Chancroid Workup

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

Laboratory Studies

  • Isolation of H ducreyi is often difficult, and varying reports estimate the sensitivity of different modalities at about 80%, with only approximately 23% isolation rate with suspected lesions.[13]
  • 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.[14] 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. These tests are being used more frequently, both in research and clinically. In settings with limited resources, the diagnosis is usually made on clinical grounds alone, but PCR testing has the advantage of being able to detect recent infection and to determine the causative agent despite prior STD infection.[15]
  • 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
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Other Tests

When possible, every patient with chancroid should be tested for the other common STDs (syphilis, HSV, gonorrhea, and chlamydia) and HIV.

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Procedures

Needle aspiration and/or incision and drainage are recommended for buboes that are fluctuant and tender. As with other abscesses, incision and drainage may be a superior technique for preventing abscess recurrence.

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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.

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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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