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Sections Chancroid in Emergency Medicine
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Guidelines
Medication
Media Gallery
References

Presentation

History

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.

Physical

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 penis, along with accompanying regional lymphadenopathy. Courtesy of the CDC/Dr. Pirozzi.

View Media Gallery

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.

View Media Gallery

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.

View Media Gallery

Causes

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

Complications

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

Differential Diagnoses

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Media Gallery

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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Author

Kristine Song, MD ER Attending Physician, US Acute Care Solutions (USACS North); Emergency Medicine Residency Core Faculty, Simulations Director, Transitional Year Residency Program Director, Mercy Health — Anderson Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Erica Jane Ross, MD Physician, Department of Emergency Medicine, Mercy Health - Anderson Hospital

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 Program Director, Emergency Medicine, Einstein Medical Center Montgomery

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Christopher I Doty, MD, MAAEM, FAAEM, FACEP Tenured Professor of Emergency Medicine, University of Kentucky College of Medicine; Vice Chair of Education, Department of Emergency Medicine, University of Kentucky Chandler Medical Center

Christopher I Doty, MD, MAAEM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Residency Directors in Emergency Medicine

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.

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.

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.

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.

Sections Chancroid in Emergency Medicine
Overview
Presentation
- History
- Physical
- Causes
- Complications
- Show All
DDx
Workup
Treatment
Guidelines
Medication
Media Gallery
References

Chancroid in Emergency Medicine Clinical Presentation

History

Physical

Causes

Complications

References

Tables

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