Dermatologic Manifestations of Chancroid Clinical Presentation

Updated: Mar 23, 2022
  • Author: Katherine H Fiala, MD; Chief Editor: Dirk M Elston, MD  more...
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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. Perianal lesions may also occur. [34] 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. [4] 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. [35, 36]


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. [4]

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.