Chancroid

Chancroid is a sexually transmitted infectious disease characterized by painful ulcers, bubo formation, and painful inguinal lymphadenopathy. The causative organism, Haemophilus ducreyi, was found by Ducrey in 1889. It is a gram-negative coccoid-bacillary rod, which is usually located in the extracellular spaces. Chancroid can be spread from person to person through vaginal intercourse, oral sex, anal sex, mutual masturbation but also through direct, skin-to-skin contact with an infected person’s ulcers.

This disease is primarily found in developing countries, associated with commercial sex workers and their clientele. Infection levels are low in the western world, about one case per two million of the population (Canada, France, UK and USA). Chancroid is endemic in tropical and subtropical countries, but it is sporadic in temperate regions. The disease is also more common in uncircumcised men, and in unhygienic and low socioeconomic conditions. Chancroid was prevalent during war-time.

Chancroid has an incubation period of 1-7 days. Usually the lesion appears 2-3 days after exposure, but it may be up to a month. 

SYMPTOMS AND SIGNS 

Chancroid begins with a small bump that becomes an ulcer within a day of its appearance. The ulcer can have different sizes, from 1/8 inch to 2 inches (3 to 50 mm) across, it can be simple or multiple and it is very painful. It has sharply defined, undetermined borders, has a base that is covered with a grey or yellowish – grey material which bleeds easily if scraped. In men, the primary lesions are commonly located on the foreskin (prepuce), the groove behind the head of the penis (coronal sulcus), the shaft of the penis, the head of the penis (glans penis), the opening of the penis (urethral meatus) or scrotum. In women the lesions can be found on the labia majora (“Kissing ulcers” may develop. These are ulcers that occur on opposing surfaces of the labia), labia minora, clitoris and fourchette. The perineum and anus are rarely affected. Primary lesions may also occur in adjacent skin such as scrotum, thigh and even fingers.

The most common symptom in women is pain during urination and intercourse.

In 50 % of Chancroid infections, the infection also presents itself in the lymph glands in the genital region. These glands become hard and swollen, and may fill with pus. These swellings, known as “buboes” can burst, becoming extremely painful.

Chancroid can be diagnosed relatively easily and can be treated in a very short period of time. A clinical diagnosis of Chancroid can be made if the patient has one or more painful ulcers in the genital area and tests are negative for syphilis or herpes. The diagnosis of Chancroid can be confirmed by a culture of the material from within the ulcer for the bacterium Hemophilus ducreyi. 

TREATMENT 

Chancroid can be treated locally or by following a drug therapy. The local treatment consists of repeated application of saline dressings to the ulcers. Abscesses less than 5 cm can be treated with aspiration through an area of healthy skin. Large abscesses may need surgical drainage. The drug therapy can be multi-dose or single-dose. The multi-dose therapy consists of:

• Erythromycin 500 mg qid x 1-2 weeks;

• Co-trimoxazole Tab. 2 bd x 1-2 weeks;

• Amoxicillin 500 mg + Clavulanic acid 125 mg tds x 1-2 weeks

• Ciprofloxacin 500 mg bd x 3 days.

The single-dose therapy:

• Ceftriaxone 250 mg IMI;

• Spectinomycin 2 mg IMI;

• Co-trimoxazole 8 tablets orally;

• Ofloxacin 400 mg orally.

COMPLICATIONS 

       The most common complications of Chancroid are: inguinal lymphadenitis (Inflammation of the lymphatic nodes), phimosis (a constriction of the opening of the foreskin so that it cannot be drawn back over the tip of the penis), fistula formation, haemorrhage from erosive lesions, fusospirochaetosis, infection and scarring (as a result of numerous ulcers). Chancroid has been associated with increased risk for developing other STDs, including Chlamydia, Gonorrhea, and HIV. 

PREVENTION 

The only sure way to avoid contracting Chancroid is not to have sex at all. Also, limiting the number of sexual partners reduces the chances of exposure. Using condoms correctly with all partners will decrease the possibility of becoming infected with Chancroid or any other STD.

If you think you are infected, avoid any sexual contact until you have visited a doctor, hospital or STD clinic. If you are infected, notify your sex partners immediately so they can be tested and treated.

Sexually Transmitted Disease STD       HPV HPV and HPV Vaccine HIV AIDS HIV AIDS Epidemic Among Men Who Have Sex With Men Among Women Who Have Sex With Women Mother To Child Transmission