Chancroid Clinical Presentation

  • Author: Pamela Arsove, MD, FACEP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Dec 1, 2010
 

History

  • Patients usually present with single or multiple painful genital ulcers.
  • In women with lesions of the vulva, vagina, or cervix, the chief symptom may be dysuria or dyspareunia.
  • Painful inguinal lymphadenopathy, usually unilateral, develops in approximately 30-60% of patients within 1-2 weeks.
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Physical

  • Lesions
    • The lesion of chancroid begins as a small tender papule with surrounding erythema that rapidly becomes pustular and then erodes to form an extremely painful and deep ulcer with soft (compared to the chancre of syphilis) ragged margins.
    • The ulcer base is composed of easily friable granulation tissue that is usually covered with malodorous yellow-gray exudates.
    • Ulcers may be single or multiple, and as many as 10 ulcers have been reported on a single patient.
    • Men more commonly present with single ulcers, whereas women typically have multiple lesions.
    • Individual ulcers vary in size from 1-20 mm, with 1-2 cm being the most common size.
    • In circumcised men, lesions are most commonly found on the coronal sulcus; in uncircumcised men, the lesions are commonly found on the prepuce. Lesions may be obscured by a painful phimosis in uncircumcised men.
    • In women, lesions most commonly are found on the fourchette, labia, vestibule, clitoris, cervix, and anus.
    • In both men and women, adjacent lesions may merge and form confluent lesions.
    • Superinfection of ulcers, especially fusospirochetal, may occur and lead to rapid destruction of the external genitalia, known as phagedenic chancroid.
  • Lymphadenopathy: Painful, usually unilateral, regional lymphadenopathy occurs in 30-60% of patients and is more common in men. Of the patients with lymphadenitis, 25% may have progression to a suppurative bubo, which may rupture spontaneously and ulcerate. If untreated, chronic draining sinuses may follow.
  • Other types of chancroid: Although relatively rare, chancroid sometimes may be associated with a variety of presentations different from the classic form described above.
    • Transient chancroid produces an ulcer that rapidly resolves in 4-6 days, followed 10-20 days later by a suppurative lymphadenitis.
    • Dwarf chancroid manifests as one or several herpeslike ulcerations, with or without inguinal lymphadenopathy.
    • Follicular chancroid produces ulcerations of the pilar apparatus in hair-bearing areas.
    • Giant chancroid consists of multiple small ulcerations, which coalesce to form a single large lesion.
  • Pseudogranuloma inguinale is another chancroid variety that closely resembles granuloma inguinale.
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Causes

Chancroid is an STD resulting from direct contact with H ducreyi. Risk factors include residing in an endemic area, lower socioeconomic status, prostitution (especially among commercial sex workers), and drug abuse. The incidence of chancroid in circumcised males is lower than that of uncircumcised males, suggesting circumcised men are at lower risk for this disease.[12]

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Contributor Information and Disclosures
Author

Pamela Arsove, MD, FACEP  Associate Residency Director, Department of Emergency Medicine, Hofstra Northshore Long Island Jewish School of Medicine; Attending Physician, Department of Emergency Medicine, Long Island Jewish Medical Center; Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine

Pamela Arsove, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara Edwards, MD  Associate Physician, Division of Infectious Diseases, Department of Medicine, Long Island Jewish Medical Center; Assistant Professor, Department of Medicine, Albert Einstein College of Medicine of Yeshiva University

Barbara Edwards, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Janowicz DM, Ofner S, Katz BP, Spinola SM. Experimental Infection of Human Volunteers with Haemophilus ducreyi: Fifteen Years of Clinical Data and Experience. J Infect Dis. Jun 1 2009;199(11):1671-9. [Medline].

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

  3. Bauer ME, Townsend CA, Doster RS, Fortney KR, Zwickl BW, Katz BP, et al. A fibrinogen-binding lipoprotein contributes to the virulence of Haemophilus ducreyi in humans. J Infect Dis. Mar 1 2009;199(5):684-92. [Medline].

  4. Leduc I, Banks KE, Fortney KR, Patterson KB, Billings SD, Katz BP, et al. Evaluation of the repertoire of the TonB-dependent receptors of Haemophilus ducreyi for their role in virulence in humans. J Infect Dis. Apr 15 2008;197(8):1103-9. [Medline].

  5. Banks KE, Fortney KR, Baker B, Billings SD, Katz BP, Munson RS Jr, et al. The enterobacterial common antigen-like gene cluster of Haemophilus ducreyi contributes to virulence in humans. J Infect Dis. Jun 1 2008;197(11):1531-6. [Medline].

  6. CDC. 2008 Sexually Transmitted Diseases Surveillance. Center for Disease Control and Prevention. Available at http://www.cdc.gov/std/stats08/other.htm. Accessed 11/11/10.

  7. World Health Organization. An overview of selected curable sexually transmitted diseases. World Health Organization. Available at http://www.who.int/asd/figures/globalreport.html#chancroid. Accessed 10/28/10.

  8. Corbell, Catherine BPharm, MSc*; Stergachis, Andy PHD†‡; Ndowa, Francis MBChB§; Ndase, Patrick MBChB, et al. Genital Ulcer Disease Treatment Policies and Access to Acyclovir in Eight Sub-Saharan African Countries. Sexually Transmitted Diseases. August 2010;37:488-493. [Full Text].

  9. Wang CC, Celum CL. Global risk of sexually transmitted diseases. Med Clin North Am. Jul 1999;83(4):975-95, vi. [Medline].

  10. Hand WL. Haemophilus species including chancroid. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Philadelphia, Pa:. Churchill Livingstone;2000:2380-2381.

  11. Benson PA, Hergenroeder AC. Bacterial sexually transmitted infections in gay, lesbian, and bisexual adolescents: medical and public health perspectives. Semin Pediatr Infect Dis. Jul 2005;16(3):181-91. [Medline].

  12. H A Weiss, S L Thomas, S K Munabi, R J Hayes. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006;82:101-110. [Full Text].

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

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

  15. T R Suntoke, A Hardick, A A R Tobian, et al. Evaluation of multiplex real-time PCR for detection of Haemophilus ducreyi, Treponema pallidum, herpes simplex virus type 1 and 2 in the diagnosis of genital ulcer disease in the Rakai District, Uganda. Sex Transm Infect. April/2009;85:97-101. [Medline]. [Full Text].

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

  17. Czelusta A, Yen-Moore A, Van der Straten M. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol. Sep 2000;43(3):409-32; quiz 433-6. [Medline].

  18. Mohammed, T. T. and Olumide, Y. M. Chancroid and human immunodeficiency virus infection - a review. International Journal of Dermatology [serial online]. 2008;47:1-8. Available from: doi: 10.1111/j.1365-4632.2007.03435.x. Accessed 11/12/2010. Available at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2007.03435.x/full.

  19. Zuckerman JM. Macrolides and ketolides: azithromycin, clarithromycin, telithromycin. Infect Dis Clin North Am. 2004;18:621-649. [Medline].

 
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This photograph shows an early chancroid on the penis, along with accompanying regional lymphadenopathy. Courtesy of the CDC/Dr. Pirozzi.
 
 
 
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