Dermatologic Manifestations of Chancroid Treatment & Management

  • Author: Mark A Hall, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 9, 2010
 

Medical Care

  • Local therapy for chancroid includes gentle topical cleansing, soaks, and measures to reduce edema.
  • Patients with nonfluctuant buboes respond well to antibiotics, and the chancroid lesions do not need to be drained.
  • If appropriate chancroid therapy is provided and no clinical improvement is evident, the clinician must consider whether the diagnosis is correct, whether the patient is co-infected with another STD, whether the patient is infected with HIV, whether the treatment instructions were followed properly, and whether the H ducreyi strain is resistant to the prescribed antimicrobial.
  • In resource-poor settings, where diagnostic facilities are not readily available, the World Health Organization advocates the use of a syndromic approach for the therapy of GUD.[16, 17, 25, 26]
    • The syndromic approach for the therapy of STDs delivers effective treatment quickly to people when they first come in for care and is focused on the most common STDs that can be cured, including syphilis, gonorrhea, chlamydia, chancroid, trichomoniasis, and candidiasis.
    • The syndromic approach does not require the use of expensive tests, which often are not available. People who may have more than one STD infection are treated with the most effective drug available. In some undeveloped regions, 6 of every 10 patients with an STD have 2 or more different infections at the same time. This approach also emphasizes treatment during the first visit. Treating curable STDs as soon as possible limits the future spread of STDs, including HIV.
    • STD syndromes that cause similar signs and symptoms are included in a simple flow chart to help health care workers use the syndromic approach to make a diagnosis and begin appropriate therapy.
    • Using the syndromic approach is as follows:
      • Men who present with a urethral discharge are treated for both gonorrhea and chlamydia.
      • Women who present with lower abdominal pain are treated for gonorrhea, chlamydia, and other bacterial infections.
      • Women who present with vaginal discharge and cervicitis are treated for gonorrhea and chlamydia.
      • Women who present with vaginal discharge and vaginitis are treated for trichomoniasis and candidiasis.
      • Men or women who present with genital ulcers are treated for syphilis, chancroid, and genital herpes.
    • Treating people with STDs in this way is less expensive long term because more people are cured the first time they come for care and because the spread of STD may be limited.
    • The recommended drugs for STDs should be selected based on cost, availability, and local resistance patterns.[27, 28]
    • A proper supply of STD drugs and training programs for health care workers are essential.
    • With the syndromic approach, less emphasis is placed on identifying the cause of a particular STD. This may be difficult for some health care workers to accept when they have been trained to identify the specific cause of a disease before starting therapy. However, in a setting where rapid therapy is of utmost importance and sophisticated laboratories are not available, the syndromic approach provides effective treatment.
    • Prompt, effective therapy and education of patients helps them decide to use condoms, change their risky sexual behavior, and convince their partner to seek treatment.
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Surgical Care

  • Fluctuant buboes should be drained with the patient under local anesthesia. Insert a large-gauge needle into the bubo, passing through normal tissue from the side or the top of the lesion rather than the bottom, thus avoiding continuous dependent drainage and fistula formation, as demonstrated in the image below. Large fluctuant buboes should be drained with the 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.
  • Incision and drainage is an effective method for treating fluctuant buboes and may be preferable to traditional needle aspiration, considering the frequency of required repeat aspirations in some studies.[29]
  • If circumcision is needed, it should be completed after the patient successfully completes treatment with antibiotics.
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Activity

Patients should refrain from sexual activity until ulcers are healed. Untreated chancroid ulcers may persist for 1-3 months. Chancroid ulcers treated with the appropriate antibiotic agent resolve within 7-14 days.

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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

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.

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.

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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

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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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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