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Chancroid

Review literature: (Brown et al., 1999) (CDC Guidelines, 2006) (Roest and van der Meijden, 2001) (Schneede et al., 2003).

Definition of Chancroid

Sexually transmitted disease caused by Haemophilus ducreyi infection leading to genital ulcers (ulcus molle, soft chancre) and painful lymphadenopathy (bubo).

Epidemiology of Chancroid

Chancroid occurs especially in tropical countries. Very rare in Europe or North America.

Etiology

Pathogen of Chancroid:

Haemophilus ducreyi: immobile gram-negative bacteria, oval cocci arranged in a chain.

Signs and Symptoms

Genital Ulcer:

Chancroid leads to one or more deep purulent genital ulcer. The ulcers are very painful and 2–20 mm in diameter. Genital lymphedema is possible.

Lymphadenopathy

Painful tender groin lumps (bubo) is typical for chancroid in combination with a painful genital ulcer. A suppurative lymphadenopathy (abscess formation and drainage over the inguinal skin) is pathognomonic for chancroid.

Diagnosis of Chancroid

Microscopic detection of pathogens from the depths of the genital ulcer is possible. The Gram stain shows gram-negative cocci in chain formation [fig. Microscopy: Haemophilus ducreyi]. Diagnosis can be achieved with a selective culture. The investigation of sexual partners and testing for other STD is necessary.

Microscopy of Haemophilus ducreyi stained using Gentian violet. Fig. from Public Health Image Library, Center for Disease Control and Prevention, USA, https://phil.cdc.gov/.

Treatment of Chancroid

Recommended antibiotic treatment of Chancroid:

• Azithromycin 1 g p.o. once
• Ceftriaxone 250 mg i.m. once
• Ciprofloxacin 500 mg p.o. 1-0-1 for 3 days
• Erythromycin 500 mg p.o. 1-1-1-1 for 7 days

Resistance to antibiotic treatment is possible. Symptomatic improvement is expected within three days, objective ulcer healing within 7 days of antibiotic treatment. Fluctuating lymph nodes and abscess formations should be incised and drained (alternatively needle aspiration).

References

Schneede u.a. 2003 SCHNEEDE, P. ; TENKE, P. ; HOFSTETTER, A. G.: Sexually transmitted diseases (STDs)-a synoptic overview for urologists.
In: Eur Urol
44 (2003), Nr. 1, S. 1–7

  Deutsche Version: Ulcus molle (weicher Schanker).