Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Dermatologic Manifestations of Chancroid Medication

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

Medication Summary

Guidelines for therapy are usually based on the presenting symptoms and the clinical distribution of infection. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents chancroid transmission to others. The US Centers for Disease Control and Prevention (CDC) recommends any one of the following treatments for chancroid:

  • Azithromycin 1 g orally in a single dose
  • Ceftriaxone 250 mg intramuscularly in a single dose
  • Ciprofloxacin 500 mg orally twice a day for 3 days
  • Erythromycin base 500 mg 3 times a day for 7 days

Ciprofloxacin is contraindicated for pregnant and lactating women. Azithromycin and ceftriaxone offer the advantage of single-dose therapy.[35] Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported.[30, 36]

A 2009 study of 54 subjects from Brazil suggests that single-dose therapy with thiamphenicol (89% cure rate) is more effective than single-dose therapy with azithromycin (73% cure rate). However, HIV seropositivity was associated with treatment failures. Notably, all HIV-positive subjects treated with azithromycin had treatment failure, prompting the authors to recommend avoiding azithromycin in HIV-coinfected patients.[37]

Uncircumcised men and patients who are infected with HIV do not respond to therapy as well as others. Chancroid relapses after antibiotic therapy in as many as 5% of patients, and relapses are more common in patients who are uncircumcised or are infected with HIV. If they are not infected with HIV, repeating the original therapy is usually effective.

Because chancroid treatment is often accompanied by treatment for gonococcal infections, it is important to be aware of changes to the CDC guidelines for STDs. In December of 2010, the CDC updated treatment guidelines for sexually transmitted diseases. Of significance to the treatment of chancroid, it details the increasing prevalence of antimicrobial-resistant Neisseria gonorrhea, and that oral cephalosporins are no longer recommended for the treatment of gonorrhea. For more information see, the CDC’s Antibiotic-Resistant Gonorrhea Web site.

Next

Antibiotic, Other

Class Summary

The goal of pharmacotherapy for chancroid is to reduce morbidity and to prevent complications.

Ceftriaxone (Rocephin)

 

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Azithromycin (Zithromax)

 

Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.

Azithromycin concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that its concentration in phagocytes may contribute to drug distribution to inflamed tissues.

Azithromycin treats mild-to-moderate microbial infections. Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. It has a long tissue half-life.

Erythromycin (E-Mycin, Eryc, Ery-Tab)

 

The recommended dosing schedule for erythromycin may result in GI upset, causing one to prescribe an alternative macrolide or change to thrice-daily dosing. Erythromycin covers most potential etiologic agents, including Mycoplasma species. It is less active against Haemophilus influenzae. Although 10 days seems to be a standard course of treatment, treating until the patient has been afebrile for 3-5 days seems more rational.

It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is ndicated for staphylococcal and streptococcal infections.

In children, age, weight, and severity of infection determine proper dosage. When twice-daily dosing is desired, half the total daily dose may be taken q12h. For more severe infections, double the dose. Erythromycin has the added advantage of being a good anti-inflammatory agent by inhibiting migration of polymorphonuclear leukocytes.

Ciprofloxacin (Cipro)

 

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Previous
 
 
Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

References
  1. Ducrey A. Experimentelle Untersuchungen uber den Ansteckungsstof des weichen Schankers und uber die Bubonen. Monats Prakt Dermatol. 1889. 9:387-405.

  2. Hammond GW. A history of the detection of Haemophilus ducreyi, 1889-1979. Sex Transm Dis. 1996 Mar-Apr. 23(2):93-6. [Medline].

  3. Lewis DA. Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect. 2003 Feb. 79(1):68-71. [Medline]. [Full Text].

  4. 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].

  5. 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].

  6. Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012 Feb 1. 85(3):254-62. [Medline].

  7. 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].

  8. 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].

  9. 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].

  10. 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].

  11. 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].

  12. 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].

  13. 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].

  14. Bhunu CP, Mushayabasa S. Chancroid transmission dynamics: a mathematical modeling approach. Theory Biosci. 2011 Dec. 130(4):289-98. [Medline].

  15. Spinola SM, Bauer ME, Munson RS Jr. Immunopathogenesis of Haemophilus ducreyi infection (chancroid). Infect Immun. 2002 Apr. 70(4):1667-76. [Medline].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

  21. Ballard RC. Syndromic case management of STDs in Africa. Afr Health. 1998 Mar. 20(3):13-5. [Medline].

  22. 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].

  23. 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].

  24. 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.

  25. 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].

  26. Alfa M. The laboratory diagnosis of Haemophilus ducreyi. Can J Infect Dis Med Microbiol. 2005 Jan. 16(1):31-4. [Medline].

  27. 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].

  28. 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].

  29. 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].

  30. World Health Organization. Management of sexually transmitted diseases. World Health Organization. Available at http://www.who.int/en/.

  31. 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/.

  32. 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].

  33. Annan NT, Lewis DA. Treatment of chancroid in resource-poor countries. Expert Rev Anti Infect Ther. 2005 Apr. 3(2):295-306. [Medline].

  34. 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].

  35. Rosen T, Vandergriff T, Harting M. Antibiotic use in sexually transmissible diseases. Dermatol Clin. 2009 Jan. 27(1):49-61. [Medline].

  36. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. MMWR. 2006. 55:[Full Text].

  37. 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].

  38. Steen R. Sex, soap and antibiotics: the case for chancroid eradication. Int J STD AIDS. 2001. 12(Suppl 2):147.

  39. Steen R. Eradicating chancroid. Bull World Health Organ. 2001. 79(9):818-26. [Medline].

  40. 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.

  41. [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].

  42. Mohammed TT, Olumide YM. Chancroid and human immunodeficiency virus infection--a review. Int J Dermatol. 2008 Jan. 47(1):1-8. [Medline].

  43. 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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.