Chancroid

Haemophilus ducreyi |

Overview

Chancroid is a rare form of as genital ulceration that presents with/without bubo formation (localised swollen painful lymph nodes).
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.
Local acquisition is very uncommon in the developed world and increasingly uncommon in developing countries. Regions where chancroid is thought to occur include . 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
Phagedenia (rapidly spreading, necrotic) 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
Situation	Recommended	Alternative
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: Thursday, 29 March 2018