Chancroid

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This is a bacterial infection, which presents as a small inflammatory papule then pustule at the site of inoculation (genitalia) of men and women, the papule may erode to form painful deep ulceration accompanied by inguinal lymphadenopathy.

Causes

  • Haemophilus ducreyi (a small gram-negative cocobacillus)

Signs and symptoms

  • Soft papule (chancroid) then pustules
  • Painful, deep, genital ulcers: the ulcer feels soft, hence the name ‘soft sore’ (ulcus molle)
    • Common sites:
      • Men - prepuce, frenulum, glans or shaft of the penis
      • Women - labia, fourchette, vestibule, clitoris, cervix, or perineum
  • Dysuria
  • Painful sexual intercourse (dyspareunia)
  • Lymph node swelling in inguinal region

Differential diagnosis

Other causes of genital ulcers include:

  • Syphilis, herpes, granuloma inguinale, lymphogranuloma venereum, cancer, trauma and tuberculous chancre

Investigations

  • Histologic examination (gram stain)
  • Culture and isolation of H. ducreyi

Treatment objectives

  • Manage symptoms and prevent complications
  • Eradicate the organism
  • Prevent transmission of infection

Non-pharmacological treatment

  • Keep the ulcerated lesions clean

Pharmacological treatment

Non-pregnant patient with chancroid

Ceftriaxone, IM

Adult:   

250 mg single dose

OR

Ciprofloxacin, oral

Adult: 

500 mg every 12 hours for 3 days (contraindicated in pregnancy)

OR

Azithromycin 

Adult: 

1g single oral dose

OR

Erythromycin, oral

Adult:

1g every 12 hours or 500 mg every 6 hours for 7 days

Note: Longer treatment courses may be necessary in immunocompromised patients

Pregnant women with chancroid

Ceftriaxone IM

Adult:    

250 mg single dose

Note: Ceftriaxone is the treatment of choice in pregnant women

Prevention

  • Abstain from sex during treatment or use female or male condom
  • Counsel and treat sexual partner(s) regardless of absence of symptoms
  • Male circumcision

Referral

  • Follow up on patient for a week to confirm improvement of lesion. Refer for specialist care if there is not improvement