Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Chancroid in Emergency Medicine Treatment & Management

  • Author: Andrew D Nguyen, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Jul 26, 2016
 

Emergency Department Care

Clean the local area with plain antibacterial soap and water or any other skin cleansing solution.

Incision and drainage of fluctuant buboes is preferable over needle aspiration, as repeat aspiration typically is required due to reaccumulation.

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 and, therefore, warrant close monitoring.

According to the CDC 2015 guidelines, antibiotic treatment includes azithromycin at 1 g orally as a single dose, ceftriaxone at 250 mg intramuscularly as single a dose, erythromycin at 500 mg orally thrice daily for 7 days, or ciprofloxacin at 500 mg orally twice daily bid for 3 days.[15]

In patients with HIV infection, the same regimens may be used, but note that these patients are more likely to experience treatment failure, which may necessitate repeated or longer therapy.[15]

Azithromycin and ceftriaxone can be given during pregnancy, while ciprofloxacin is potentially toxic during breastfeeding and should be avoided in breastfeeding patients.[15]

Streptomycin and ceftriaxone have been shown to be synergistic in the treatment of chancroid.

Single-dose ciprofloxacin (92% cure rate) and azithromycin are effective. These treatment options also offer the advantage of directly observed, single-dose therapy. Several isolates have showed intermediate resistance to single-dose therapy. The prevalence of these isolates is not known at this time.[11]

Treatment of partners is similar to the source patient. All sexual partners encountered 10 days preceding the onset of symptoms should be treated.[11]

Patients should not engage in sexual activity until ulcers are healed and antibiotic therapy is complete.[12]

 
 
Contributor Information and Disclosures
Author

Andrew D Nguyen, MD Clinical Instructor, Resident Physician, Department of Emergency Medicine, King’s County Hospital Center, SUNY Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Ninfa Mehta, MD, MPH Clinical Assistant Professor, Ultrasound Fellowship Director, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Ninfa Mehta, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Society for Academic Emergency Medicine, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Miguel A Martinez-Romo, MD Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Miguel A Martinez-Romo, MD is a member of the following medical societies: Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition 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.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Kaycie L Corburn, MD, MEd Resident Physician, Emergency Medicine and Internal Medicine Combined Program, Kings County and SUNY Downstate Hospitals

Kaycie L Corburn, MD, MEd is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

References
  1. Albritton WL. Biology of Haemophilus ducreyi. Microbiol Rev. 1989 Dec. 53(4):377-89. [Medline]. [Full Text].

  2. Lagergård T, Bölin I, Lindholm L. On the evolution of the sexually transmitted bacteria Haemophilus ducreyi and Klebsiella granulomatis. Ann N Y Acad Sci. 2011 Aug. 1230:E1-E10. [Medline].

  3. Gangaiah D, Li W, Fortney KR, et al. Carbon storage regulator A contributes to the virulence of Haemophilus ducreyi in humans by multiple mechanisms. Infect Immun. 2013 Feb. 81(2):608-17. [Medline]. [Full Text].

  4. Li W, Katz BP, Bauer ME, Spinola SM. Haemophilus ducreyi infection induces activation of the NLRP3 inflammasome in nonpolarized but not in polarized human macrophages. Infect Immun. 2013 Aug. 81(8):2997-3008. [Medline]. [Full Text].

  5. Wising C, Azem J, Zetterberg M, Svensson LA, Ahlman K, Lagergard T. Induction of apoptosis/necrosis in various human cell lineages by Haemophilus ducreyi cytolethal distending toxin. Toxicon. 2005 May. 45(6):767-76. [Medline].

  6. Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012 Feb 1. 85(3):254-62. [Medline].

  7. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/stats14/surv-2014-print.pdf. Nov 2015; Accessed: July 3, 2016.

  8. Spinola SM, Bauer ME, Munson RS Jr. Immunopathogenesis of Haemophilus ducreyi infection (chancroid). Infect Immun. 2002 Apr. 70(4):1667-76. [Medline].

  9. Kyriakis KP, Hadjivassiliou M, Paparizos VA, Flemetakis A, Stavrianeas N, Katsambas A. Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece. Int J Dermatol. 2003 Nov. 42(11):876-81. [Medline].

  10. Van Howe RS. Sexually transmitted infections and male circumcision: a systematic review and meta-analysis. ISRN Urol. 2013. 2013:109846. [Medline]. [Full Text].

  11. [Guideline] Workowski, KA, Berman, S. Diseases Characterized by Genital, Anal, and Perianal Ulcers. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59 (No. RR-12). Centers for Disease Control and Prevention. Available at http://www.cdc.gov/std/treatment/2010/genital-ulcers.htm. Accessed: June 14, 2012.

  12. Kemp M, Christensen JJ, Lautenschlager S, Vall-Mayans M, Moi H. European guideline for the management of chancroid, 2011. Int J STD AIDS. 2011 May. 22(5):241-4. [Medline].

  13. Lewis DA. Diagnostic tests for chancroid. Sex Transm Infect. 2000 Apr. 76(2):137-41. [Medline].

  14. Patterson K, Olsen B, Thomas C, Norn D, Tam M, Elkins C. Development of a rapid immunodiagnostic test for Haemophilus ducreyi. J Clin Microbiol. 2002 Oct. 40(10):3694-702. [Medline].

  15. [Guideline] Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm. 2015 June 05; Accessed: July 3, 2016.

  16. [Guideline] Centers for Disease Control and Prevention. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):332-6. [Medline].

  17. [Guideline] Centers for Disease Control and Prevention, Workowski KA, Berman SM. Diseases characterized by genital ulcers. Sexually transmitted diseases treatment guidelines 2006. MWR Morb Mortal Wkly Rep. 2006 Aug 4. 55(RR-11):14-30. [Full Text].

  18. Annan NT, Lewis DA. Treatment of chancroid in resource-poor countries. Expert Rev Anti Infect Ther. 2005 Apr. 3(2):295-306. [Medline].

  19. [Guideline] Centers for Disease Control and Prevention. 1993 sexually transmitted diseases treatment guidelines. MMWR Morb Mortal Wkly Rep. 1993 Sep 24. 42(RR-14):1-102. [Medline].

  20. Cole LE, Toffer KL, Fulcher RA, San Mateo LR, Orndorff PE, Kawula TH. A humoral immune response confers protection against Haemophilus ducreyi infection. Infect Immun. 2003 Dec. 71(12):6971-7. [Medline].

  21. Dallabetta GA, Gerbase AC, Holmes KK. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect. 1998 Jun. 74 Suppl 1:S1-11. [Medline].

  22. DiCarlo RP, Armentor BS, Martin DH. Chancroid epidemiology in New Orleans men. J Infect Dis. 1995 Aug. 172(2):446-52. [Medline].

  23. Ernst AA, Marvez-Valls E, Martin DH. Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid. Sex Transm Dis. 1995 Jul-Aug. 22(4):217-20. [Medline].

  24. Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb. 75(1):3-17. [Medline].

  25. Goens JL, Schwartz RA, De Wolf K. Mucocutaneous manifestations of chancroid, lymphogranuloma venereum and granuloma inguinale. Am Fam Physician. 1994 Feb 1. 49(2):415-8, 423-5. [Medline].

  26. Hammond GW. A history of the detection of Haemophilus ducreyi, 1889-1979. Sex Transm Dis. 1996 Mar-Apr. 23(2):93-6. [Medline].

  27. Hollier LM, Workowski K. Treatment of sexually transmitted diseases in women. Obstet Gynecol Clin North Am. 2003 Dec. 30(4):751-75, vii-viii. [Medline].

  28. Htun Y, Morse SA, Dangor Y, Fehler G, Radebe F, Trees DL, et al. Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Sex Transm Infect. 1998 Jun. 74 Suppl 1:S23-8. [Medline].

  29. Humphreys TL, Baldridge LA, Billings SD, Campbell JJ, Spinola SM. Trafficking pathways and characterization of CD4 and CD8 cells recruited to the skin of humans experimentally infected with Haemophilus ducreyi. Infect Immun. 2005 Jul. 73(7):3896-902. [Medline].

  30. Humphreys TL, Schnizlein-Bick CT, Katz BP, Baldridge LA, Hood AF, Hromas RA, et al. Evolution of the cutaneous immune response to experimental Haemophilus ducreyi infection and its relevance to HIV-1 acquisition. J Immunol. 2002 Dec 1. 169(11):6316-23. [Medline].

  31. Joseph AK, Rosen T. Laboratory techniques used in the diagnosis of chancroid, granuloma inguinale, and lymphogranuloma venereum. Dermatol Clin. 1994 Jan. 12(1):1-8. [Medline].

  32. Lewis DA. Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect. 2003 Feb. 79(1):68-71. [Medline].

  33. Marrazzo JM, Handsfield HH. Chancroid: new developments in an old disease. Curr Clin Top Infect Dis. 1995. 15:129-52. [Medline].

  34. Martin DH, Mroczkowski TF. Dermatologic manifestations of sexually transmitted diseases other than HIV. Infect Dis Clin North Am. 1994 Sep. 8(3):533-82. [Medline].

  35. Martin DH, Sargent SJ, Wendel GD Jr, McCormack WM, Spier NA, Johnson RB, et al. Comparison of azithromycin and ceftriaxone for the treatment of chancroid. Clin Infect Dis. 1995 Aug. 21(2):409-14. [Medline].

  36. Mayaud P, Ka-Gina G, Grosskurth H. Effectiveness, impact and cost of syndromic management of sexually transmitted diseases in Tanzania. Int J STD AIDS. 1998. 9 Suppl 1:11-4. [Medline].

  37. Mertz KJ, Weiss JB, Webb RM, Levine WC, Lewis JS, Orle KA, et al. An investigation of genital ulcers in Jackson, Mississippi, with use of a multiplex polymerase chain reaction assay: high prevalence of chancroid and human immunodeficiency virus infection. J Infect Dis. 1998 Oct. 178(4):1060-6. [Medline].

  38. Morse SA. Chancroid and Haemophilus ducreyi. Clin Microbiol Rev. 1989 Apr. 2(2):137-57. [Medline].

  39. O'Farrell N. Soap and water prophylaxis for limiting genital ulcer disease and HIV-1 infection in men in sub-Saharan Africa. Genitourin Med. 1993 Aug. 69(4):297-300. [Medline].

  40. O'Farrell N. Targeted interventions required against genital ulcers in African countries worst affected by HIV infection. Bull World Health Organ. 2001. 79(6):569-77. [Medline].

  41. Paz-Bailey G, Rahman M, Chen C, Ballard R, Moffat HJ, Kenyon T, et al. Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clin Infect Dis. 2005 Nov 1. 41(9):1304-12. [Medline].

  42. Pillay A, Hoosen AA, Loykissoonlal D, Glock C, Odhav B, Sturm AW. Comparison of culture media for the laboratory diagnosis of chancroid. J Med Microbiol. 1998 Nov. 47(11):1023-6. [Medline].

  43. Post DM, Mungur R, Gibson BW, Munson RS Jr. Identification of a novel sialic acid transporter in Haemophilus ducreyi. Infect Immun. 2005 Oct. 73(10):6727-35. [Medline].

  44. Prather DT, Bains M, Hancock RE, Filiatrault MJ, Campagnari AA. Differential expression of porins OmpP2A and OmpP2B of Haemophilus ducreyi. Infect Immun. 2004 Nov. 72(11):6271-8. [Medline].

  45. Rome ES. Sexually transmitted diseases: testing and treating. Adolesc Med. 1999 Jun. 10(2):231-41, vi. [Medline].

  46. Rosen T, Brown TJ. Cutaneous manifestations of sexually transmitted diseases. Med Clin North Am. 1998 Sep. 82(5):1081-104, vi. [Medline].

  47. Schmid GP, Faur YC, Valu JA, Sikandar SA, McLaughlin MM. Enhanced recovery of Haemophilus ducreyi from clinical specimens by incubation at 33 versus 35 degrees C. J Clin Microbiol. 1995 Dec. 33(12):3257-9. [Medline].

  48. Schmid GP, Sanders LL Jr, Blount JH, Alexander ER. Chancroid in the United States. Reestablishment of an old disease. JAMA. 1987 Dec 11. 258(22):3265-8. [Medline].

  49. Spinola SM, Fortney KR, Katz BP, Latimer JL, Mock JR, Vakevainen M, et al. Haemophilus ducreyi requires an intact flp gene cluster for virulence in humans. Infect Immun. 2003 Dec. 71(12):7178-82. [Medline].

  50. Steen R. Eradicating chancroid. Bull World Health Organ. 2001. 79(9):818-26. [Medline].

  51. Steen R. Sex, soap and antibiotics: the case for chancroid eradication. Int J STD AIDS. 2001. 12(Suppl 2):147.

  52. Steen R, Dallabetta G. Genital ulcer disease control and HIV prevention. J Clin Virol. 2004 Mar. 29(3):143-51. [Medline].

  53. Trager JD. Sexually transmitted diseases causing genital lesions in adolescents. Adolesc Med Clin. 2004 Jun. 15(2):323-52. [Medline].

  54. WHO. World Health Organization. Management of sexually transmitted diseases. (WHO/GPA/TEM/94.1 Rev 1 ed). 1997. [Full Text].

  55. WHO: World Health Organization. - Syndromic Case Management of STD (Sexually Transmitted Diseases)- A Guide for Decision-makers, Health Care Workers, and Communicators. 1997. [Full Text].

  56. [Guideline] Workowski KA, Berman SM. CDC sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2002 Oct 15. 35:S135-7. [Medline].

 
Previous
Next
 
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 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 chancroid. The bubo on the right side drained spontaneously. The bubo in the left inguinal canal required needle aspiration.
Large fluctuant buboes should be drained with the patient under local anesthesia and a large-gauge needle inserted through surrounding healthy skin. The insertion site should be superior or lateral to the bubo to prevent chronic drainage from the site.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.