Chancroid

Chancroid - Acute

Definition  

A relatively uncommon (in the United States), localized, sexually-transmitted anogenital infection characterized by a necrotizing ulceration at the site of inoculation and tender suppurative inguinal adenopathy

 

Medical History  

* Multiple sexual contacts

* Prostitution

* Genital herpes simplex

* Foreign travel history finding

 

Findings  

* Genital ulcer

* Genitourinary pain

* Inguinal lymphadenopathy

* Tenderness of male genitalia

 

Tests  

Suspected syphilis  

* Dark field microscopy: Identification of Treponema pallidum by darkfield microscopy can confirm the diagnosis of early syphilis and congenital syphilis (in neonates) .

 

Suspected and known syphilis.  

* Rapid plasma reagin test: A fourfold or greater rise in antibody titer is presumptive of syphilis but requires confirmatory treponemal testing .

 

Suspected genital herpes simplex  

* Herpes simplex virus culture: Genital herpes infection can be confirmed by the isolation of herpes simplex virus (HSV) in cell culture ..

 

Suspected HIV infection  

* HIV-1 and HIV-2 antibody, single assay: The first time a person is found to be seropositive, the initial reactive (positive) result must prompt a repeat screening test.

 

Differential Diagnosis  

* Syphilis - Acute

* Genital herpes simplex

* Granuloma inguinale

* Lymphogranuloma venereum

* Mixed infectious disease

* Genital injury

* False aneurysm of artery

* Inguinal hernia - Acute

* Cancer

* Fixed drug reaction

* Crohn's disease

* Behcet's syndrome

* Lichen planus

* Infection due to Entamoeba histolytica

 

Treatment  

 

Drug Therapy  

 

Suspected and known chancroid  

 

AZITHROMYCIN  

Adults: 1 gram orally in a single dose

 

CEFTRIAXONE SODIUM  

Adults: 250 mg IM in a single dose

 

ERYTHROMYCIN  

Adults: 500 mg orally 3 times daily for 7 days

 

CIPROFLOXACIN  

Adults: 500 mg orally twice daily for 3 days; avoid in pregnant or lactating women

 

Procedural Therapy  

 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

 

At risk for sexually transmitted disease  

* Infection prevention education: Patient education and counseling is one of the essential strategies for the prevention and control of sexually transmitted diseases (STDs) .

 

Non-Procedural Therapy  

 

Chancroid  

* Sexual Abstinence