eMedicine Specialties > Emergency Medicine > Infectious Diseases

Chancroid: Treatment & Medication

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

Treatment

Emergency Department Care

  • Clean the local area. Local cleaning should be completed with plain antibacterial soap and water or any other skin cleansing solution.
  • Incision and drainage of fluctuant buboes is preferable over needle aspiration because aspiration frequently needs to be repeated because of recurrence.
  • If syndromic management is used, patients should be treated for other STDs as well. In endemic areas, patients should be treated for granuloma inguinale. Therapy for lymphogranuloma venereum should be given if inguinal buboes are present.
  • Health education and safe sex practices should be encouraged.
  • Serologic testing for syphilis, HIV, and all other STDs should be performed, retesting 3 months later if test results are negative.
  • HIV-positive patients may fail single-dose therapy.
  • For treatment with antibiotics, the CDC recommends the following: azithromycin 1 g PO single dose, ceftriaxone 250 mg IM single dose, erythromycin 500 mg PO qid for 7 days, or ciprofloxacin 500 mg PO bid for 3 days.6
  • Streptomycin and ceftriaxone have been shown to be synergistic in the treatment of chancroid.
  • Single-dose ciprofloxacin (92% cure rate) and azithromycin are effective.
  • Treatment of partners is similar to the source patient.
  • Patients should not engage in sexual activity until the ulcers are healed.

Medication

The goal of therapy is to eradicate the microorganism. Since treatment of chancroid may accompany treatment of gonorrhea, it is important to be aware of the updated CDC guidelines for treating STDs. In April 2007, the Centers for Disease Control and Prevention (CDC) updated treatment guidelines for gonococcal infection and associated conditions. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) reached 6.7%, an 11-fold increase from 0.6% in 2001. The data were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report.7 This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose). Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented. For more information see, the CDC's Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.

Antibiotics

These agents are always indicated in chancroid. Therapy must be aimed at covering all likely pathogens according to the clinical setting.


Azithromycin (Zithromax)

Used to treat mild to moderately severe infections caused by susceptible strains of microorganisms. Indicated for chlamydial and gonorrheal infections of genital tract.

Adult

1 g PO once

Pediatric

<12 years: Not established
>12 years: 10 mg/kg PO on day 1 followed by 5 mg/kg days 2-5 suggested

May increase toxicity of theophylline, warfarin, and digoxin; aluminum and/or magnesium antacids may decrease effects; cyclosporine may increase risk of nephrotoxicity and neurotoxicity

Documented hypersensitivity; hepatic impairment; concurrent pimozide use (sudden death may occur)

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 use; may increase hepatic enzymes and cholestatic jaundice; caution in impaired hepatic function, prolonged QT intervals, or pneumonia; caution in hospitalized, geriatric, or debilitated patients


Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms and higher efficacy against resistant organisms than earlier generation cephalosporins. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Adult

250 mg IM once

Pediatric

Not established
50-75 mg/kg/d IV divided q12h suggested; not to exceed 2 g/d

Probenecid may increase levels; 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 (EES, E-Mycin, Ery-Tab)

Blocks peptide bond formation by blocking peptidyl tRNA translocation from the A- to the P- site. Inhibits bacterial growth.

Adult

250 mg erythromycin stearate/base (or 400 mg ethylsuccinate) PO q6h 1 h ac, or 500 mg q12h
Alternatively, use 333 mg PO q8h; increase up to 4 g/d depending on severity of infection

Pediatric

Not established
30-50 mg/kg/d (15-25 mg/lb/d) PO in divided doses suggested

May increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; lovastatin or 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; adverse GI effects are common (give doses pc); discontinue if nausea, vomiting, malaise, abdominal colic, or fever occur


Ciprofloxacin (Cipro)

Bactericidal antibiotic that inhibits bacterial DNA synthesis, and consequently growth, by inhibiting DNA-gyrase in susceptible organisms. Indicated for pseudomonal infections and those due to multidrug-resistant gram-negative organisms. If co-infection with gonorrhea suspected, do not use fluoroquinolones. CDC no longer recommends fluoroquinolones for gonorrhea or related conditions because of resistance.

Adult

500 mg PO bid for 3 d

Pediatric

Not established

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; reduces therapeutic effects of phenytoin; probenecid may increase 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 therapy

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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