Chancroid

Haemophilus ducreyi |

Overview

  • Chancroid presents as genital ulcers with/without bubo formation.
  • The infections is more frequently seen in men than women, in uncircumcised versus circumcised men and has been associated with commercial sex workers and drug use in countries outside of Australia.
  • Almost all cases are symptomatic and asymptomatic carriage is thought to be rare.
  • Most commonly found in Sub-Saharan Africa, Asia (except Thailand), Latin America and the Caribbean.

Cause

Haemophilus ducreyi

Clinical presentation

Male Female
Symptoms

Multiple, deep, painful genital ulcers with ragged undermined edges typically occur on the prepuce and in the coronal sulcus

Multiple, deep, painful genital ulcers with ragged undermined edges typically occur on the vulva and, less commonly, on the cervix

Similar ulcers may occur perianally in men engaging in receptive anal intercourse

Similar ulcers may occur extremely rarely perianally in women engaging in receptive anal intercourse

Extragenital lesions (e.g. fingers) may occur as a result of accidental inoculation

Extragenital lesions (e.g. fingers) may occur as a result of accidental inoculation

Complications
Bubo formation Bubo formation
Phagedenic ulceration of the penile tissue  

See STI Atlas for images.

Diagnosis

If chancroid suspected, seek specialist advice.

Patients with genital ulcers should also be tested for syphilis and herpes infection, as well as Chlamydia trachomatis, serovars L1-L3 and donovanosis if indicated. All patients with genital ulcer disease should be offered an HIV test. Refer to ano-genital ulcers.

Management

Seek specialist advice before treating.

Principal Treatment Options
SituationRecommendedAlternative
Uncomplicated infection Azithromycin 1g PO, stat
OR
Ceftriaxone 500mg in 2mL of 1% lignocaine IMI, stat
OR
Ciprofloxacin 500mg PO, BD for 3 days

Alternative regimens are not recommended

Treatment advice

Most patients respond to the single dose regimens. However, HIV positive patients may require longer courses. All patients should return for review if their ulcers have not healed.

Other immediate management

  • Advise no sexual contact for 7 days after treatment is administered
  • Contact tracing
  • Provide patient with fact sheet
  • Notify the state/territory health department.

Special treatment situations

Special considerations

Seek specialist advice before treating any complicated presentation.

 

Contact tracing

  • Trace back to 2 weeks before ulcer appeared or since arrival in endemic area.
  • Specialist support for contact tracing should be sought if local acquisition or transmission is possible.
  • Treat sexual partners presumptively.

See Australasian Contact Tracing - Chancroid for more information.

Follow up

Will be provided by specialist service.

Test of Cure (TOC)

Not required.

Retesting

Will be provided by specialist service.

Special considerations

Notifiable by all doctors and by laboratory on positive isolation.

References

BMJ Best Practice. Chancroid; Epidemiology. 2015. Accessed online via http://bestpractice.bmj.com/best-practice/monograph/932/basics/epidemiology.html [Accessed November 2015].
Last Updated: Friday, 20 May 2016