eMedicine Specialties > Infectious Diseases > Sexually Transmitted Diseases

Chancroid: Differential Diagnoses & Workup

Author: Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Coauthor(s): Gregory Shipkey, MD, Consulting Staff, Department of Emergency Medicine, MCH Medical Center, Odessa, Texas
Contributor Information and Disclosures

Updated: May 15, 2009

Differential Diagnoses

Herpes Simplex
Syphilis

Other Problems to Be Considered

Granuloma inguinale
Squamous cell carcinoma

Workup

Laboratory Studies

  • Gram stain: Gram stain of the ulcer exudates may demonstrate short, plump, gram-negative rods in the classic "school of fish" appearance; however, this method is notoriously unreliable because of the frequency of polymicrobial contamination.
  • Culture: Definitive diagnosis rests with culture of the organism; however, this is also fraught with difficulty.7 A special medium of enriched chocolate-based agar (ie, Nairobi medium, Mueller-Hinton agar) to which 3 mg/mL of vancomycin has been added is required; incubation is at 90-95% humidity in 2-3% carbon dioxide. Even with an experienced laboratory using this technique, isolation rates of greater than 90% are rare, with most laboratories reporting an isolation rate of 0-80%.
  • Monoclonal antibodies: Polymerase chain reaction (PCR) testing and indirect immunofluorescence using monoclonal antibodies have been touted to have high sensitivity and specificity; however, these tests are not widely available.
  • CDC criteria: Because of the difficulty in definitively isolating the organism for diagnosis, the CDC has recommended the following criteria for diagnosis of chancroid:
    • One or more painful genital ulcers
    • Clinical presentation and associated lymphadenopathy
    • Characteristics of chancroid (eg, painful ulceration associated with tender inguinal lymphadenopathy is considered suggestive; an associated suppurative adenopathy is near pathognomonic)
    • Negative laboratory evaluation (serology or darkfield microscopy) for Treponema pallidum
    • Negative test result for herpes simplex

Procedures

  • Needle aspiration and/or incision and drainage are recommended for treatment if clinically indicated.

Histologic Findings

Gram stain of the ulcer exudates may reveal short, plump, gram-negative rods in the classic school of fish appearance. Ulcer biopsy should reveal 3 distinct zones. The most superficial zone contains erythrocytes, fibrin, necrotic tissue, and neutrophils. The next zone consists of marked endothelial cell proliferation and many thrombosed new blood vessels. The deepest layer is characterized by a dense infiltrate of plasma and lymphoid cells.

More on Chancroid

Overview: Chancroid
Differential Diagnoses & Workup: Chancroid
Treatment & Medication: Chancroid
Follow-up: Chancroid
Multimedia: Chancroid
References
Further Reading
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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. 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].

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

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

  9. Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part I. J Am Acad Dermatol. Oct 1999;41(4):511-32. [Medline].

  10. 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].

  11. 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.

  12. Lundqvist A, Kubler-Kielb J, Teneberg S, Ahlman K, Lagergård T. Immunogenic and adjuvant properties of Haemophilus ducreyi lipooligosaccharides. Microbes Infect. Mar 2009;11(3):352-60. [Medline].

  13. Rosen T, Brown TJ. Genital ulcers. Evaluation and treatment. Dermatol Clin. Oct 1998;16(4):673-85, x. [Medline].

  14. Schmid GP. Chancroid and granuloma inguinale. In: Kelley W, ed. Textbook of internal medicine. 3rd ed. Philadelphia, Pa:. Lippincott-Raven;1997:1670-1671.

  15. Tomecki. Chancroid and Haemophilus ducreyi: an update. J Am Acad Dermatol. 1997;36(5):776.

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

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

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Further Reading

Clinical guidelines

Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 1993 (revised 2006 Aug 4). 17 pages. NGC:005184

Chancroid. In: Sexually transmitted infections: UK national screening and testing guidelines.
British Association for Sexual Health and HIV - Medical Specialty Society. 2006 Aug. 5 pages. NGC:006398

Clinical prevention guidance. Sexually transmitted diseases treatment guidelines 2006.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 1993 (revised 2006 Aug 4). 5 pages. NGC:005181

Clinical trials

Lay Health Advisors for Sexually Transmitted Disease Prevention

Related eMedicine topics

Chancroid (Dermatology)

Chancroid (Emergency Medicine)

Dermatologic Diseases of the Male Genitalia: Nonmalignant

Benign Cervical Lesions

Lymphogranuloma Venereum

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Keywords

sexually transmitted diseases, STD, genital ulcers, inguinal lymphadenopathy, Haemophilus ducreyi, H ducreyi, phagedenic chancroid, suppurative bubo, transient chancroid, dwarf chancroid, follicular chancroid, giant chancroid, pseudogranuloma inguinale

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Contributor Information and Disclosures

Author

Alexandre F Migala, DO, Staff Physician, Department of Emergency Medicine, Denton Regional Medical Center
Alexandre F Migala, DO is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic Association, Association of Military Osteopathic Physicians and Surgeons, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Gregory Shipkey, MD, Consulting Staff, Department of Emergency Medicine, MCH Medical Center, Odessa, Texas
Gregory Shipkey, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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: Nothing to disclose.

CME Editor

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.

 
 
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