Chancroid 307.

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BASIC INFORMATION
DEFINITION
Chancroid is a sexually transmitted disease
characterized by painful genital ulceration and
inflammatory inguinal adenopathy.
SYNONYMS
Soft chancre
Ulcus molle
ICD-10CM CODES
A57 Chancroid
EPIDEMIOLOGY &
DEMOGRAPHICS
• Most frequent cause of genital ulcer disease
worldwide.
• Exact incidence in U.S. is unknown. The preva-
lence of chancroid has declined in the United
States and is currently rare (1 per 2 million in
the developed world). When infection occurs, it
is usually associated with sporadic outbreaks
and in association with trading sex for drugs,
particularly crack cocaine.
• Occurs more frequently in men (male:female
ratio of 5:1 to 10:1).
• Clinical infection is rare in women.
• There is a higher incidence in uncircum-
cised men and in tropical and subtropical
regions.
• Incubation period is 4 to 7 days but may take
up to 3 wk.
• High incidence of HIV infection associated
with chancroid.
PHYSICAL FINDINGS & CLINICAL
PRESENTATION
• One to three extremely painful ulcers (Fig. E1)
accompanied by tender inguinal lymphade-
nopathy (especially if fluctuant). The chancre
is typically soft in comparison with the hard,
painless chancre of syphilis.
• May present with inguinal bubo and several
ulcers.
• In women: initial lesion in the fourchette,
labia minora, urethra, cervix, or anus; inflam-
matory pustule or papule that ruptures,
leaving a shallow, nonindurated ulceration,
usually 1 to 2 cm in diameter with ragged,
undermined edges.
• Unilateral lymphadenopathy develops 1 wk
later in 50% of patients.
ETIOLOGY
Haemophilus ducreyi, a bacillus
DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
• Other genitoulcerative diseases such as
syphilis, herpes, lymphogranuloma venereum
(LGV), granuloma inguinale.
• A clinical algorithm for the initial manage-
ment of genital ulcer disease is described in
Section III.
WORKUP
Diagnosis based on history and physical exami-
nation is often inadequate. Must rule out syphilis
in women because of the consequences of
inappropriate therapy in those who are pregnant.
Practitioner can base initial diagnosis and treat-
ment recommendations on clinical impression of
appearance of ulcer and most likely diagnosis for
population. Definitive diagnosis is made by isola-
tion of organism from ulcers by culture or Gram
stain. Special culture media for H. ducreyi is not
widely available commercially, and even when
these media are used, sensitivity is <80%.
The CDC criteria for clinical diagnosis include
all of the following:
1. Single or multiple painful genital ulcers
2. No evidence to support a diagnosis of syphi-
lis (no evidence of T. pallidum infection by
darkfield examination or ulcer exudate or by
a serologic test for syphilis performed at least
7 days after onset of ulcers)
3. A typical clinical presentation and appear-
ance of the ulcer and, if present, regional
lymphadenopathy are typical for chancroid
4. A negative test (HSV PCR test or HSV culture)
for the presence of HSV in the ulcer exudate
LABORATORY TESTS
• Darkfield microscopy, RPR, HSV cultures,
H. ducreyi culture, HIV testing recommended
• No FDA-cleared PCR test for H. ducreyi is
available in the U.S.
TREATMENT
NONPHARMACOLOGIC THERAPY
Fluctuant nodes should be aspirated through
healthy adjacent skin to prevent formation of
draining sinus. Incision and drainage not recom-
mended because it delays healing. Use warm
compresses to remove necrotic material.
ACUTE GENERAL Rx
• Azithromycin 1 g PO (single dose) or
• Ceftriaxone 250 mg IM (single dose) or
• Ciprofloxacin 500 mg PO bid for 3 days or
• Erythromycin 500 mg PO qid for 7 days
note: Ciprofloxacin is contraindicated in
patients who are pregnant, lactating, or <18 yr.
• HIV-infected patients may need more pro-
longed therapy.
• In HIV-positive patients, failures have been
reported with single-dose azithromycin and
ceftriaxone regimens.
DISPOSITION
• All sexual partners should be treated with a
10-day course of one of the regimens (see
“Acute General Rx”).
• Patients should be reexamined 3 to 7 days
after initiation of therapy. Ulcers should
improve symptomatically within 3 days and
objectively within 7 days after initiation of
successful therapy.
PEARLS &
CONSIDERATIONS
COMMENTS
• In the U.S. HSV-1 and syphilis are the most
common causes of genital ulcers followed by
chancroid, LGV, and granuloma inguinale.
• The combination of a painful genital ulcer
and tender suppurative inguinal adenopathy
suggests the diagnosis of chancroid.

RELATED CONTENT
Chancroid (Patient Information)
Condyloma Acuminatum (Related Key Topic)
Granuloma Inguinale (Related Key Topic)
Urethritis, Gonococcal (Related Key Topic)
Lymphogranuloma Venereum (Related Key
Topic)
Syphilis (Related Key Topic)
AUTHOR: ANTHONY SCISCIONE, D.O.

FIG. E1  Chancroid. (From James WD, et al.: Andrews’ diseases of the skin, ed 12, Philadelphia, 2016,
Elsevier.)

Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en mayo 08, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.
Chancroid 307.e6

SUGGESTED READING
Workowski KA, et al.: Sexually transmitted diseases treatment guidelines, MMWR
Recomm Rep 64(RR-03):1–137, 2015.

Descargado para Anonymous User (n/a) en National Autonomous University of Mexico de ClinicalKey.es por Elsevier en mayo 08, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.