Chancroid
Encyclopedia
Chancroid is a sexually transmitted infection characterized by painful sores on the genitalia. Chancroid is known to be spread from one individual to another solely through sexual contact.
In more specific terms, the CDC
's standard clinical definition for a probable case of chancroid includes all of the following:
About half of infected men have only a single ulcer. Women frequently have four or more ulcers, with fewer symptoms. The ulcers appear in specific locations, such as the coronal sulcus of the uncircumcised glans penis in men, or the fourchette
and labia minora
in women.
. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the labia. Other areas such as the labia minora
, perineal
area, and inner thighs may also be involved. The most common symptoms in women are dysuria
(pain with urination) and dyspareunia
(pain with intercourse).
The initial ulcer may be mistaken as a "hard" chancre
, the typical sore of primary syphilis
, as opposed to the "soft chancre" of chancroid.
Approximately one-third of the infected individuals will develop enlargements of the inguinal
lymph nodes, the nodes located in the fold between the leg and the lower abdomen.
Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin, producing draining abscesses. The swollen lymph nodes and abscesses are often referred to as buboes.
l infection
caused by the fastidious
Gram-negative
streptobacillus Haemophilus ducreyi
. It is a disease found primarily in developing countries, most prevalent in low socioeconomic groups, associated with commercial sex workers.
Infection levels are low in the Western world, typically around one case per two million of the population (Canada, France, Australia, UK and US). Most individuals diagnosed with chancroid have visited countries or areas where the disease is known to occur frequently, although outbreaks have been observed in association with crack cocaine use and prostitution.
Chancroid is a risk factor for contracting HIV
, due to their ecological association or shared risk of exposure, and biologically facilitated transmission of one infection by the other.
recommendation for chancroid is a single oral dose (1 gram) of Azithromycin
or a single IM dose of Ceftriaxone
or oral Erythromycin
for seven days.
and chancroid (reference 1 and 2)
Similarities
Differences
Symptoms and signs
After an incubation period of one day to two weeks, chancroid begins with a small bump that becomes an ulcer within a day of its appearance. The ulcer characteristically:- Ranges in size dramatically from 3 to 50 mm (1/8 inch to two inches) across
- Is painful
- Has sharply defined, undermined borders
- Has irregular or ragged borders
- Has a base that is covered with a gray or yellowish-gray material
- Has a base that bleeds easily if traumatized or scraped
In more specific terms, the CDC
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
's standard clinical definition for a probable case of chancroid includes all of the following:
- Patient has one or more painful genital ulcers. The combination of a painful ulcer with tender adenopathy is suggestive of chancroid; the presence of suppurative adenopathy is almost pathognomonic.
- No evidence of Treponema pallidumTreponema pallidumTreponema pallidum is a species of spirochaete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta and yaws. The treponemes have a cytoplasmic and outer membrane...
is indicated by dark-field examination of ulcer or by a serologic test for SyphilisSyphilisSyphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
performed at least 7 days after the onset of ulcer.
- The clinical presentation is not typical of disease caused by human herpesvirus 2 (Herpes Simplex VirusHerpes simplex virusHerpes simplex virus 1 and 2 , also known as Human herpes virus 1 and 2 , are two members of the herpes virus family, Herpesviridae, that infect humans. Both HSV-1 and HSV-2 are ubiquitous and contagious...
), or result of culture for HSV is negative.
About half of infected men have only a single ulcer. Women frequently have four or more ulcers, with fewer symptoms. The ulcers appear in specific locations, such as the coronal sulcus of the uncircumcised glans penis in men, or the fourchette
Frenulum labiorum pudendi
In female human anatomy, the frenulum labiorum pudendi is a frenulum where the labia minora meet posteriorly.-Pathology:...
and labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
in women.
Common locations in women
In women, the most common location for ulcers is the labia majoraLabia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the labia. Other areas such as the labia minora
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
, perineal
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
area, and inner thighs may also be involved. The most common symptoms in women are dysuria
Dysuria
In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
(pain with urination) and dyspareunia
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
(pain with intercourse).
The initial ulcer may be mistaken as a "hard" chancre
Chancre
A chancre is a painless ulceration formed during the primary stage of syphilis. This infectious lesion forms approximately 21 days after the initial exposure to Treponema pallidum, the gram-negative spirochaete bacterium yielding syphilis. Chancres transmit the sexually transmissible disease of...
, the typical sore of primary syphilis
Syphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, as opposed to the "soft chancre" of chancroid.
Approximately one-third of the infected individuals will develop enlargements of the inguinal
Inguinal
In human anatomy, the inguinal region refers to either the groin or the lower lateral regions of the abdomen. It may also refer to:* Conjoint tendon, previously known as the inguinal aponeurotic falx, a structure formed from the transversus abdominis insertion into the pecten pubis* Granuloma...
lymph nodes, the nodes located in the fold between the leg and the lower abdomen.
Half of those who develop swelling of the inguinal lymph nodes will progress to a point where the nodes rupture through the skin, producing draining abscesses. The swollen lymph nodes and abscesses are often referred to as buboes.
Causes
Chancroid is a bacteriaBacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
l infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
caused by the fastidious
Growth medium
A growth medium or culture medium is a liquid or gel designed to support the growth of microorganisms or cells, or small plants like the moss Physcomitrella patens.There are different types of media for growing different types of cells....
Gram-negative
Gram-negative
Gram-negative bacteria are bacteria that do not retain crystal violet dye in the Gram staining protocol. In a Gram stain test, a counterstain is added after the crystal violet, coloring all Gram-negative bacteria with a red or pink color...
streptobacillus Haemophilus ducreyi
Haemophilus ducreyi
Haemophilus ducreyi is a fastidious gram-negative coccobacillus causing the sexually transmitted disease chancroid, a major cause of genital ulceration in developing countries characterized by painful sores on the genitalia. Another early symptom is dark or light green shears in excrement...
. It is a disease found primarily in developing countries, most prevalent in low socioeconomic groups, associated with commercial sex workers.
Infection levels are low in the Western world, typically around one case per two million of the population (Canada, France, Australia, UK and US). Most individuals diagnosed with chancroid have visited countries or areas where the disease is known to occur frequently, although outbreaks have been observed in association with crack cocaine use and prostitution.
Chancroid is a risk factor for contracting HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, due to their ecological association or shared risk of exposure, and biologically facilitated transmission of one infection by the other.
Treatment
The CDCCenters for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
recommendation for chancroid is a single oral dose (1 gram) of Azithromycin
Azithromycin
Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is one of the world's best-selling antibiotics...
or a single IM dose of Ceftriaxone
Ceftriaxone
Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram-positive and Gram-negative bacteria. In most cases, it is considered to be equivalent to cefotaxime in terms of safety and efficacy...
or oral Erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
for seven days.
Comparison with syphilis
There are many differences and similarities between the conditions syphilitic chancreChancre
A chancre is a painless ulceration formed during the primary stage of syphilis. This infectious lesion forms approximately 21 days after the initial exposure to Treponema pallidum, the gram-negative spirochaete bacterium yielding syphilis. Chancres transmit the sexually transmissible disease of...
and chancroid (reference 1 and 2)
Similarities
- Both originate as pustules at the site of inoculation, and progress to ulcerated lesions
- Both lesions are typically 1–2 cm in diameter
- Both lesions are caused by sexually transmissible organisms
- Both lesions typically appear on the genitals of infected individuals
- Both lesions can present at multiple sites and with multiple lesions
Differences
- Chancre is a lesion typical of infection with the bacterium that causes syphilisSyphilisSyphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
, Treponema pallidumTreponema pallidumTreponema pallidum is a species of spirochaete bacterium with subspecies that cause treponemal diseases such as syphilis, bejel, pinta and yaws. The treponemes have a cytoplasmic and outer membrane... - Chancroid is a lesion typical of infection with the bacterium Haemophilus ducreyiHaemophilus ducreyiHaemophilus ducreyi is a fastidious gram-negative coccobacillus causing the sexually transmitted disease chancroid, a major cause of genital ulceration in developing countries characterized by painful sores on the genitalia. Another early symptom is dark or light green shears in excrement...
- Chancres are typically painless, whereas chancroid are typically painful
- Chancres are typically non-exudative, whereas chancroid typically have a grey or yellow purulent exudateExudateAn exudate is any fluid that filters from the circulatory system into lesions or areas of inflammation. It can apply to plants as well as animals. Its composition varies but generally includes water and the dissolved solutes of the main circulatory fluid such as sap or blood...
- Chancres have a hard (indurated) edge, whereas chancroid have a soft edge
- Chancres heal spontaneously within three to six weeks, even in the absence of treatment
- Chancres can occur in the pharynxPharynxThe human pharynx is the part of the throat situated immediately posterior to the mouth and nasal cavity, and anterior to the esophagus and larynx. The human pharynx is conventionally divided into three sections: the nasopharynx , the oropharynx , and the laryngopharynx...
as well as on the genitals
External links
- Vaccine Shown Effective Against Chancroid in Medical News Today (May 9, 2006). Retrieved on May 1, 2008.