Chancroid is an exquisitely painful ulcerative infection which is sexually transmitted. It has an incubation period of a few days to two weeks, starts out as a somewhat painful papule which then turns into an ulceration (or ulcerations) which is sharply defined, has ragged borders, bleeds if traumatized and has painful lymphadenopathy.
Diagnostically, the patient would have tender lymphadenopathy, which sometimes suppurates (HSV would NEVER do this), the serology and darkfield is negative for T Pallidum, the Tzanck Smear is negative for HSV. Primary HSV tends to have multiple grouped ulcerations as well, but a careful Tzanck will sniff out the right answer.
Thus ends our "Summer of Love" series of STDs. I hope to have more mundane, less disgusting pics for you in the coming week. Happy Fourth, everyone!
In more specific terms, the CDC's standard clinical definition for a probable case of chancroid includes all of the following:
- Patient has one or more painful genital ulcers. The combination of a painful ulcer with tender adenopathy is suggestive of chancroid; the presence of suppurative adenopathy is almost pathognomonic.
- No evidence of Treponema pallidum is indicated by dark-field examination of ulcer or by a serologic test for Syphilis performed at least 7 days after the onset of ulcer.
- The clinical presentation is not typical of disease caused by human herpesvirus 2 (Herpes Simplex Virus), or result of culture for HSV is negative.
About half of infected men have only a single ulcer. Women frequently have four or more ulcers, with fewer symptoms. The ulcers appear in specific locations, such as the coronal sulcus of the uncircumcised glans penis in men, or the fourchette and labia minora in women.
Common locations in women
In women, the most common location for ulcers is the labia majora. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the labia. Other areas such as the labia minora,perineal area, and inner thighs may also be involved. The most common symptoms in women are dysuria (pain with urination) and dyspareunia (pain with intercourse).
The initial ulcer may be mistaken as a "hard" chancre, the typical sore of primary syphilis, as opposed to the "soft chancre" of chancroid.
Approximately one-third of the infected individuals will develop enlargements of the inguinal lymph nodes, the nodes located in the fold between the leg and the lower abdomen.
Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin, producing draining abscesses. The swollen lymph nodes and abscesses are often referred to as buboes.
Chancroid is a bacterial infection caused by the fastidious Gram-negative streptobacillus Haemophilus ducreyi. It is a disease found primarily in developing countries, most prevalent in low socioeconomic groups, associated with commercial sex workers.
Infection levels are low in the Western world, typically around one case per two million of the population (Canada, France, Australia, UK and US). Most individuals diagnosed with chancroid have visited countries or areas where the disease is known to occur frequently, although outbreaks have been observed in association with crack cocaine use and prostitution.
Chancroid is a risk factor for contracting HIV, due to their ecological association or shared risk of exposure, and biologically facilitated transmission of one infection by the other.
The CDC recommendation for chancroid is a single oral dose (1 gram) of Azithromycin or a single IM dose of Ceftriaxone or oral Erythromycin for seven days.
Comparison with syphilis
There are many differences and similarities between the conditions syphilitic chancre and chancroid (reference 1 and 2)
- Both originate as pustules at the site of inoculation, and progress to ulcerated lesions
- Both lesions are typically 1–2 cm in diameter
- Both lesions are caused by sexually transmissible organisms
- Both lesions typically appear on the genitals of infected individuals
- Both lesions can be present at multiple sites and with multiple lesions
- Chancre is a lesion typical of infection with the bacterium that causes syphilis, Treponema pallidum
- Chancroid is a lesion typical of infection with the bacterium Haemophilus ducreyi
- Chancres are typically painless, whereas chancroid are typically painful
- Chancres are typically non-exudative, whereas chancroid typically have a grey or yellow purulent exudate
- Chancres have a hard (indurated) edge, whereas chancroid have a soft edge
- Chancres heal spontaneously within three to six weeks, even in the absence of treatment
- Chancres can occur in the pharynx as well as on the genitals