcers, it is important to differentiate them. Genital ulcers should be examined by dark-field microscopy to detect syphilis, and cultured for H. simplex.
What cause chancroid (Pathogenesis)
Chancroid is an infection caused by the Streptobacillus Haemophilus ducreyi and transmitted by sexual activity. This Gram-negative bacillus stains well in Unna-Pappenheim. Chancroid is most common in tropical and subtropical countries.
Two to three days after infection, a red papule occurs on the coronal sulcus, foreskin, labium or vaginal opening and becomes pustular, leading to ulceration. The ulcer is accompanied by severe pain and a pustular coat in the center. The ulcer is soft to the touch. It begins as a single lesion; however, it rapidly spreads to form multiple lesions from autoinoculation. Two to 3 weeks after onset, painful unilateral swelling occurs in the inguinal lymph node in 25% to 60% of all patients with chancroid.
Transmission: By direct sexual contact with discharge from open lesions and pus from buboes. Auto-inoculation to non-genital sites may occur in infected people. Sexual abuse must be considered when chancroid is found in children.
Azithromycin, ceftriaxone and erythromycin are the first-line drugs. Most Haemophilus ducreyi strains are tolerant to tetracycline, amoxicillin and sulfamethoxazole/trimetoprim. Ceftriaxone 250 mg IM in a single dose; or erythromycin 500 mg orally qid for 7 days. Azithromycin, 1 gram orally as a stat dose, and ciprofloxacin (adults only), 500 mg orally as a stat dose.