Chancroid

Clinical Presentation:

Chancroid is caused by the bacterium Haemophilus ducreyi and results in painful, superficial ulcers, often with regional lymphadenopathy. Chancroid occurs in Asia, Africa, and the Caribbean, and is an important cofactor of HIV transmission. The genital ulcer from chancroid is painful, tender, and nonindurated. Symptoms usually occur 4-10 days after exposure. The lesion at the site of infection is, initially, a pustule that breaks down to form a painful, soft, ulcer with a necrotic base and irregular borders. Multiple lesions and inguinal adenopathy often develop. With lymph node involvement, fever, chills, and malaise may also develop. Other symptoms of chancroid include painful urination, vaginal discharge, rectal bleeding, pain with bowel movements, and dyspareunia.

Diagnostic Testing:

The combination of a painful genital ulcer and tender suppurative inguinal adenopathy suggests the diagnosis of chancroid. A probable diagnosis of chancroid can be made if:

• One or more painful genital ulcers (regional lymphadenopathy is also typical)
• No evidence of T. pallidum infection by darkfield examination of ulcer exudate or by syphilis serologic testing performed at least 7 days after onset of ulcers
• Test for herpes simplex virus performed on the ulcer exudate is negative

A definitive diagnosis of chancroid requires the identification of H. ducreyi on special culture media. However, culture media for chancroid are not widely available. Nucleic acid amplification tests can be performed in clinical laboratories that have developed their own tests.