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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

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.


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.

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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.
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