Dermatologic Manifestations of Chancroid Clinical Presentation

Updated: May 18, 2017
  • Author: Katherine H Fiala, MD; Chief Editor: Dirk M Elston, MD  more...
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Presentation

History

After an incubation period of 3-7 days, the patient develops painful, erythematous papules at the site of contact. The chancroid papules become pustular and then rupture, usually forming 1-3 painful ulcers.

Men usually have chancroid symptoms directly related to the painful genital lesions or inguinal tenderness. Most females are asymptomatic but may present with less obvious symptoms, such as dysuria, dyspareunia, vaginal discharge, pain on defecation, or rectal bleeding. In females, 1-2 weeks after the onset of ulcers, development of a bubo is the rule in most women. [2] Constitutional symptoms of chancroid, such as malaise and low-grade fevers, may be present.

Most commonly, males with chancroid report a history of recent contact with a prostitute. In addition, men who are infected are less likely to have used condoms and more likely to report a history of more than 2 sexual partners in the preceding 3 months.

Oral sex has also been documented in the transmission of chancroid.

Reports of nonsexually transmitted H ducreyi infection have also been described, most recently from Australia in expatriates visiting from Papua New Guinea and Vanuatu. Infection led to chronic lower-limb ulcers. [26, 27]

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Physical Examination

With chancroid, a small papule is the initial lesion at the site of infection. The papule rapidly becomes pustular and eventually ulcerates. The ulcer enlarges, develops ragged undermined borders, and is surrounded by a rim of erythema. The border of the chancroid ulcer is not indurated as in syphilis. A grayish fibrinous membrane covers the base of the ulcer. Autoinoculation results in multiple sites of infection in various stages of evolution.

In men, the most common site of the chancroid infection is the foreskin, but it may also occur less commonly on the shaft, the glans, or the meatus of the penis. In women, chancroid ulcers most commonly occur on the labia majora, but they may also occur on the labia minora, the thighs, the perineum, or the cervix.

As many as 50% of chancroid patients have tender, fixed, inguinal lymphadenopathy, usually unilaterally, that when fluctuant is called a bubo and is highly specific for chancroid, as seen in the images below. Additional ulceration may be seen from lymph node sites suppurating and draining to the skin. [2]

This patient shows the characteristic lesions of c 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.
Close-up view of chancroid ulcers. Close-up view of chancroid ulcers.

A probable chancroid diagnosis can be made if all the following criteria are met [28, 29, 30] :

  • The patient has one or more painful genital ulcers.

  • The patient has no evidence of Treponema pallidum infection by darkfield examination of ulcer exudate or by serologic testing for syphilis performed at least 7 days after the onset of ulcers.

  • The clinical presentation, the appearance of genital ulcers, and, if present, the presence of regional lymphadenopathy are typical for chancroid.

  • Test results for herpes simplex virus (HSV) performed on the ulcer exudate are negative. [31]

The combination of a painful ulcer and tender inguinal adenopathy, symptoms occurring in one third of patients, suggests a diagnosis of chancroid; when accompanied by suppurative inguinal adenopathy, these signs are almost pathognomonic.

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Causes

H ducreyi (a short gram-negative bacillus) causes chancroid. See Pathophysiology. Chancroid is closely associated with prostitution. H ducreyi can survive only in subgroups of the population with a sufficient turnover of sex partners. Chancroid is not a sustainable infection in sexual networks with low rates of partner change.

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Complications

Phimosis, balanoposthitis, and rupture of buboes with fistula formation and scarring are reported complications of chancroid.

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