Chancroid Clinical Presentation

Updated: Aug 05, 2019
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Presentation

History

Patients present with extremely painful suppurative ulcers that may be single or multiple. The infection begins as a papule, which quickly progresses to a pustule and subsequent ulcer formation. [39]

An asymptomatic carrier state is common among women. It is more difficult to diagnose chancroid in women than in men. In women with lesions of the vulva, vagina, or cervix, the chief symptom may be dysuria or dyspareunia and might be overlooked as a typical lower urinary tract infection. [40] They may also have a higher incidence of resolution after papule formation without ulcer formation.

Painful inguinal lymphadenopathy with subsequent ulceration, usually unilateral, develops in approximately 50% of patients within 1-2 weeks.

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Physical

Lesions

The lesion of chancroid is often termed as a soft chancre because it is not indurated, as opposed to the indurated syphilitic chancre. The lesion begins as erythematous tender papules that become pustular and later erode to form an extremely painful and deep ulcer with soft (in contrast to the chancre of syphilis) ragged margins.

The ulcer base is composed of easily friable granulation tissue that is usually covered with malodorous yellow-gray exudates.

Ulcers may be single or multiple, and as many as 10 ulcers have been reported on a single patient.

Men more commonly present with single ulcers, whereas women typically have multiple lesions. “Kissing ulcers” occur when one ulcer spreads the infection to the opposite skin surface. Kissing ulcers can form on the lips of the labia majora.

Individual ulcers vary in size from 1-20 mm, with 1-2 cm being the most common size.

In circumcised men, lesions are most commonly found on the coronal sulcus. In uncircumcised men, the lesions are commonly found on the prepuce. Lesions may be obscured by a painful phimosis in uncircumcised men.

In women, lesions are most commonly found on the fourchette, labia, vestibule, clitoris, cervix, and anus. Women may not have not external sores but may present with dysuria, dyspareunia, and vaginal or rectal discharge.

In both men and women, adjacent lesions may merge and form confluent lesions.

Superinfection of ulcers, especially fusospirochetal, may occur and cause deep, necrotic, and gangrenous ulcers. The infection rapidly spreads to subcutaneous and deeper tissues, leading to rapid destruction of the external genitalia, known as phagedenic chancroid.

Lymphadenopathy

Painful, usually unilateral, regional lymphadenopathy occurs in an approximately 50% of patients and is more common in men. Of patients with lymphadenitis, 25% may have progression to a suppurative bubo, which may rupture spontaneously and ulcerate. If untreated, chronic draining sinuses may follow.

Other types of chancroid

Chancroid lesions may not manifest as the usual tender nonindurated ulcers. Some other manifestations of chancroid have been observed, as follows:

  • Transient chancroid produces an ulcer that rapidly resolves in 4-6 days, followed 10-20 days later by a suppurative lymphadenitis.
  • Dwarf chancroid manifests as one or several herpeslike ulcerations, with or without inguinal lymphadenopathy.
  • Follicular chancroid produces ulcerations of the pilar apparatus in hair-bearing areas.
  • Giant chancroid consists of multiple small ulcerations, which coalesce to form a single large lesion.

Pseudogranuloma inguinale

Pseudogranuloma inguinale is another chancroid variety that closely resembles granuloma inguinale caused by Klebsiella granulomatis. Isolation of H ducreyi from lesions differentiates it from granuloma inguinale.

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Causes

Chancroid is an STD that results from direct contact with H ducreyi from infected lesions. Risk factors include residing in an endemic area, lower socioeconomic status, prostitution (especially among commercial sex workers), and drug abuse. The incidence of chancroid in circumcised males is lower than that in uncircumcised males, suggesting circumcised men are at lower risk for this disease. [41]

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