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. 2003 Feb;79(1):68–71. doi: 10.1136/sti.79.1.68

Chancroid: clinical manifestations, diagnosis, and management

D Lewis 1
PMCID: PMC1744597  PMID: 12576620

Abstract

Chancroid is a sexually transmitted disease (STD) caused by the Gram negative bacterium Haemophilus ducreyi and is characterised by necrotising genital ulceration which may be accompanied by inguinal lymphadenitis or bubo formation. H ducreyi is a fastidious organism which is difficult to culture from genital ulcer material. DNA amplification techniques have shown improved diagnostic sensitivity but are only performed in a few laboratories. The management of chancroid in the tropics tends to be undertaken in the context of syndromic management of genital ulcer disease and treatment is usually with erythromycin. A number of single dose regimens are also available to treat H ducreyi infection. Genital ulceration as a syndrome has been associated with increased transmission of human immunodeficiency virus (HIV) infection in several cross sectional and longitudinal studies. Effective and early treatment of genital ulceration is therefore an important part of any strategy to control the spread of HIV infection in tropical countries.

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Selected References

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  1. Al-Tawfiq J. A., Thornton A. C., Katz B. P., Fortney K. R., Todd K. D., Hood A. F., Spinola S. M. Standardization of the experimental model of Haemophilus ducreyi infection in human subjects. J Infect Dis. 1998 Dec;178(6):1684–1687. doi: 10.1086/314483. [DOI] [PubMed] [Google Scholar]
  2. Albritton W. L. Biology of Haemophilus ducreyi. Microbiol Rev. 1989 Dec;53(4):377–389. doi: 10.1128/mr.53.4.377-389.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Behets F. M., Liomba G., Lule G., Dallabetta G., Hoffman I. F., Hamilton H. A., Moeng S., Cohen M. S. Sexually transmitted diseases and human immunodeficiency virus control in Malawi: a field study of genital ulcer disease. J Infect Dis. 1995 Feb;171(2):451–455. doi: 10.1093/infdis/171.2.451. [DOI] [PubMed] [Google Scholar]
  4. Bogaerts J., Vuylsteke B., Martinez Tello W., Mukantabana V., Akingeneye J., Laga M., Piot P. Simple algorithms for the management of genital ulcers: evaluation in a primary health care centre in Kigali, Rwanda. Bull World Health Organ. 1995;73(6):761–767. [PMC free article] [PubMed] [Google Scholar]
  5. Bong Cliffton T. H., Harezlak Jaroslaw, Katz Barry P., Spinola Stanley M. Men are more susceptible than women to pustule formation in the experimental model of Haemophilus ducreyi infection. Sex Transm Dis. 2002 Feb;29(2):114–118. doi: 10.1097/00007435-200202000-00009. [DOI] [PubMed] [Google Scholar]
  6. Cameron D. W., Simonsen J. N., D'Costa L. J., Ronald A. R., Maitha G. M., Gakinya M. N., Cheang M., Ndinya-Achola J. O., Piot P., Brunham R. C. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. doi: 10.1016/s0140-6736(89)90589-8. [DOI] [PubMed] [Google Scholar]
  7. Chapel T. A., Brown W. J., Jeffres C., Stewart J. A. How reliable is the morphological diagnosis of penile ulcerations? Sex Transm Dis. 1977 Oct-Dec;4(4):150–152. doi: 10.1097/00007435-197710000-00008. [DOI] [PubMed] [Google Scholar]
  8. Chen C. Y., Ballard R. C., Beck-Sague C. M., Dangor Y., Radebe F., Schmid S., Weiss J. B., Tshabalala V., Fehler G., Htun Y. Human immunodeficiency virus infection and genital ulcer disease in South Africa: the herpetic connection. Sex Transm Dis. 2000 Jan;27(1):21–29. doi: 10.1097/00007435-200001000-00005. [DOI] [PubMed] [Google Scholar]
  9. Chui L., Albritton W., Paster B., Maclean I., Marusyk R. Development of the polymerase chain reaction for diagnosis of chancroid. J Clin Microbiol. 1993 Mar;31(3):659–664. doi: 10.1128/jcm.31.3.659-664.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Dallabetta G. A., Gerbase A. C., Holmes K. K. Problems, solutions, and challenges in syndromic management of sexually transmitted diseases. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S1–11. [PubMed] [Google Scholar]
  11. Dangor Y., Ballard R. C., da L Exposto F., Fehler G., Miller S. D., Koornhof H. J. Accuracy of clinical diagnosis of genital ulcer disease. Sex Transm Dis. 1990 Oct-Dec;17(4):184–189. doi: 10.1097/00007435-199010000-00007. [DOI] [PubMed] [Google Scholar]
  12. Dangor Y., Radebe F., Ballard R. C. Transport media for Haemophilus ducreyi. Sex Transm Dis. 1993 Jan-Feb;20(1):5–9. doi: 10.1097/00007435-199301000-00002. [DOI] [PubMed] [Google Scholar]
  13. DiCarlo R. P., Armentor B. S., Martin D. H. Chancroid epidemiology in New Orleans men. J Infect Dis. 1995 Aug;172(2):446–452. doi: 10.1093/infdis/172.2.446. [DOI] [PubMed] [Google Scholar]
  14. DiCarlo R. P., Martin D. H. The clinical diagnosis of genital ulcer disease in men. Clin Infect Dis. 1997 Aug;25(2):292–298. doi: 10.1086/514548. [DOI] [PubMed] [Google Scholar]
  15. Ernst A. A., Marvez-Valls E., Martin D. H. Incision and drainage versus aspiration of fluctuant buboes in the emergency department during an epidemic of chancroid. Sex Transm Dis. 1995 Jul-Aug;22(4):217–220. doi: 10.1097/00007435-199507000-00003. [DOI] [PubMed] [Google Scholar]
  16. Fleming D. T., Wasserheit J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb;75(1):3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hammond G. W., Slutchuk M., Scatliff J., Sherman E., Wilt J. C., Ronald A. R. Epidemiologic, clinical, laboratory, and therapeutic features of an urban outbreak of chancroid in North America. Rev Infect Dis. 1980 Nov-Dec;2(6):867–879. doi: 10.1093/clinids/2.6.867. [DOI] [PubMed] [Google Scholar]
  18. Htun Y., Morse S. A., Dangor Y., Fehler G., Radebe F., Trees D. L., Beck-Sague C. M., Ballard R. C. Comparison of clinically directed, disease specific, and syndromic protocols for the management of genital ulcer disease in Lesotho. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S23–S28. [PubMed] [Google Scholar]
  19. Johnson S. R., Martin D. H., Cammarata C., Morse S. A. Development of a polymerase chain reaction assay for the detection of Haemophilus ducreyi. Sex Transm Dis. 1994 Jan-Feb;21(1):13–23. doi: 10.1097/00007435-199401000-00004. [DOI] [PubMed] [Google Scholar]
  20. Kimani J., Bwayo J. J., Anzala A. O., MacLean I., Mwatha A., Choudri S. H., Plummer F. A., Ronald A. R. Low dose erythromycin regimen for the treatment of chancroid. East Afr Med J. 1995 Oct;72(10):645–648. [PubMed] [Google Scholar]
  21. King R., Choudhri S. H., Nasio J., Gough J., Nagelkerke N. J., Plummer F. A., Ndinya-Achola J. O., Ronald A. R. Clinical and in situ cellular responses to Haemophilus ducreyi in the presence or absence of HIV infection. Int J STD AIDS. 1998 Sep;9(9):531–536. doi: 10.1258/0956462981922773. [DOI] [PubMed] [Google Scholar]
  22. King R., Gough J., Ronald A., Nasio J., Ndinya-Achola J. O., Plummer F., Wilkins J. A. An immunohistochemical analysis of naturally occurring chancroid. J Infect Dis. 1996 Aug;174(2):427–430. doi: 10.1093/infdis/174.2.427. [DOI] [PubMed] [Google Scholar]
  23. Kreiss J. K., Coombs R., Plummer F., Holmes K. K., Nikora B., Cameron W., Ngugi E., Ndinya Achola J. O., Corey L. Isolation of human immunodeficiency virus from genital ulcers in Nairobi prostitutes. J Infect Dis. 1989 Sep;160(3):380–384. doi: 10.1093/infdis/160.3.380. [DOI] [PubMed] [Google Scholar]
  24. Lewis D. A. Chancroid: from clinical practice to basic science. AIDS Patient Care STDS. 2000 Jan;14(1):19–36. doi: 10.1089/108729100318109. [DOI] [PubMed] [Google Scholar]
  25. Lewis D. A. Diagnostic tests for chancroid. Sex Transm Infect. 2000 Apr;76(2):137–141. doi: 10.1136/sti.76.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. MacDonald K. S., Cameron D. W., D'Costa L., Ndinya-Achola J. O., Plummer F. A., Ronald A. R. Evaluation of fleroxacin (RO 23-6240) as single-oral-dose therapy of culture-proven chancroid in Nairobi, Kenya. Antimicrob Agents Chemother. 1989 May;33(5):612–614. doi: 10.1128/aac.33.5.612. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Malonza I. M., Tyndall M. W., Ndinya-Achola J. O., Maclean I., Omar S., MacDonald K. S., Perriens J., Orle K., Plummer F. A., Ronald A. R. A randomized, double-blind, placebo-controlled trial of single-dose ciprofloxacin versus erythromycin for the treatment of chancroid in Nairobi, Kenya. J Infect Dis. 1999 Dec;180(6):1886–1893. doi: 10.1086/315133. [DOI] [PubMed] [Google Scholar]
  28. Morse S. A. Chancroid and Haemophilus ducreyi. Clin Microbiol Rev. 1989 Apr;2(2):137–157. doi: 10.1128/cmr.2.2.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Morse S. A. Etiology of genital ulcer disease and its relationship to HIV infection. Sex Transm Dis. 1999 Jan;26(1):63–65. doi: 10.1097/00007435-199901000-00010. [DOI] [PubMed] [Google Scholar]
  30. Morse S. A., Trees D. L., Htun Y., Radebe F., Orle K. A., Dangor Y., Beck-Sague C. M., Schmid S., Fehler G., Weiss J. B. Comparison of clinical diagnosis and standard laboratory and molecular methods for the diagnosis of genital ulcer disease in Lesotho: association with human immunodeficiency virus infection. J Infect Dis. 1997 Mar;175(3):583–589. doi: 10.1093/infdis/175.3.583. [DOI] [PubMed] [Google Scholar]
  31. O'Farrell N. Increasing prevalence of genital herpes in developing countries: implications for heterosexual HIV transmission and STI control programmes. Sex Transm Infect. 1999 Dec;75(6):377–384. doi: 10.1136/sti.75.6.377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Orle K. A., Gates C. A., Martin D. H., Body B. A., Weiss J. B. Simultaneous PCR detection of Haemophilus ducreyi, Treponema pallidum, and herpes simplex virus types 1 and 2 from genital ulcers. J Clin Microbiol. 1996 Jan;34(1):49–54. doi: 10.1128/jcm.34.1.49-54.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Parsons L. M., Waring A. L., Otido J., Shayegani M. Laboratory diagnosis of chancroid using species-specific primers from Haemophilus ducreyi groEL and the polymerase chain reaction. Diagn Microbiol Infect Dis. 1995 Nov;23(3):89–98. doi: 10.1016/0732-8893(95)00172-7. [DOI] [PubMed] [Google Scholar]
  34. Plummer F. A., Simonsen J. N., Cameron D. W., Ndinya-Achola J. O., Kreiss J. K., Gakinya M. N., Waiyaki P., Cheang M., Piot P., Ronald A. R. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis. 1991 Feb;163(2):233–239. doi: 10.1093/infdis/163.2.233. [DOI] [PubMed] [Google Scholar]
  35. Plummer F. A., Wainberg M. A., Plourde P., Jessamine P., D'Costa L. J., Wamola I. A., Ronald A. R. Detection of human immunodeficiency virus type 1 (HIV-1) in genital ulcer exudate of HIV-1-infected men by culture and gene amplification. J Infect Dis. 1990 Apr;161(4):810–811. doi: 10.1093/infdis/161.4.810. [DOI] [PubMed] [Google Scholar]
  36. Schmid G. P., Faur Y. C., Valu J. A., Sikandar S. A., McLaughlin M. M. Enhanced recovery of Haemophilus ducreyi from clinical specimens by incubation at 33 versus 35 degrees C. J Clin Microbiol. 1995 Dec;33(12):3257–3259. doi: 10.1128/jcm.33.12.3257-3259.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Schmid G. P., Sanders L. L., Jr, Blount J. H., Alexander E. R. Chancroid in the United States. Reestablishment of an old disease. JAMA. 1987 Dec 11;258(22):3265–3268. [PubMed] [Google Scholar]
  38. Schmid G. P. Treatment of chancroid, 1997. Clin Infect Dis. 1999 Jan;28 (Suppl 1):S14–S20. doi: 10.1086/514727. [DOI] [PubMed] [Google Scholar]
  39. Sturm A. W., Zanen H. C. Characteristics of Haemophilus ducreyi in culture. J Clin Microbiol. 1984 May;19(5):672–674. doi: 10.1128/jcm.19.5.672-674.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Totten P. A., Morton W. R., Knitter G. H., Clark A. M., Kiviat N. B., Stamm W. E. A primate model for chancroid. J Infect Dis. 1994 Jun;169(6):1284–1290. doi: 10.1093/infdis/169.6.1284. [DOI] [PubMed] [Google Scholar]
  41. Trees D. L., Morse S. A. Chancroid and Haemophilus ducreyi: an update. Clin Microbiol Rev. 1995 Jul;8(3):357–375. doi: 10.1128/cmr.8.3.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Tyndall M. W., Agoki E., Plummer F. A., Malisa W., Ndinya-Achola J. O., Ronald A. R. Single dose azithromycin for the treatment of chancroid: a randomized comparison with erythromycin. Sex Transm Dis. 1994 Jul-Aug;21(4):231–234. doi: 10.1097/00007435-199407000-00010. [DOI] [PubMed] [Google Scholar]
  43. Tyndall M., Malisa M., Plummer F. A., Ombetti J., Ndinya-Achola J. O., Ronald A. R. Ceftriaxone no longer predictably cures chancroid in Kenya. J Infect Dis. 1993 Feb;167(2):469–471. doi: 10.1093/infdis/167.2.469. [DOI] [PubMed] [Google Scholar]
  44. Van Dyck E., Bogaerts J., Smet H., Tello W. M., Mukantabana V., Piot P. Emergence of Haemophilus ducreyi resistance to trimethoprim-sulfamethoxazole in Rwanda. Antimicrob Agents Chemother. 1994 Jul;38(7):1647–1648. doi: 10.1128/aac.38.7.1647. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Viravan C., Dance D. A., Ariyarit C., Looareesuwan S., Wattanagoon Y., Davis T. M., Wuthiekanun V., Tantivanich S., Angus B. J., White N. J. A prospective clinical and bacteriologic study of inguinal buboes in Thai men. Clin Infect Dis. 1996 Feb;22(2):233–239. doi: 10.1093/clinids/22.2.233. [DOI] [PubMed] [Google Scholar]
  46. West B., Wilson S. M., Changalucha J., Patel S., Mayaud P., Ballard R. C., Mabey D. Simplified PCR for detection of Haemophilus ducreyi and diagnosis of chancroid. J Clin Microbiol. 1995 Apr;33(4):787–790. doi: 10.1128/jcm.33.4.787-790.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]

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