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
Tara Babu, MD, MSc
Adjunct Assistant Professor of Medicine
Division of Infectious Diseases
University of Rochester Medical Center
TB declares that she has no competing interests.
Dr Tara Babu would like to gratefully acknowledge Dr Marguerite A. Urban and Dr Christina Bailey, previous contributors to this topic. MAU and CB declare that they have no competing interests.
Eva Jungmann, FRCP, MSc
GUM/HIV Camden Primary Care Trust
Archway Sexual Health Clinic
EJ declares that she has no competing interests.
Diane M. Janowicz, MD
Assistant Research Professor in Medicine
Indiana University Department of Medicine
School of Medicine
DMJ declares that she has no competing interests.
- Syphilis infection
- HSV infection
- Lymphogranuloma venereum
- Sexually transmitted disease treatment guidelines, 2021
- Sexually transmitted diseases treatment guidelines, 2021
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