Chancroid in Emergency Medicine Treatment & Management

Updated: Jun 17, 2019
  • Author: Kristine Song, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Treatment

Approach Considerations

Patients with chancroid, along with all of their sexual partners within 10 days of contact preceding the onset of symptoms, should receive treatment. [15]

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Emergency Department Care

CDC treatment guidelines for chancroid recommend one of the following options: [15]

  • Azithromycin 1 g orally as a single dose
  • Ceftriaxone 250 mg IM as a single dose
  • Ciprofloxacin 500 mg orally twice a day for 3 days
  • Erythromycin base 500 mg orally three times a day for 7 days

Resistance to ciprofloxacin and erythromycin has been reported.

Ciprofloxacin should be avoided in pregnant breastfeeding patients. [15]

A longer course of treatment may be necessary in the following patients: [15]

  • Uncircumcised males
  • Patients with HIV infection
  • Patients with fluctuant lymphadenopathy

Other, more common, causes of painful genital ulcers and tender suppurative inguinal adenopathy should be considered, and patients should be treated for other STDs as well. [15] In endemic areas, patients should be treated for granuloma inguinale. Therapy for lymphogranuloma venereum should be given if inguinal buboes are present.

Streptomycin and ceftriaxone have been shown to be synergistic in the treatment of chancroid.

Single-dose ciprofloxacin (92% cure rate) and azithromycin are effective. These treatment options also offer the advantage of directly observed, single-dose therapy. Several isolates have showed intermediate resistance to single-dose therapy. The prevalence of these isolates is not known at this time. [12]

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Surgical Care

Fluctuant lymphadenopathy may require incision and drainage or needle aspiration. [15] Incision and drainage is preferred, as it decreases the likelihood of repeat drainage.

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Complications

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

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Prevention

Patients need to be educated about safe sex practices. [15]

Patients should be educated about the increased risk of HIV transmission in the presence of genital ulcers. [9]

Treatment of partners is similar to the source patient. All sexual partners encountered 10 days preceding the onset of symptoms should be treated. [12]

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Long-Term Monitoring

Considerations in cases of treatment failure include the following: [15]

  • Incorrect diagnosis
  • Coinfection with other STDs
  • Coinfection with HIV
  • Treatment noncompliance
  • Resistance of the H ducreyi strain
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Further Outpatient Care

Follow-up should occur within 3-7 days after treatment initiation. [15]

Ulcers should symptomatically improve within 3 days and objectively within 7 days. [15]

Factors associated with treatment-resistant chancroid include the following: [9, 15]

  • HIV infection
  • Large ulcer
  • Uncircumcised male
  • Fluctuant lymphadenopathy

Single-dose therapy may fail in HIV-positive patients, warranting close monitoring. [15]

In patients with HIV infection, the same regimens may be used, but note that these patients are more likely to experience treatment failure, which may necessitate repeated or longer therapy. [15]

Patients should be tested for HIV at the time of diagnosis. If the screening test is negative, they should be retested for HIV and syphilis in 3 months. [12]

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