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Chancroid

What is chancroid?
Chancroid is a highly contagious yet curable sexually transmitted disease (STD) caused by the bacteria Haemophilus Ducreyi [hum-AH-fill-us DOO-cray]. Chancroid causes ulcers, usually of the genitals. Swollen, painful lymph glands,or inguinal buboes [in-GWEEN-al BEW-boes], in the groin area are often associated with chancroid. Left untreated, chancroid may facilitate the transmission of HIV.


How common is it?
Chancroid is very common in Africa and is becoming more common in the United States. Transmission
Chancroid is transmitted in two ways:

  • sexual transmission through skin-to-skin contact with open sore(s).
  • non-sexual transmission by means of autoinoculation when contact is made with the pus-like fluid from the ulcer.

A person is considered to be infectious when ulcers are present. There has been no reported disease in infants born to women with active chancroid at time of delivery.

Signs or Symptoms

  • Symptoms usually occur within 10 days from exposure. They rarely develop earlier than three days or later than 10 days.
  • The ulcer begins as a tender, elevated bump, or papule, that becomes a pus-filled, open sore with eroded or ragged edges.
  • It is soft to the touch (unlike a syphilis chancre that is hard or rubbery). The term soft chancre is frequently used to describe the chancroid sore.
  • The ulcers can be very painful in men but women are often unaware of them.
  • Because chancroid is often asymptomatic in women, they are often unaware of the lesion(s).
  • Painful lymph glands may occur in the groin, usually only on one side; however, they can occur on both sides.

Testing
Diagnosis is made by isolating the bacteria Hemophilus Ducreyi (hum-AH-fill-us DOO-cray) in a culture from a genital ulcer. The chancre is often confused with syphilis, herpes, or lymphogranuloma venereum; therefore, it is important that your health care provider rule these diseases out. A gram stain to identify H. Ducreyi is possible but can be misleading because of other organisms found in most genital ulcers.


Treatment
Chancroid can be treated with antibiotics. Successful treatment cures infection, resolves symptoms and prevents transmission.

Treatment regimens may include the following:

  • Azithromycin
  • Ceftriaxone
  • Ciprofloxacin (not recommended for pregnant or nursing females, or people younger than 18 years.)
  • Erythromycin base

A follow-up examination should be conducted three to seven days after treatment begins. If treatment is successful, ulcers usually improve within three to seven days. The time required for complete healing is related to the size of the ulcer. Large ulcers may require two weeks or longer to heal. In severe cases, scarring may result. Partners should be examined and treated regardless of whether symptoms are present.

Prevention

  • Abstinence (not having sex)
  • Mutual monogamy (having sex with only one uninfected partner)
  • Water-based spermicides can be used along with latex condoms for additional protection during vaginal intercourse. Use of spermicide is not recommended nor found to be effective for oral or anal intercourse.
  • Latex condoms for vaginal, oral and anal sex. Using latex condoms may protect the penis or vagina from infection, but does not protect other areas such as the scrotum or anal area.

If you do get chancroid, avoid contact with the infected area to prevent chance of autoinoculation. Why worry?
Chancroid had been well established as a cofactor for HIV transmission. Moreover, persons with HIV may experience slower healing of chancroid, even with treatment, and may need to take medications for a longer period of time.

Complications from chancroid include:

  • In 50 percent of cases, the lymph node glands in the groin become infected within five to eight days of appearance of initial sores.
  • Glands on one side become enlarged, hard, painful and fuse together to form a bubo (BEW-bo), an inflammation and swelling of one or more lymph nodes with overlying red skin. Surgical drainage of the bubo may be necessary to relieve pain.
  • Ruptured buboes are susceptible to secondary bacterial infections.
  • In uncircumcised males, new scar tissue may result in phimosis (constriction so the foreskin cannot be retracted over the glans). Circumcision may be required to correct this.
Partner Communication
You should talk to your partner as soon as you learn you have chancroid. Telling a partner can be hard, but it's important that you talk to your partner as soon as possible so she or he can get treatment.