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Chancroid
A chancroid is an STD characterized by painful sores on the genitalia.
Chancroid is a disease known to be spread solely through sexual
contact. It is caused by the bacterium Haemophilus ducreyi.
Causes
Chancroid is a bacterial infection caused by the organism Haemophilus
ducreyi. It is a disease found primarily in developing countries.
Only a few hundred cases a year are diagnosed in the United States.
The majority of individuals in the U.S. diagnosed with chancroid
have traveled outside the country to areas where the disease is
known to occur frequently.
Uncircumcised men are at 3 times greater risk than circumcised men for
contracting chancroid from an infected partner. Chancroid is a risk
factor for contracting HIV.
Clinical picture
After an incubation period of one day to two weeks, chancroid begins
with a small bump that becomes an ulcer within a day of its
appearance. The ulcer characteristically:
- Ranges in size dramatically (from 1/8 inch to 2 inches
across)
- Is painful
- Has sharply defined, undermined borders
- Has irregular or ragged borders
- Has a base that is covered with a grey or yellowish-grey
material
- Has a base that bleeds easily if traumatized or scraped
- About half of infected men have only a single ulcer. Women
frequently have 4 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 men:
- Foreskin (prepuce)
- Groove behind the head of the penis (coronal sulcus)
- Shaft of the penis
- Head of the penis (glans penis)
- Opening of the penis (urethral meatus)
- Scrotum
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,
perianal area, and inner thighs may also be involved. The most
common symptoms in women are pain with urination and 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.
Diagnosis
It is likely that chancroid is underreported in the United States
because laboratory diagnosis of chancroid is difficult and most
laboratories are incapable of culturing H. ducreyi. H. ducreyi may
be identified in a gram-stained smear based on cell morphology,
staining, and arrangement or by isolating and identifying the
organism by its biochemical reaction patterns. Neither method of
identification is very sensitive. Thus, improved methods for the
identification of H. ducreyi in specimens has become a priority.
Treatment
Antimicrobial resistance has emerged in H. ducreyi. The detection of
high-level tetracycline resistance due to the acquisition of the
TetM determinant by H. ducreyi as well as plasmids encoding
resistance to beta-lactams, aminoglycosides, and other antimicrobial
agents has renewed interest in the antimicrobial susceptibilities of
this organism.
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