Chancroid

Ulcerations Caused by Chancroid

Chancroid, a sexually transmitted disease (STD), is characterized by painful genital ulcerations, which are often accompanied by enlarged lymph nodes in the groin region. This condition was once endemic in many areas of the world, but due to social awareness of chancroid and improved diagnosis and treatment, it is now less common. However, chancroid continues to be prevalent in many underdeveloped regions of the Caribbean, Africa, and Asia. People traveling to these high risk areas are at risk for contracting the condition. The World Health Organization (WHO) estimates that chancroid increases the risk of HIV infection by as much as 50 percent in women and 100 percent in men. If left untreated, chancroid can lead to female infertility due to secondary bacterial infections and chronic ulceration of the cervix or external genitalia. In men, superinfection of lesions (phagedenic chancroid) could lead to widespread disfigurement and surgical excision of the penis.

Overview of Chancroid

Chancroid is a bacterial infection that is sexually transmitted. This infection is found mostly in developing and third world countries, but a few cases are seen in the United States each year. Most Americans contract chancroid when they travel outside of the U.S. to areas where the condition is more common. Chancroid causes painful ulcers to form on the genital region of the body.

Causes of Chancroid

Haemophilus ducreyia (H. ducreyi) is the microorganism that causes chancroid. This pathogen is a small, gram-negative anaerobic bacillus that is highly infective to humans. It is the only human pathogen that enters the skin by way of a disruption in the mucosa or a skin tear. Once in the skin, it causes a local inflammatory reaction and cytocidal toxins form the ulceration or ulcer. H ducreyi is sexually transmitted by direct contact with open lesions and by inoculation to nonsexual sites, such as the eyes or mouth. The organism incubates anywhere from one day to two weeks. As the disease begins, a small papule forms at the site of exposure, and this lesion starts to form a deep, painful ulcer. Without treatment, the ulcer lasts for months and causes lymphadenopathy (swollen inguinal lymph nodes).

Risk Factors for Chancroid

There are several risk factors concerning the development of chancroid. These include:

  • Residing in an endemic area.
  • Prostitution.
  • Low socioeconomic status.
  • Poor hygiene.
  • Drug use/abuse.
  • Uncircumcised penis.

Incidence and Prevalence of Chancroid

In the U.S., chancroid has declined steadily from 1987 to present time. The CDC reports that there were over 5,000 cases in the U.S. in 1987, but in 2010, only 24 cases were reported from nine different states. While chancroid was once an endemic in large U.S. cities, it is now currently seen in sporadic cases and is associated with poor hygiene, low socioeconomic status, prostitution, and drug use/abuse. Because of difficulties culturing the causative organism (H. ducreyi), the CDC can only estimate the actual incidence of chancroid.

Internationally, the WHO estimated that there were 7 million cases of chancroid in 1995. This condition has surpassed herpes simplex virus 2 as the worldwide most common genital ulcerative disease. The Health Protection Agency in U.K. reported 450 cases of chancroid from 1995 to 2000, with three percent of genital ulcer cases diagnosed in a STD clinic in Paris, France.

Chanroid is most often observed in nonwhite men who are not circumcised. Health experts estimate that women make up only 10 percent of the cases of this condition, but they often are asymptomatic carriers. Chancroid can affect sexually active people of any age, but it is more common among females age 15 to 19 and men aged 20 to 24 years old. Chancroid is not a lethal condition, but superinfection of lesions (phagedenic chancroid) could lead to widespread disfigurement and surgical excision of the affected region.

Signs and Symptoms of Chancroid

People with a chancroid lesion usually have a single ulcer, but multiple lesions are not uncommon. The infection begins as a single papule, but that sore progresses quickly to ulceration. Women who are asymptomatic carriers often have painful urination or pain with sex. Lymph node swelling occurs in around 50 percent of cases, usually within one to two weeks from onset of the chancroid lesion.

Within one day to two weeks, symptoms and signs include an ulcer that is:

  • Painful.
  • Soft.
  • One to two inches across.
  • Sharply defined with borders.
  • Covered with a grey or yellowish material.
  • Is easy to bleed.

Common locations for chancroid ulcers in men include:

  • Scrotum.
  • Foreskin.
  • Groove behind the head of the penis.
  • Shaft of the penis.
  • Head of the penis.
  • Opening of the penis.

Common locations for chancroid ulcers in women include:

  • Outer lips of vagina (labia majora).
  • Inner vagina (labia minora).
  • Area between vagina and anus (perineal area).
  • Inner thighs.

Diagnosis and Treatment of Chancroid

There are no laboratory tests that can confirm a diagnosis of chancroid. Treatment is based on a suspected case and involves antibiotics. The goal of therapy is to eradicate the microorganism and improve symptoms. Special considerations for treatment include HIV infection, pregnancy, and compliance. Commonly used antibiotics include:

  • Azithromycin.
  • Erythromycin.
  • Cefitriaxone.
  • Ciprofloxacin.

Resources

  • eMedicine (2013). Chancroid. Retrieved from: http://emedicine.medscape.com/article/214737-overview

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