Chancroid is primarily a sexually transmitted infection that is most common in resource-poor countries. It is rare in North America and Europe.
Chancroid is caused by the fastidious, gram-negative coccobacillus Haemophilus ducreyi. Classically it presents with the acute onset of a painful genital ulcer, and is often associated with fluctuant lymphadenitis (bubo formation).
An important co-factor in HIV transmission. HIV status must be assessed.
It usually resolves with antibiotic therapy; recurrence is rare.
Sexual partners within 10 days prior to onset of symptoms must be traced and treated, even if asymptomatic.
Non-sexually transmitted limb ulcers due to H ducreyi have been described in yaws-endemic countries.
Chancroid is an infectious disease caused by the fastidious, gram-negative coccobacillus Haemophilus ducreyi, most commonly presenting with a painful genital ulcer, and often associated with fluctuant lymphadenitis.
History and exam
Key diagnostic factors
- presence of risk factors
- genital papules
- genital ulcers
- lymphadenitis and buboes
Other diagnostic factors
- urethritis and dysuria
- vaginal discharge
- rectal pain or bleeding
- rectovaginal fistula
- extra-genital ulcers
- multiple sex partners
- sexual contact with sex worker
- unprotected intercourse
- substance abuse
- male sex
- lack of circumcision (in men)
- poor personal hygiene
- asymptomatic carriage
1st investigations to order
- Gram stain of ulcer swabs and bubo aspirates
- culture of ulcer swabs or bubo aspirates
- Haemophilus ducreyi PCR
- syphilis serology (FTA-ABS test, Treponema pallidum particle agglutination [TPPA], treponemal enzyme immunoassay [EIA])
- rapid plasma reagin (RPR) test
- HSV PCR and viral cultures
- HIV test
Investigations to consider
- Haemophilus ducreyi serology
- Haemophilus ducreyi antibiotic sensitivity
- ulcer biopsy
- darkfield microscopy for Treponema pallidum
- direct or indirect Haemophilus ducreyi antigen testing
no response to initial treatment
- Syphilis infection
- HSV infection
- Lymphogranuloma venereum
- Reducing sexually transmitted infections
- Sexually transmitted diseases treatment guidelines, 2021
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