Chancroid Clinical Presentation

Chancroid is considered one of the classical ulcerative genital diseases that is caused by Gram-negative bacterial pathogen Haemophilus ducreyi. This disease is commonly observed (and sporadically endemic) in the poorest regions of the world that have weak public health infrastructure (such as Asia, Africa and the Caribbean).

Following infection with Haemophilus ducreyi there is an incubation period between three and seven days in length, without any prodromal symptoms. This period may be even longer if pre-existing infection with human immunodeficiency virus (HIV) is present. A history of recent sexual activity (often with a commercial sex worker) may also be noted.

Lesion Development and Location

The initial lesion presents as a tender, inconspicuous papule with surrounding peripheral erythema (also known as erythematous halo) that swiftly develops into a pustule, and subsequently into a soft and painful ulcer. Central necrosis ensues, which leads to a characteristic painful ulcer with slightly raised and undermined edges.

Chancroid ulcer is classically described as “ulcus molle,” or a soft non-indurated sore, which is different in comparison to the indurated ulcer seen in syphilis. However, a large number of patients may exhibit poor personal hygiene, which results in secondary bacterial infections. This in turn makes the ulcer indurated and a lot more painful.

Regional inflammation and enlargement of one or more lymph nodes (also known as ‘bubo’) accompanies chancroid ulcer in more than 40 percent of all patients. Buboes are usually located only on one side of the body and coupled with erythema of the superjacent skin. They sometimes spontaneously rupture and form inguinal sinuses.

The most common lesion location in men is the inner part of the foreskin, while the frenulum and coronal sulcus of the penis may also be affected. In women the lesions are seen in the labia, posterior commissure and urethral orifice (albeit occasionally both cervix and vagina may be involved).

Anal lesions are also common, originating from anal sexual intercourse or autoinoculation. Extragenital lesions may also be observed, especially in individuals with HIV, and are usually located in the hands, around the mouth, on the inner parts of the thigh, as well as in the inguinal fold.

Types of Chancroid

Men affected with chancroid usually harbor a single lesion, while in women multiple lesions are typically observed. Furthermore, the size of lesion may be highly variable, and two main types are dwarf chancroid (smaller than 0.5 centimeters in size) and giant chancroid (2 centimeters or larger). However, a myriad of unusual variations and types of chancroid have been described.

For example, when an ulcer involves one or more follicles in the pubic mound, the condition is known as follicular chancroid. On the other hand, papular chancroid is a designation we use if there is a rise of granulation tissue from the ulcer base above the surface of the skin. Transient chancroid is a term for a tiny papule that is often overlooked, but characteristic lymphadenopathy is present.

Mixed infections (particularly with spirochetal organisms) result in massive ulcers and tissue destruction – this is called phagadenic chancroid. The variant of the latter type of chancroid is serpiginous chancroid, characterized by progressive lesions towards the umbilical region or down the thighs.

Reviewed by Afsaneh Khetrapal Bsc (Hons)

Sources

  1. http://www.antimicrobe.org/new/b80.asp
  2. http://www.iusti.org/regions/europe/pdf/2017/chancroid.pdf
  3. http://www.diseaseamonth.com/article/S0011-5029(16)00091-2/fulltext
  4. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2007.03435.x/pdf
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1744597/pdf/v079p00068.pdf
  6. Sakuma TH, Dal’Asta Coimbra D, Lupi O. Chancroid. In: Gross G, Tyring SK. Sexually Transmitted Infections and Sexually Transmitted Diseases. Springer Science & Business Media, 2011; pp. 183-190.

Further Reading

Last Updated: Oct 19, 2017

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