Chancroid

Chancroid (Haemophilus ducreyi Infection)

Medical content reviewed and approved by Dr. GP Yadav, MD, Dermatology Specialist; STI/STD Expert

Definition

Chancroid is a sexually transmitted bacterial infection caused by Haemophilus ducreyi, characterized by painful genital ulcers and inguinal lymphadenopathy. It is a major cause of genital ulcer disease in resource-limited settings and is a known cofactor for HIV transmission.

Symptoms of Chancroid

Symptoms of chancroid typically appear 4-10 days after exposure. Initial presentation is a small inflammatory papule that rapidly progresses to a pustule and then ruptures to form a painful, shallow ulcer. The ulcers are characteristically ragged, undermined, and covered with a gray or yellowish necrotic exudate. Approximately 50% of patients develop painful, swollen inguinal lymph nodes (buboes) that may become fluctuant and rupture spontaneously. Women often have less symptomatic disease, with ulcers on the labia, vaginal wall, or cervix.

Common Symptoms:

Painful genital papules that rupture into ulcers
Tender inguinal lymphadenopathy (buboes)
Purulent discharge from ulcer base
ulcers with ragged, undermined borders
Erythema and edema of surrounding tissue

Clinical Images

Chancroid painful genital ulcer on male foreskin showing characteristic ragged undermined borders and necrotic exudate - clinical presentation at STD Nepal — Primary chancroid ulcer on the foreskin showing the characteristic ragged, undermined borders with purulent necrotic exudate.
Image provided by Dr. GP Yadav

Multiple chancroid ulcers on penile shaft exhibiting painful erythematous lesions with surrounding edema diagnosed at STD Nepal clinic — Multiple chancroid ulcers on the penile shaft demonstrating the typical painful, non-indurated lesions with surrounding inflammatory edema.
Image provided by Dr. GP Yadav

Chancroid inguinal bubo showing swollen tender lymph node with overlying erythema as complication of Haemophilus ducreyi infection — Inguinal bubo in chancroid infection showing a large, tender, fluctuant lymph node with erythematous overlying skin, a common complication requiring aspiration.
Image provided by Dr. GP Yadav

Chancroid ulcer on female labia showing painful ragged lesion with surrounding inflammation and edema documented at STD Nepal — Chancroid ulcer on the labia in a female patient, demonstrating the painful, friable ulcer with ragged borders and surrounding tissue edema.
Image provided by Dr. GP Yadav

Transmission of Chancroid

Chancroid is primarily transmitted through direct sexual contact with infected lesions or purulent discharge. The bacterium enters through micro-abrasions in the skin or mucous membranes during sexual activity. Asymptomatic carriers, particularly women, can transmit the infection. Transmission is facilitated by poor genital hygiene and the presence of other STIs. The incubation period ranges from 4-10 days but can extend to up to 14 days in some cases.

Transmission Methods:

Unprotected vaginal intercourse
Unprotected anal intercourse
Skin-to-skin contact with infected lesions

Incubation Period

Typical period: 4-10 days

The incubation period for chancroid is typically 4-10 days after exposure, though it can range from 1-14 days. Factors such as inoculum size, host immune status, and presence of other STIs may influence the incubation duration. The short incubation period contributes to rapid spread within sexual networks.

Complications of Chancroid

Untreated chancroid can lead to significant complications including suppurative inguinal lymphadenitis (buboes) that may rupture, causing chronic draining sinuses. In uncircumcised males, phimosis or paraphimosis can develop. Urethral fistulas and strictures are rare but serious complications. The most significant complication is the 3-5 fold increased risk of HIV transmission and acquisition due to ulcer disruption of mucosal barriers. Scarring and disfigurement can occur with extensive ulceration.

Possible Complications:

Inguinal bubo formation with spontaneous rupture
Phimosis and paraphimosis in uncircumcised males
Urethral fistula and stricture formation
Increased HIV transmission and acquisition risk
Chronic ulceration and scarring

Treatment Options for Chancroid

Chancroid is readily treatable with antibiotics. Successful treatment resolves symptoms, prevents complications, and reduces HIV transmission risk. All sexual partners within the preceding 10 days should be treated regardless of symptoms. Patients should be tested for HIV and other STIs at the time of diagnosis. Re-examination 3-7 days after treatment initiation is recommended to confirm clinical improvement. Antimicrobial resistance patterns should be monitored locally to guide therapy selection.

Azithromycin 1g single oral dose

Single-dose therapy with azithromycin 1g orally is highly effective, with cure rates exceeding 95%. It is the preferred regimen due to its single-dose convenience and high compliance.

Ceftriaxone 250mg intramuscular injection

Single intramuscular injection of ceftriaxone 250mg provides effective treatment. This option is suitable for patients who cannot tolerate oral medications.

Ciprofloxacin 500mg twice daily for 3 days

Oral ciprofloxacin 500mg twice daily for 3 days is an effective alternative regimen. Contraindicated in pregnant women and patients under 18 years.

Prevention of Chancroid

Prevention of chancroid relies on standard STI prevention measures including consistent condom use, reducing the number of sexual partners, and regular STI screening. Partner notification and treatment are essential to prevent reinfection and further transmission. There is no vaccine available for chancroid. Public health measures include education about recognizing symptoms and seeking prompt medical care. Individuals with genital ulcers should abstain from sexual activity until treatment is completed and lesions have healed.

Prevention Measures:

Consistent and correct use of condoms
Limiting number of sexual partners
Regular STI screening for sexually active individuals
Prompt treatment of symptomatic individuals and partners
Patient education about safe sexual practices

Important Disclaimer

⚠️This information is for educational purposes only and should not be used for self-diagnosis.
⚠️For accurate diagnosis and treatment, please consult with a qualified healthcare professional at an accredited medical facility.
⚠️Medical procedures and treatments should only be administered by licensed healthcare providers.
⚠️If you suspect you have an STI, visit STD Nepal clinic for confidential testing and treatment.

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