Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi.
Chancroid is a sexually transmitted infection (STI) caused by the organism Haemophilus ducreyi. It is highly contagious and characterised by multiple, deep painful ulcers. It is one of the sexually transmitted causes of genital ulcers.
Traditionally, chancroid was very common, but with more attention paid to STI transmission with the rise in HIV cases in the 1980’s, the prevalence of chancroid has been falling. Herpes simplex is now the most common genital ulcerative disease.
The major causes of genital ulcers include:
Chancroid is rarely observed within the UK.
There are few cases of chancroid annually within the UK. These are usually acquired abroad from high prevalent areas. Chancroid is still prevalent in parts of Africa (e.g. Zambia, Mozambique), the Caribbean basin and Southwest Asia.
The disease is most commonly seen in young (21-30 years old), sexually active patients with the highest incidence in young non-white and uncircumcised males.
Chancroid causes ulcerative genital lesions secondary to the bacterium Haemophilus ducreyi.
Chancroid is caused by the bacterium Haemophilus ducreyi, which is a gram negative bacilli and highly infective. The incubation period (time between infection and develop of symptoms) is usually 4-7 days.
It is transmitted through direct contact with infected lesions during sexual intercourse. The bacterium is able to establish infection by penetrating through breaks in the skin or mucous membranes. Once barriers are breached, it causes a local inflammatory response with early development of painful papules. These deteriorate into deep, painful ulcers due to a number of virulence factors that cause necrosis of surrounding cells.
Due to local tissue inflammation and destruction, chancroid disrupts the normal integrity of the skin barrier and increases the risk of HIV transmission.
Chancroid is characterised by multiple, deep painful ulcers and lymphadenitis.
Traditionally, microscopy & culture is needed to diagnose chancroid but sensitivity is <80%.
There are limited investigations that can be used to diagnosis chancroid.
Chancroid presents very similarly to other ulcerative genital lesions including granuloma inguinale, LGV and herpes simplex. It can be difficult to distinguish between these conditions, particularly granuloma inguinale.
Patients with suspected Chancroid require referral and assessment at a genitourinary medicine (GUM) clinic. This enables a full sexual health screen including testing for other STIs such as chlamydia, gonorrhoea, syphilis and HIV.
A single dose of azithromycin is an effective first line treatment for chancroid.
All patients with chancroid should be advised to avoid sexual contact until treatment with antibiotics is completed and they have undergone appropriate follow-up. All sexual contacts should have contact tracing as advised by the GUM clinic. This usually refers to all sexual partners within 10 days prior to the onset of symptoms.
Single dose treatment with azithromycin should be avoided in patients who are co-infected with HIV. In these cases ciprofloxacin or erythromycin is usually preferred.
Complications from chancroid are most commonly seen in men.
For more information see British Association for Sexual Health and HIV (BASHH) guidelines.
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