Dermatologic Manifestations of Chancroid Follow-up
- Author: Ivan D Camacho, MD; Chief Editor: Dirk M Elston, MD more...
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.
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. Male circumcision is also moderately protective against H ducreyi.
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.[16, 39]
The American College of Obstetricians and Gynecologists (ACOG) has released guidelines on expedited partner therapy for chlamydial and gonorrheal sexually transmitted diseases (STDs).[40, 41] While designed to prevent reinfection with chlamydia and gonorrhea, the recommendations can also be applied to other STDs. The ACOG recommendations include the following:
Expedited partner therapy to prevent reinfection, with legalization of expedited partner therapy
Counsel partners to undergo screening for HIV infection and other STDs
Expedited partner therapy contraindicated in cases of suspected abuse or compromised patient safety; pretreatment evaluation for abuse potential recommended
Expedited partner therapy medications and protocols based on CDC, state, and/or local guidelines
Phimosis, balanoposthitis, and rupture of buboes with fistula formation and scarring are reported complications of chancroid.
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.
Chancroid produces painful ulcers on the genitals, often (50%) associated with unilateral tender inguinal lymphadenitis (ie, a bubo). Left untreated, the buboes can form fluctuant abscesses that spontaneously rupture, resulting in a nonhealing ulcer.
The patient should be strongly advised to avoid sexual contacts while the ulcers are open because they are highly infectious and may cause a community outbreak.
Patients should be advised to avoid prostitutes, to use condoms, and to avoid having multiple partners.
Cocaine and alcohol abuse should be addressed because both contribute to higher rates of the disease.
Ducrey A. Experimentelle Untersuchungen uber den Ansteckungsstof des weichen Schankers und uber die Bubonen. Monats Prakt Dermatol. 1889. 9:387-405.
Hammond GW. A history of the detection of Haemophilus ducreyi, 1889-1979. Sex Transm Dis. 1996 Mar-Apr. 23(2):93-6. [Medline].
Spinola SM, Fortney KR, Katz BP, Latimer JL, Mock JR, Vakevainen M, et al. Haemophilus ducreyi requires an intact flp gene cluster for virulence in humans. Infect Immun. 2003 Dec. 71(12):7178-82. [Medline].
Kulkarni K, Lewis DA, Ison CA. Expression of the cytolethal distending toxin in a geographically diverse collection of Haemophilus ducreyi clinical isolates. Sex Transm Infect. 2003 Aug. 79(4):294-7. [Medline].
Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012 Feb 1. 85(3):254-62. [Medline].
Kemp M, Christensen JJ, Lautenschlager S, Vall-Mayans M, Moi H. European guideline for the management of chancroid, 2011. Int J STD AIDS. 2011 May. 22(5):241-4. [Medline].
Spinola SM, Fortney KR, Katz BP, Latimer JL, Mock JR, Vakevainen M, et al. Haemophilus ducreyi requires an intact flp gene cluster for virulence in humans. Infect Immun. 2003 Dec. 71(12):7178-82. [Medline]. [Full Text].
Janowicz DM, Cooney SA, Walsh J, et al. Expression of the Flp proteins by Haemophilus ducreyi is necessary for virulence in human volunteers. BMC Microbiol. 2011 Sep 22. 11:208. [Medline]. [Full Text].
Humphreys TL, Schnizlein-Bick CT, Katz BP, Baldridge LA, Hood AF, Hromas RA, et al. Evolution of the cutaneous immune response to experimental Haemophilus ducreyi infection and its relevance to HIV-1 acquisition. J Immunol. 2002 Dec 1. 169(11):6316-23. [Medline].
Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb. 75(1):3-17. [Medline].
Mutua FM, M'imunya JM, Wiysonge CS. Genital ulcer disease treatment for reducing sexual acquisition of HIV. Cochrane Database Syst Rev. 2012 Aug 15. 8:CD007933. [Medline].
Johnson LF, Dorrington RE, Bradshaw D, Coetzee DJ. The role of sexually transmitted infections in the evolution of the South African HIV epidemic. Trop Med Int Health. 2012 Feb. 17(2):161-8. [Medline].
Bhunu CP, Mushayabasa S. Chancroid transmission dynamics: a mathematical modeling approach. Theory Biosci. 2011 Dec. 130(4):289-98. [Medline].
Spinola SM, Bauer ME, Munson RS Jr. Immunopathogenesis of Haemophilus ducreyi infection (chancroid). Infect Immun. 2002 Apr. 70(4):1667-76. [Medline].
Van Howe RS. Genital ulcerative disease and sexually transmitted urethritis and circumcision: a meta-analysis. Int J STD AIDS. 2007 Dec. 18(12):799-809. [Medline].
Weiss HA. Male circumcision as a preventive measure against HIV and other sexually transmitted diseases. Curr Opin Infect Dis. 2007 Feb. 20(1):66-72. [Medline].
Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006 Apr. 82(2):101-9; discussion 110. [Medline].
Kyriakis KP, Hadjivassiliou M, Paparizos VA, Flemetakis A, Stavrianeas N, Katsambas A. Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece. Int J Dermatol. 2003 Nov. 42(11):876-81. [Medline].
Peel TN, Bhatti D, De Boer JC, Stratov I, Spelman DW. Chronic cutaneous ulcers secondary to Haemophilus ducreyi infection. Med J Aust. 2010 Mar 15. 192(6):348-50. [Medline].
Ballard RC. Syndromic case management of STDs in Africa. Afr Health. 1998 Mar. 20(3):13-5. [Medline].
Bogaerts J, Vuylsteke B, Martinez Tello W, Mukantabana V, Akingeneye J, Laga M, et al. Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda. Bull World Health Organ. 1995. 73(6):761-7. [Medline].
Dallabetta GA, Gerbase AC, Holmes KK. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect. 1998 Jun. 74 Suppl 1:S1-11. [Medline].
Mackay IM, Harnett G, Jeoffreys N, et al. Detection and discrimination of herpes simplex viruses, Haemophilus ducreyi, Treponema pallidum, and Calymmatobacterium (Klebsiella) granulomatis from genital ulcers. Clin Infect Dis. 2006 May 15. 42(10):1431-8.
Pillay A, Hoosen AA, Loykissoonlal D, Glock C, Odhav B, Sturm AW. Comparison of culture media for the laboratory diagnosis of chancroid. J Med Microbiol. 1998 Nov. 47(11):1023-6. [Medline].
Alfa M. The laboratory diagnosis of Haemophilus ducreyi. Can J Infect Dis Med Microbiol. 2005 Jan. 16(1):31-4. [Medline].
Patterson K, Olsen B, Thomas C, Norn D, Tam M, Elkins C. Development of a rapid immunodiagnostic test for Haemophilus ducreyi. J Clin Microbiol. 2002 Oct. 40(10):3694-702. [Medline].
Orle KA, Gates CA, Martin DH, Body BA, Weiss JB. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers. J Clin Microbiol. 1996 Jan. 34(1):49-54. [Medline].
Mertz KJ, Weiss JB, Webb RM, Levine WC, Lewis JS, Orle KA, et al. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis. 1998 Oct. 178(4):1060-6. [Medline].
World Health Organization. Management of sexually transmitted diseases. World Health Organization. Available at http://www.who.int/en/.
World Health Organization. Syndromic Case Management of STD (Sexually Transmitted Diseases)- A Guide for Decision-makers, Health Care Workers, and Communicators. World Health Organization. Available at www.who.int/en/.
Van der Veen F, Fransen L. Drugs for STD management in developing countries: choice, procurement, cost, and financing. Sex Transm Infect. 1998 Jun. 74 Suppl 1:S166-74. [Medline].
Annan NT, Lewis DA. Treatment of chancroid in resource-poor countries. Expert Rev Anti Infect Ther. 2005 Apr. 3(2):295-306. [Medline].
Ernst AA, Marvez-Valls E, Martin DH. Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid. Sex Transm Dis. 1995 Jul-Aug. 22(4):217-20. [Medline].
Rosen T, Vandergriff T, Harting M. Antibiotic use in sexually transmissible diseases. Dermatol Clin. 2009 Jan. 27(1):49-61. [Medline].
Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR. 2006. 55:[Full Text].
Belda Jr W, Di Chiacchio NG, Di Chiacchio N, Romiti R, Criado PR, Velho PE. A comparative study of single-dose treatment of chancroid using thiamphenicol versus Azithromycin. Braz J Infect Dis. 2009 Jun. 13(3):218-20. [Medline].
Steen R. Sex, soap and antibiotics: the case for chancroid eradication. Int J STD AIDS. 2001. 12(Suppl 2):147.
Steen R. Eradicating chancroid. Bull World Health Organ. 2001. 79(9):818-26. [Medline].
Barclay L. ACOG recommends expedited partner therapy for STIs. Medscape Medical News. Available at http://www.medscape.com/viewarticle/845221. May 22, 2015; Accessed: June 24, 2015.
[Guideline] American College of Obstetricians and Gynecologists. Committee opinion no 632: expedited partner therapy in the management of gonorrhea and chlamydial infection. Obstet Gynecol. 2015 Jun. 125 (6):1526-8. [Medline].
Mohammed TT, Olumide YM. Chancroid and human immunodeficiency virus infection--a review. Int J Dermatol. 2008 Jan. 47(1):1-8. [Medline].
O'Farrell N. Targeted interventions required against genital ulcers in African countries worst affected by HIV infection. Bull World Health Organ. 2001. 79(6):569-77. [Medline].