Chancroid
Dr. Mehenaz Alam
Assistant professor
Department of dermatology
Barind medical college and hospital
Rajshahi
Definition
An infectious, ulcerative STD caused by the gram
negative bacillus Haemophilus ducreyi characterized
by presence of one or more deep or superficial tender
ulcers on the genitalia and painful inguinal adenitis in
50% which may suppurate
Epidemiology
Age: sexually active people
Sex: male outnumber women in many fold
Etiology
Haemophilus ducreyi
Incubation period
1-5 days
Site of infection
Men: penis, perianal area
Women: vulva, cervix, perianal area
Extragenital: hands, eyelid, lips, breast
Clinical features
Begins as inflammatory macule or pustule that ruptures early with formation of ragged
ulcer.
Typically ulcers are :
• Multiple
• Painful
• Soft
• Punched out ulcer
• Undermined, irregular edges
• Surrounded by mild hyperemia
• Base covered with purulent exudate
• Bleeds easily
• Very tender
• Lacks of indurations
Chancroid ulcer
Chancroid ulcer
Chancroid ulcer
Clinical features…
Lymphadenopathy typically are
• Unilateral
• Tender
• Suppurative
• May rupture spontaneously
Differential diagnosis
Chancre
Herpes progenitalis
Traumatic ulceration
Lymphogranuloma venereum
Granuloma inguinale
Investigations
Routine:
• Complete blood count
• Urine R/M/E
• Random blood sugar
• VDRL
• TPHA
Investigations…
Specific:
Direct microscopic examination:
• Specimen: smear from purulent ulcer base and
active border without cleaning
• Stain: Gram stain, Giemsa stain
• Findings: Gram negative bacilli are found in small
cluster as parallel chain or rail tract appearance
Microscopic examination:
Gram negative bacilli are found in small cluster as parallel chain
or rail tract appearance
Haemophilus ducreyi
Investigations…
Culture and sensitivity:
• Specimen: purulent ulcer base and active border
• Findings: small , nonmucoid, yellow gray translucent
colony in 2-4 days
Skin biopsy for histopathology
PCR
Multiple PCR
Immunochromatography of antibody of [Link]
Treatment
General measures:
• Counselling and education
• Practice of safe sex: use of condom, single partner
• Avoidance of sex until lesion heal
• Treatment of partner
Treatment…
Specific measures:
Treatment of choice:
• Azithromycin 1 gm oral single dose
Alternative:
• Erythromycin 500 mg 6 hourly for 7 days or
• Ceftriaxone 250 mg I/M single dose or
• Ciprofloxacin 500 mg 12 hourly for 3 days
Treatment…
Treatment of partner:
• Partners who have had sexual contact with the
patient within the 10 days before onset of symptoms
should be treated with the recommended regimen
Complications
Phimosis
Paraphimosis
HIV transmission
Painful inguinal adenitis
Thank you