eMedicine Specialties > Emergency Medicine > Infectious Diseases

Chancroid

Author: Ninfa Mehta, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital
Coauthor(s): Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Contributor Information and Disclosures

Updated: Sep 1, 2009

Introduction

Background

Chancroid is a sexually transmitted infectious disease characterized by painful ulcers, bubo formation, and painful inguinal lymphadenopathy. The causative organism, Haemophilus ducreyi, was found by Ducrey in 1889. It is a gram-negative coccoid-bacillary rod, which is usually located in the extracellular spaces.

Pathophysiology

H ducreyi enters the skin through an epithelial break, usually following some minor trauma such as sexual intercourse. Once the bacteria have breached the integument, it recruits keratinocytes, fibroblasts, endothelial cells, and melanocytes to secrete interleukin 6 (IL-6) and interleukin 8 (IL-8). IL-8 induces polymorphonuclear neutrophils (PMNs) and macrophages to form intradermal pustules. IL-6 stimulates T-cell interleukin 2 (IL-2) receptor expression, which, in turn, stimulates CD4 cells in the region. H ducreyi secretes a cyto-lethal distending toxin (HdCDT) that causes apoptosis and necrosis of human cells such as myeloid cells, epithelial cells, keratinocytes, and primary fibroblasts.1 This toxin inhibits cell proliferation and induces cell death causing the characteristic ulcer formation seen in chancroid.

H ducreyi is also able to evade phagocytosis leading to slow healing of ulcers. For an unknown reason, macrophages in ulcers have greater CCR5 and CXCR4 chemokine receptors, which are receptors for human immunodeficiency virus (HIV) entry, than normal cells.

Frequency

United States

Chancroid is rare in the United States. Localized endemic outbreaks may occur within isolated STD and prostitution populations where it may coexist with other STDs.

International

Annual global incidence is about 6 million cases per year.2 Chancroid is more common in areas of low socioeconomic status such as Africa, Asia, and the Caribbean. It has also been found to be more common in areas where the prevalence of HIV is high (>8%). Other risk factors are low education level, risky sexual behavior, other sexually transmitted diseases, noncircumcision, and older male homosexuals.3 Note that the frequency of chancroid as well as other bacterial STDs has recently shifted away from bacterial infections and toward viral etiologies such as herpes simplex virus (HSV) and HIV.

Mortality/Morbidity

If chancroid is diagnosed and treated early, it can be cured easily and quickly. H ducreyi produces painful ulcers and painful inguinal lymphadenopathy known as buboes. These may rupture after becoming an abscess. Scarring in this region may be permanent. Open sores secondary to H ducreyi infection also facilitate the transmission of HIV. Immunocompromised patients have lower cure rates and more complications.

Sex

The male-to-female ratio is between 3 and 25:12 , depending on the geographic region being studied. Although males are affected more often, female sex workers appear to be the reservoir of the disease.

Age

Mean patient age is 30 years.

Clinical

History

The patient complains of painful papules, pustules, or ulcers. They may also have dyspareunia, vaginal discharge, fever, or weakness. Patients may report a history of unprotected contact with a prostitute. HIV-positive and other immune compromised patients may have an atypical presentation.

Physical

The organisms enter through breaks in the skin on the genitals, which is where an erythematous papule will form, becoming a pustule in 2-3 days. The pustule ulcerates in a matter of weeks, and lymphadenopathy also usually is seen. The ulcer is characterized by a soft chancre with irregular borders and possibly a ring of erythema. Painful inguinal lymphadenopathy or bubo formation is present in 50% of patients.4 Lymphadenopathy is usually unilateral, and lymph nodes may rupture.

This photograph shows an early chancroid on the p...

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

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This photograph shows an early chancroid on the p...

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



Chancroid usually starts as a small papule that r...

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.

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Chancroid usually starts as a small papule that r...

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 ...

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.

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This patient shows the characteristic lesions of ...

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.

Causes

H ducreyi, a gram-negative bacillus, is the causative organism.

More on Chancroid

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

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Keywords

chancroid, genital ulcer, chancre, STD, sexually transmitted disease, painful ulcers, bubo formation, painful inguinal lymphadenopathy, Haemophilus ducreyi, sexually transmitted infectious disease

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Contributor Information and Disclosures

Author

Ninfa Mehta, MD, Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital
Ninfa Mehta, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American Medical Association, and American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB, Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn
Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Barry J Sheridan, DO, Chief, Department of Emergency Medical Services, Brooke Army Medical Center
Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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