eMedicine Specialties > Dermatology > Bacterial Infections

Chancroid: Follow-up

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Contributor Information and Disclosures

Updated: Aug 22, 2008

Follow-up

Further Outpatient Care

  • Chancroid patients should receive follow-up care to ensure resolution of the disease. Clinical improvement of chancroid should occur over 7 days, and, with appropriate antibiotic therapy, healing should be complete in 2 weeks. Healing is slower for some uncircumcised men who have ulcers under the foreskin. Lymphadenopathy may be slow to resolve and may require needle aspiration if a significant bubo is present.
  • Because of the highly infectious nature of chancroid, routine treatment of contacts of men with chancroid is recommended even if they are asymptomatic. All sexual contacts during the 10 days prior to the development of the genital lesion should be treated.
  • Empirical chancroid treatment of high-risk women has been shown to significantly decrease the prevalence of disease.
  • Isolation or quarantine is not required for chancroid, but patients must avoid sexual contact until all lesions, including discharging regional lymph nodes, are healed.

Deterrence/Prevention

  • Eradication of chancroid is a feasible public health objective. H ducreyi has a short duration of infectivity and requires frequent contacts to spread within a population. Humans are the only reservoir for H ducreyi, and rates of infection can be easily reduced through a variety of methods. Simple washing with soap and water within a few hours of sexual exposure is effective in reducing the risk of contracting chancroid.30 Male circumcision is also moderately protective against H ducreyi.12
  • Instituting a condom policy directed at protecting sex workers and their clients from exposure to STDs and improving curative services are among the most effective strategies.
  • Offering regular examinations and treatment for registered sex workers or monthly presumptive antibiotic treatment to women at risk have both been shown to dramatically reduce the prevalence of chancroid. Antibiotic treatment of the highest-risk populations can reduce chancroid transmission in the short term and can lead to a rapid decline in chancroid prevalence in a community.
  • Breaking the chancroid transmission cycle in any of these ways can markedly reduce the prevalence of chancroid, even when other conditions favor its spread.11,31

Complications

  • Phimosis, balanoposthitis, and rupture of buboes with fistula formation and scarring are reported complications of chancroid.

Prognosis

  • The prognosis is excellent if chancroid is treated properly and if no co-infection with HIV is present.
  • As many as 5% of patients have a chancroid relapse and usually respond to a repeat course of their original therapy.
  • No adverse effects of chancroid on pregnancy outcome have been reported.
  • Chancroid-infected patients who have HIV should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to evaluate and treat co-infections, such as syphilis, herpes simplex, or HIV, is a pitfall.

Special Concerns

  • Confirmed chancroid cases should be reported to the Division of Sexually Transmitted Diseases at the CDC.
  • Mother-to-infant transmission has not been reported. Because sexual contact is the only known route of transmission, the diagnosis of chancroid in infants and young children is strong evidence of sexual abuse. Also see Pediatrics, Child Sexual Abuse.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Mark A. Hall, MD, to the development and writing of this article.



More on Chancroid

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Differential Diagnoses & Workup: Chancroid
Treatment & Medication: Chancroid
Follow-up: Chancroid
Multimedia: Chancroid
References
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Further Reading

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Keywords

chancroid, HIV transmission, soft chancre, genital ulcers, STD, genital ulcer disease, GUD, Haemophilus ducreyi, H ducreyi, sexually transmitted disease, genital ulcer, bubo

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Contributor Information and Disclosures

Author

Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Janet Fairley, MD, Professor and Head, Department of Dermatology, University of Iowa
Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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