eMedicine Specialties > Infectious Diseases > Sexually Transmitted Diseases

Chancroid: Treatment & Medication

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

Treatment

Medical Care

Patients presenting with suspected or diagnosed chancroid should undergo complete evaluation for other possible concomitant STDs and receive appropriate antimicrobial therapy for the eradication of H ducreyi.

  • The CDC recommends antibiotic therapy from 1 of 4 equally efficacious agents, as follows8 :
    • Azithromycin
    • Ceftriaxone
    • Erythromycin base
    • Ciprofloxacin
  • Evaluate patients for syphilis, herpes simplex virus (HSV), and HIV.
  • Drain fluctuant lymph nodes larger than 5 cm in diameter by either needle aspiration or incision and drainage.

Activity

Patients should abstain from unprotected sexual intercourse while undergoing treatment.

Medication

The goal of therapy is the eradication of the organism.

Antibiotics

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.


Azithromycin (Zithromax)

Treats mild-to-moderate microbial infections.

Adult

1 g PO single dose

Pediatric

<6 months: Not established
>6 months: 10 mg/kg PO single dose; not to exceed 500 mg/d

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Documented hypersensitivity; hepatic impairment; concomitant administration with pimozide

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in patients who are hospitalized, elderly, or debilitated


Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum gram-negative activity. Lower efficacy against gram-positive organisms. Higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Adult

250 mg IM single dose

Pediatric

>7 days: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d

Probenecid may increase levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; caution in breastfeeding women and allergy to penicillin


Erythromycin (E.E.S., E-Mycin, Eryc, Ery-Tab, Erythrocin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections.

Adult

500 mg PO qid for 7 d

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Documented hypersensitivity; hepatic impairment

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (administer pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur


Ciprofloxacin (Cipro)

Fluoroquinolone with activity against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, and most gram-negative organisms, but no activity against anaerobes. Inhibits bacterial DNA synthesis and, consequently, growth.

Adult

500 mg PO bid for 3 d

Pediatric

<18 years: Not recommended
>18 years: Administer as in adults

Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy

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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