Chancroid – Definition, Treatment, and Prevention.

Definition

Chancroid is a sexually transmitted disease/infection (STD/SDI) caused by bacterial infection and is highly contagious. Chancroid causes painful ulcers on and around the genitals in both males and females. Unlike common STDs such as gonorrhea, trichomoniasis, chlamydia, syphilis and herpes, cases of chancroid have been declining globally. However, it is highly infectious as just touching a chancroid sore is enough to contract the disease. The symptoms of chancroid are often confused with herpes, however, unlike herpes, it is bacterial so it responds well to antibiotics. If antibiotics are unavailable, there is a chancroid treatment at home you can try.

It is transmitted in two ways:

• Sexual transmission through skin-to-skin contact with the open sore(s).
• Non-sexual transmission when pus-like fluid from the ulcer is moved to other parts of the body or to another person.

A person is considered to be infectious when ulcers are present. There has been no reported disease in infants born to women with active chancroid at time of delivery.

Epidemiology

Chancroid was endemic worldwide until the 20th century but is now most common in the Caribbean, Africa, Asia (except Thailand), and Latin America. There were an estimated 7 million new cases in the world during 1995; however, due to difficulties in diagnosis and reporting, the true number is unknown.  The prevalence of chancroid has significantly declined in some countries, which is thought to be due to the therapeutic syndromic management of genital ulcer disease and significant social change. In the US, the prevalence peaked in 1947 with over 9500 cases and has since declined dramatically. In 2016, only 7 cases of it were reported in the US.

Types of Chancroid

Men affected with chancroid usually harbor a single lesion, while in women multiple lesions are typically observed. Furthermore, the size of the lesion may be highly variable.

The two main types are

• Dwarf chancroid (smaller than 0.5 centimeters in size) and
• Giant chancroid (2 centimeters or larger)

However, a myriad of unusual variations and types of chancroid have been described.

For example, when an ulcer involves one or more follicles in the pubic mound, the condition is known as follicular chancroid. On the other hand, papular chancroid is a designation we use if there is a rise of granulation tissue from the ulcer base above the surface of the skin. Transient chancroid is a term for a tiny papule that is often overlooked, but characteristic lymphadenopathy is present.

Mixed infections (particularly with spirochetal organisms) result in massive ulcers and tissue destruction – this is called phagedenic chancroid. The variant of the latter type of chancroid is serpiginous chancroid, characterized by progressive lesions towards the umbilical region or down the thighs.

Risk factors

• Multiple sex partners
• Sexual contact with the sex worker
• Unprotected intercourse
• Substance abuse
• Male gender
• Lack of circumcision (in men)
• Poor personal hygiene
• Asymptomatic carriage

Causes of Chancroid

Chancroid is a sexually transmitted bacterial infection that’s caused by the Haemophilus ducreyi bacteria. This disease isn’t diagnosed too often in STD testing clinics in the United States, but it’s more commonly seen in Africa and Southwest Asia. Most people who receive this diagnosis in the US have traveled to areas where it is more common.

Symptoms

• Symptoms usually occur within four days to ten days from exposure. They rarely develop earlier than three days or later than ten days.
• The ulcer begins as a tender, elevated bump, or papule, that becomes a pus-filled, open sore with eroded or ragged edges.
• The ulcer is soft to the touch (unlike a syphilis chancre that is hard or rubbery). The term soft chancre is frequently used to describe the chancroid sore.
• The ulcers can be very painful in men but women are often unaware of them.
• Because it is often asymptomatic in women, they may be unaware of the lesion(s).
• Painful lymph glands may occur in the groin, usually only on one side; however, they can occur on both sides.

Ulcer begins as a tender

Complications of Chancroid

• Complications include urethral fistulas and scars on the foreskin of the penis in uncircumcised males.
• People with chancroid should also be checked for other sexually transmitted infections, including syphilis, HIV, and genital herpes.
• In people with HIV, it may take much longer to heal.

Diagnosis and test

• The one and the only way to proceed with correct diagnoses are to turn to a doctor for additional tests and examinations. He will take samples of fluid from a sore.
• It will be examined in a laboratory. Several other tests may be required in order to confirm diagnoses. At the same time, blood tests will help to identify it.
• Groin lymph nodes may also be examined by a doctor in case you have pains in that area.
• It is also recommended to take additional medical tests which make it easy to determine other possible sexually transmitted infections.
• Chancroid lesions can look like syphilis or genital herpes, so a doctor needs to analyze the discharge from the sores to get an accurate diagnosis.

Treatment and medications

The infection is treated with antibiotics including ceftriaxone, and azithromycin. Large lymph node swellings need to be drained, either with a needle or local surgery.

Successful treatment cures the infection, resolves the clinical symptoms, and prevents transmission to others. In advanced cases, scarring can result despite successful therapy.

• Azithromycin 1 g orally in a single dose
• Ceftriaxone 250 mg IM in a single dose
• Ciprofloxacin 500 mg orally twice a day for 3 days
• Erythromycin base 500 mg orally three times a day for 7 days

Azithromycin and ceftriaxone offer the advantage of single-dose therapy. Worldwide, several isolates with intermediate resistance to either ciprofloxacin or erythromycin have been reported. However, because cultures are not routinely performed, data are limited regarding the current prevalence of antimicrobial resistance.

Prevention of Chancroid

• Exclusion from school and work is not necessary
• Practice safer sex
• Do not have sex until antibiotic treatment is completed and the sores have completely healed
• Contact all sexual partners for testing and, treatment if indicated.