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.^[13]

Emergency Department Care

CDC treatment guidelines for chancroid recommend one of the following options^[13]:

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.^[13]

In pregnancy, ceftriaxone and azithromycin are preferred treatment regimens.

A longer course of treatment may be necessary in the following patients^[13]:

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, including HSV and syphilis.^[13]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.^[13]

Encourage abstinence until ulcer has healed. Sexual partners of patients with chancroid should be treated if there has been sexual contact within 10 days of symptom presentation.

Surgical Care

Fluctuant lymphadenopathy may require incision and drainage or needle aspiration.^[13]Incision and drainage is preferred, as it decreases the likelihood of repeat drainage.

Complications

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

Prevention

Patients need to be educated about safe sex practices.^[13]

Patients should be educated about the increased risk of HIV transmission in the presence of genital ulcers.^[10]

Treatment of partners is similar to the source patient. All sexual partners encountered 10 days preceding the onset of symptoms should be treated.^[13]

Long-Term Monitoring

Considerations in cases of treatment failure include the following^[13]:

Incorrect diagnosis
Coinfection with other STDs
Coinfection with HIV
Treatment noncompliance
Resistance of the H ducreyi strain

Further Outpatient Care

Follow-up should occur within 3-7 days after treatment initiation.^[13]

Ulcers should symptomatically improve within 3 days and objectively within 7 days.^[13]

Factors associated with treatment-resistant chancroid include the following^{[10, 13]}:

HIV infection
Large ulcer
Uncircumcised male
Fluctuant lymphadenopathy

Single-dose therapy may fail in HIV-positive patients, warranting close monitoring.^[13]

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.^[13]

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.^[18]

Guidelines

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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.

of 4

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.