CHANCROID
Alternative name: Soft chancre, soft sore
Chancroid is an ulcerative sexually transmitted disease, usually localized at the anogenital area and often associated with suppurative regional lymphadenitis.
Caused by Haemophilus ducreyi, a gram-negative bacillus.
Chancroid occurs as a mixed infection with syphilis or HSV in 10% of cases.
Alternative name: Soft chancre, soft sore
Chancroid is an ulcerative sexually transmitted disease, usually localized at the anogenital area and often associated with suppurative regional lymphadenitis.
Caused by Haemophilus ducreyi, a gram-negative bacillus.
Chancroid occurs as a mixed infection with syphilis or HSV in 10% of cases.
EPIDEMIOLOGY
nChancroid has been described as a disease of the “socially unenlightened, economically unfortunate and unwashed.”
nIt is major genital ulcerative disease in Africa and South-east Asia.
nAssociated with augmented transmission of HIV.
nPrimarily a disease of sexually active individuals (age group 20-30 years mostly).
nMales are far more affected than females.
CILNICAL FEATURE OF CHANCROID
One or more deep or superficial painful ulcers on the genitalia and painful inguinal adenitis in 50%, which may suppurate, are characteristic of the disease.
Chancroid begins as inflammatory papules or pustules after 2 to 5 days –after intercourse.
The ulcers have undermined irregular edges surrounded by erythema.
The base is covered with a purulent, dirty exudates.
The ulcer bleeds readily on gentle manipulation.
One or more deep or superficial painful ulcers on the genitalia and painful inguinal adenitis in 50%, which may suppurate, are characteristic of the disease.
Chancroid begins as inflammatory papules or pustules after 2 to 5 days –after intercourse.
The ulcers have undermined irregular edges surrounded by erythema.
The base is covered with a purulent, dirty exudates.
The ulcer bleeds readily on gentle manipulation.
PATHOGENESIS OF CHANCROID
èIn order to produce disease, the organism must penetrate the skin of the external genitilia, colonize the subcutaneous tissue and then produce tissue damage which results in ulcer formation.
èThe adherence of bacteria to epithelial cells and growth on their surface and production of cytotoxin result in cell damage that is responsible for the development of ulcer.
èLymphadenopathy is associated with a pyogenic inflammatory response showing a vast number of neutrophils and almost complete absence of bacilli.
Clinical variants of soft Ulcer
nGiant chancroid: a single lesion extends peripherally and shows extensive ulceration.
nLarge serpiginous ulcer: a lesion that becomes confluent, spreading by extension and autoinoculation.
nPhagedenic chancroid: starts as small lesion, but becomes large and destructive with widespread necrosis of tissue. In some cases superinfection with Vincent’s organisms plays a part in the process.
n4.Transient chancroid: a small ulcer that resolves spontaneously in a few days.
n5. Follicular chancroid: multiple small ulcers in a follicular distribution.
n6. Papular chancroid: starts as small ulcer but latter becomes raised. It resemble the secondary syphilis.
n7. Dwarf chancroid: a very small lesion which may resemble the erosions of herpes genitalis.
Diagnosis of Chancroid
nDiagnosis is made with Gram’s stain showing characteristic “school of fish” or “ Chinese characters ”.
nPCR (Polymerase chain reaction).
nCulture is difficult.
nNegative dark-field examination, Syphilis serology and HSV culture are all may aid in diagnosis.
Differential diagnosis of Chancroid
Differential diagnosis of Chancroid
Herpes simplex infection
à HSV is preceded by blisters.
à Borders are not undermined
Primary Syphilis
à Borders are indurated, not undermined.
à The lesion is painless.
THERAPY OF CHANCROID
èThe treatment of choice is Azithromycin, 1 g orally in a single dose.
Other recommended alternatives:
èCeftriaxone, 250 mg IM in a single dose or
èCiprofloxacin, 500 mg orally twice daily for 3 days or
èErythromycin, 500 mg orally 4 times daily for 7 days.
Adherence with 4C’s:
1. Compliance with treatment.
2. Counseling for prevention.
3. Condoms: demonstration of correct use.
