SEXUALLY TRANSMITTED DISEASES: CHANCROID

Chancroid is caused by infection with a gram-negative rod, Haemophilus ducreyi. In the United Sates, H. ducreyi infection tends to occur in discrete outbreaks, and it is often acquired from asymptomatic carriers. About 10% of people with chancroid in the United States are co-infected with T. pallidum or HSV, and it is also associated with human immunodeficiency virus infection.

Clinical Findings

The incubation period for chancroid is only a few days, and the genital ulcers that form tend to be deep and painful. Auto-inoculation gives rise to more lesions on the genitals and surrounding skin. Generalized symptoms such as fever are sometimes present, and tender inguinal adenopathy occurs in 50% of cases. Suppuration of these nodes is almost diagnostic of chancroid.

Diagnosis

H. ducreyi cannot be cultured on routine medium, and its nutritional requirements seem to be geographically defined. Culture is 80% sensitive at best. Polymerase chain reaction is a promising alternative, but there are no tests yet available that are approved by the Food and Drug Administration.

A probable diagnosis of chancroid can be made if all of the following criteria are met:

• One or more painful genital ulcers
• Negative testing for T. pallidum by dark-field examination or a serologic test for syphilis performed at least 7 days after onset of ulcer
• Clinical presentation and ulcer appearance are typical of chancroid
• Negative test for HSV performed on the ulcer exudates

Treatment

Chancroid can be treated with short courses of azithromycin (Zithromax), ceftriaxone (Rocephin), ciprofloxacin (Cipro), or erythromycin. Intermediate resistance to ciprofloxacin and erythromycin has been reported. Patients should be reevaluated within 1 week of diagnosis. Recent (10 days) sexual partners should be evaluated and treated. HIV and syphilis testing should be repeated at 3 months.

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Men's Health