Chancroid in Emergency Medicine Clinical Presentation

Updated: Jan 04, 2023
  • Author: Kristine Song, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Patients with chancroid may report painful papules, pustules, or ulcers with associated dyspareunia, vaginal discharge, fever, or weakness. Patients also can have tender inguinal lymphadenopathy. 

HIV-positive and other immunocompromised patients may present atypically.



The organisms enter through breaks in the skin on the genitals. Approximately 3-7 days following inoculation, tender, erythematous papules form. The papules are most often seen on the prepuce or frenulum in males and on the vulva, cervix, or perianal region in females. The papules commonly develop into pustules, which ulcerate after several weeks. These ulcers are characterized by irregular borders, a possible ring of erythema, purulent exudate, and granulomatous bases. [14] Painful inguinal lymphadenopathy or bubo formation is present in 50% of patients and may present around the time of ulceration. [15] Lymphadenopathy is usually unilateral, and lymph nodes may rupture themselves. Note the images below.

This photograph shows an early chancroid on the pe 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 ra 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 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.


H ducreyi, a gram-negative coccobacillus, is the causative organism.



Scarring, phimosis, balanoposthitis, ruptured buboes with severe pain, and fistula formation are complications. Sexual dysfunction due to scar formation may also occur.