Chancroid

What is chancroid ?

Chancroid is a sexually transmitted illness caused by the microbe Haemophilus ducreyi.

Is chancroid frequent ?

From a global point of view, chancroid is more often the offending agent responsible for the occurrence of genital ulcers. Once again, from a global perspective, chancroid is more frequent than syphilis (please refer to the section on syphilis). While the incidence is greater in tropical and sub-tropical countries, such as Africa (where Haemophilus ducreyi is responsible for up to 70 % of genital ulcers), there are infrequent outbreaks in Canada and the United States (some specialty STI clinics report up to 10-20 % of genital ulcers secondary to this pathogen).

How is the microbe responsible for chancroid transmitted ?

This infection can be transmitted by sexual contacts with a partner who is infected and contagious. Transmission can occur via genital, oral or anal contact – and this with or without penetration.

What is the incubation period of chancroid ?

The incubation period (the time between contact with an infected partner and the appearance of symptoms) is typically quite short, varying between 1 to 5 days (usually 2-3 days).

What are the symptoms of chancroid ?

The infection generally firsts presents itself as small red lesions or bumps that quite rapidly transform into "pustules" (fluid-filled blisters). These pustules then evolve towards small painful superficial ulcers (open wounds that vary between 3-20 mm in diameter). A grey membrane covers the surface of these ulcers. When this membrane is removed (quite easy to do), one exoses a « granular » tissue (new growth) that bleeds readily upon contact. In contrast with ulcers caused by syphilis, the ulcers secondary to Haemophilus ducreyi have an irregular contour that is not swollen and hard (indurated).

In 60 % of individuals infected with chancroid, the inguinal lymph nodes (immune system centers in your groin) will swell up in the days to weeks subsequent to contact with the infection. Early on, these swollen nodes may be subtle yet painful. As the infection progresses, approximately 50 % of locally affected nodes will become infected and develop into an abscess. The skin overlying these infected swollen nodes typically becomes red and may even break open allowing the abscess to drain.

Men and chancroid

In men, it is primarily in the region of the foreskin that chancroid is found. Occasionally, chancroid in this region may cause the complication known as «phimosis » (a narrowing or tightening of the foreskin that makes retraction of the foreskin difficult, if not impossible). Another complication that occurs from time to time (rare) secondary to chancroid is a « paraphimosis » (a complication of phimosis, whereby the foreskin causes strangulation of the glans). Chancroid can also appear on the glans of the penis (the head), the body or shaft of the penis, or at the urethral orifice (the opening into the penis and its conduit, the urethra). The anus and/or rectum may be afflicted. At times infection may manifest itself on the scrotum and/or thighs.

Women and chancroid

In women, chancroid is primarily found in the vagina, on the genital labia, the perineal or peri-anal region and only rarely at the level of the uterine cervix. Extra-genital lesions are not very common.

Chancroid and pregnancy

Chancroid does not appear to affect the normal course of pregnancy. In addition, maternal to fetal transmission does not seem to occur. It is very easy to treat the infected pregnanct women with antibiotics that are safe and approved for use during pregnancy (little to no risk to the developing baby). Some examples of antibiotics used to treat chancroid in pregnancy include erythromycin and ceftriaxone.

How is chancroid diagnosed ?

Chancroid is quite often difficult to diagnose based on the clinical visual exam alone. The diagnosis is made more difficult in regions of the world where the incidence or number of cases are low. In the presence of an abscess or ulcers in the genital region, the microscopic visualisation of secretions from lesions enable the physician to identify Haemophilus ducreyi (one looks for bacteria that resemble rods forming a train track pattern. The culture (a swab of secretions sent to be grown in the laboratory) of material from the base of an ulcer permit the identification of the bacteria responsible in 70 – 80 % of cases of true chancroid. Newer methods under investigation including DNA amplification identification and blood tests are not yet available for clinical use.

Is there a treatment available for chancroid ?

Chancroid responds very well to a treatment with the antibiotics azythromycin, ceftriaxone, ciprofloxacin and erythromycin. Once treatment is initiated, symptoms begin to resolve after approximately three days with lesions/ulcers healing over within three to seven days. In addition to antibiotics, the application of frequent saline compresses to ulcers/lesions will help to ensure a timely cure and aid in the prevention of secondary bacterial infection (infection by another local bacteria). In most cases, the associated abscesses in the groin must be aspirated (removal of the infected material/liquid by needle) before antibiotics are started.

Your physician will assist you in determining the antibiotics best suited to you.

Who is at risk of contracting chancroid ?

The risk of contracting chancroid is greater when an individual engages in unprotected sexual relations (without condoms), with or without penetration of the vagina, anus or mouth with :

• a new sexual partner (male or female), who has not been examined for STIs or chancroid
• a partner who has other sexual partners (perhaps multiple) with or without your knowledge
• more than one sexual partner
• an anonymous sexual partner, or one whose past sexual history is unkown
• a partner who works in the sex industry
• a partner who has recently traveled to or recently emigrated from a tropical or sub-tropical country (and was of an age of sexual activity).

How can the individual with chancroid prevent transmission ?

In the presence of an ulcer, lump/bump or unusual redness it would be better to refrain from all sexual activity (abstinence) and consult a physician

Condoms, when used systematically and effectively, offer an excellent protection against chancroid and many other STIs

Have an open discussion about sexual health and sexually transmitted illness with your sexual partner(s) li

Contact and advise all sexual partners that you may have been in contact with in the last 1 to 90 days (prior to symptom onset and/or diagnosis). Partner notification is extremely important for the chain of transmission to be interrupted. Partner notification also ensures that you are not re-infected by one of your sexual partners.

How can I prevent infection by chancroid ?

Use a latex condom (male, female or dental dam – the latter for cunnilingus) with all partners, and this at all times.

Abstinence or a stable monogamous relationship with a well-known sexual partner who is free of symptoms and who has undergone STI testing is an effective method of decreasing the risk of chancroid and other STIs in sexually active adults.