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DESCRIPTION
Chancroid (Soft Chancre) is a sexually transmitted disease characterized by painful genital ulcerations. Exposure is usually through sexual intercourse, but accidentally acquired lesions have occurred on the hands. The incubation period is from 3 to 5 days. Chancroid can be transmitted from someone who has no symptoms.
FREQUENT SIGNS & SYMPTOMS
After an incubation period of 1 day to 2 weeks, chancroid begins with a small bump that becomes a small painful lesion (ulcer, sore or boil) within a day of its appearance. It is usually found on the external genitalia. After it becomes an open running ulceration, more lesions often develop. The ulcer characteristically:
- Ranges in size dramatically from 1/8 inch to 2 inches across).
- Is painful.
- Has sharply defined borders.
- Has irregular or ragged borders.
- Has a base that is covered with a grey or yellowish-grey material.
- Has a base that bleeds easily if traumatized or scraped.
The ulcers appear in specific locations. On women, the lesions most commonly appear on the labia majora. "Kissing ulcers" may develop. These are ulcers that occur on opposing surfaces of the skin. Other areas such as the labia minora, cervix, perineal area, and inner thighs may also be involved. The most common symptoms in women are pain with urination and pain with intercourse. Some women may have no external signs of infection. Women frequently have 4 or more ulcers. About half of men only have a single ulcer.
Common locations in men (most common to least common) are:
- Foreskin (prepuce).
- Groove behind the head of the penis (coronal sulcus).
- Shaft of the penis.
- Head of the penis (glans).
- Opening of the penis (urethral meatus).
- Scrotum.
The initial ulcer may be mistaken as a chancre, the typical sore of primary syphilis. See Diagnosis below.
Approximately half (50%) of the infected individuals will develop enlargements of the inguinal lymph nodes. The inguinal lymph nodes are located in the fold between the leg and the lower abdomen and can become tender, enlarged and matted together, forming an abscess (bubo) in the groin. The swollen lymph nodes and abscesses are often referred to as buboes.
CAUSES
Chancroid is a sexually transmitted infection caused by the Haemophilusducreyi, a Gram negative bacterium. The main symptoms is genital sores that rupture after a few days. The disease is found primarily in developing and third world countries. Only a few hundred cases a year are diagnosed in the United States. The majority of individuals in the U.S. diagnosed with chancroid have traveled outside the country to areas where the disease is known to occur frequently. Uncircumcised men are at a much higher risk than circumsized men for contracting chancroid from an infected partner. Chancroid is a risk factor for contracting the HIV virus.
RISK INCREASES WITH
Multiple sexual partners.
HIV infection.
PREVENTION MEASURES
Practice safe sex. Abstinence is the only safe sure prevention. However, safe sex practices are helpful in preventing the spread of chancroid.
Use a condom. Condoms provide very good protection from the spread of most sexually transmitted diseases when used properly and consistently.
Do not touch or have sexual contact with anyone that has open lesions.
Monogamous sexual relations with a known disease-free partner is the safest and most practical "safe sex" method.
EXPECTED OUTCOME
Complete healing with appropriate treatment. However, some people may experience months of painful ulceration and draining. Antibiotic treatment usually results in rapid clearing of lesions with a minimal to small amount of scarring.
In some patients, the chancroid sores heal spontaneously.
POSSIBLE COMPLICATIONS
Scarring.
Untreated or inadequately treated cases of chancroid may persist and secondary infection may develop.
Urethral fistulas.
Phimosis in uncircumcised males (scars on the foreskin of the penis).
Patients with chancroid should also be checked for syphilis, HIV, and genital herpes.
Patients with HIV may take much longer to heal.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnostic tests may include a culture of fluid from the lesions and laboratory blood studies and evaluating the ulcers and presence of swollen lymph nodes. There is no lab test for chancroid like there is for syphilis.
If it's a chancre sore, you can expect a diagnosis of syphilis. The sore itself is painless and will disappear on its own in three to eight weeks but if untreated, the underlying syphilis infection will remain to ravage the body in later years. Of the two kinds of sores, this is the more insidious one: easy to ignore, yet ultimately life-threatening.
Chancroid, on the other hand, is much more likely to send you to your health care provider in a hurry. The sores are painful, tend to merge into large patches of damaged tissue, and are often accompanied by an infected abscess in the groin. If left untreated, they can spread to new locations; and they provide an ideal entryway for HIV, the cause of AIDS.
Sexual partners should be examined also.
TREATMENT
Treatment is with antibiotic medications including azithromycin, ceftriaxone, ciprofloxacin, and erythromycin. Large buboes in the lymph nodes may require needle aspiration or local surgery.
Warm sitz baths may help ease any pain or discomfort. Sit in a bathtub with warm water 8 to 10 inches deep for 15 to 20 minutes. Do this 2 to 3 times a day.
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Other sexually transmitted diseases (STDs) are often present and will need to be treated.
Additional information available from: Sexually Transmitted Diseases Hotline
(800)227-8922.
MEDICATION
An antibiotic medication will be prescribed. The treatment regimen may consist of a single dose or treatment for a week depending upon the medication used.
ACTIVITY
Avoid sexual activity until healing is complete.
DIET
No special diet. However, a good nutritionally sound diet will aid in tissue repair and strengthening the immune system.
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NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You have any of the following occurs:
- You or your sexual partner has signs and symptoms of chancroid or have had sexual contact with a person known to have any STD, or if you have engaged in high-risk sexual practices.
- Symptoms worsen after treatment is started.
- New or unexplained symptoms develop. Drugs used in treatment may cause side effects.
