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Dermatologic Manifestations of Chancroid Follow-up

  • Author: Ivan D Camacho, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 24, 2015

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.[38] Male circumcision is also moderately protective against H ducreyi.[17]

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.

Chancroid has been shown to be a major cofactor in the transmission of HIV-1 infection.[42] This relationship has been especially significant in the heterosexual spread of HIV in Africa.[11, 43]


Patient Education

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.

For patient education resources, see the Men's Health Center and Sexually Transmitted Diseases Center, as well as Sexually Transmitted Diseases, Birth Control Overview, and Birth Control FAQs.

Contributor Information and Disclosures

Ivan D Camacho, MD Dermatologist, Private Practice; Voluntary Assistant Professor of Dermatology, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Ivan D Camacho, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Florida Medical Association, International Society of Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.


Joshua R Freedman, MD, MS Resident Physician, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine

Joshua R Freedman, MD, MS is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Janet Fairley, MD Professor and Head, Department of Dermatology, University of Iowa, Roy J and Lucille A Carver College of Medicine

Janet Fairley, MD is a member of the following medical societies: American Academy of Dermatology, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


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.

Mark A Hall, MD President/Founder, Central Oregon Dermatology, PC

Mark A Hall, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Chancroid usually starts as a small papule that rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops ragged undermined borders, and is surrounded by a rim of erythema. Unlike syphilis, lesions are tender and the border of the ulcer is not indurated. Courtesy of Hon Pak, MD.
This patient shows the characteristic lesions of chancroid. The bubo on the right side drained spontaneously. The bubo in the left inguinal canal required needle aspiration.
Close-up view of chancroid ulcers.
Large fluctuant buboes should be drained with the patient under local anesthesia and a large-gauge needle inserted through surrounding healthy skin. The insertion site should be superior or lateral to the bubo to prevent chronic drainage from the site.
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