What is Chancroid?
Chancroid is a form of sexually transmitted disease caused by the Haemophilus Ducreyi Bacteria. It is common in certain parts of South East Asia and India. This infection can also co-exist with herpesinfection and syphilis infection. The incubation period is about 3 to 14 days.
Clinical Symptoms of Chancroid
Patients often present with 1 or more painful genital ulcers with ragged irregular edges which has a necrotic, purulent base which bleeds easily. The ulcers may be foul smelling and will be associated with bilateral enlarged rubbery groin lymph nodes (Bubo). Scarring may result as a consequence.
Confirmatory tests for Chancroid
1.The smear from the ulcer and the aspirate from the enlarged lymph nodes can be sent for culture for the haemophilus ducreyi bacteria.
2.Smear from the ulcer can also be sent for direct microscopy to look for gram-negative coccobacilli which are arranged in “shoals of fish” pattern.
3.PCR detection of the haemophilus ducreyi bacteria can also be used as a confirmatory test.
Diagnosis is often made by its typical clinical signs and after exclusion of herpes simplex virus infection and syphilis.
General management of ulcer
The ulcer can be cleansed with anti-septic or saline lotion. The enlarged fluctuant suppurative lymph nodes can be aspirated.
Medical treatment of chancroid
The patients can be treated by oral azithromycin 1 gram single dose or intra-muscular injection of one dose of ceftriaxone 250mg.
Other oral antibiotics alternative treatments include:
1.Oral ciprofloxacin 500 mg twice daily for 3 days. However it is contraindicated in pregnant women.
2.Oral co-trimoxazole 2 tablets of 160/800mg twice daily for 1 week.
3.Oral erythromycin 500 mg 4 times daily for one week.
HIV patients and uncircumcised patients may not respond to treatment well as compared to circumcised and non-HIV patients. Especially HIV patients need to be monitored periodically as they are more likely to have treatment failure and their ulcers will take longer to heal. They may require longer courses of medical treatment.
Under normal circumstances, the ulcer will start to heal from 3rd day of treatment. By 1-2 weeks, the ulcer should heal completely. If it takes longer than usual, then suspect other STD infection/ HIV infection, non-STD ulcer condition, patient may also be non-compliant with treatment or the bacteria maybe resistant to the antibiotic used.
Follow up on Chancroid
Patients should be followed up in 1-2 weeks’ time to see if the ulcer resolves if not other STD and HIV screening tests should be done. Culture and repeat microscopy of the smear samples should also be repeated.
Sexual partners who have sexual contact with patients with chancroid 10 days before the onset of the patients’ symptoms should be screened and treated when necessary.