Makindo Medical Notes

The ulcers can be very painful in men, but women are often unaware of them.

About

• Chancroid is a sexually transmitted infection that has been well established as a cofactor for HIV transmission.

Aetiology

• Caused by the bacterium Haemophilus ducreyi.
• Transmitted through sexual contact, often in areas with poor hygiene and low socioeconomic conditions.

Clinical

• Presents with painful genital ulceration, which can appear on the anus, tongue, vagina, or penis.
• May also cause sores on the mouth, throat, or lips, particularly with oral-genital contact.
• Often associated with localized inguinal or cervical lymphadenopathy (bubo formation).
• The incubation period is typically about 1 week, but it can range from 3 to 10 days.

Investigations

• Culture: Identification of H. ducreyi using special culture media.
• PCR Testing: Polymerase chain reaction (PCR) can confirm the presence of H. ducreyi.
• Serological testing is recommended to rule out co-infections like HIV, syphilis, and herpes simplex virus.

Pathology

• The ulceration caused by H. ducreyi is characterized by a painful, soft ulcer with irregular edges and a purulent base.
• The bacteria invades the epithelial tissue, leading to necrosis and inflammation, which contribute to the painful nature of the sores.

Management

• First-line therapy: Azithromycin 1 g orally in a single dose or Ceftriaxone 250 mg intramuscularly (IM) in a single dose.
• Alternative therapy: Ciprofloxacin 500 mg orally twice daily for 3 days or Erythromycin 500 mg orally 4 times a day for 7 days.
• Ciprofloxacin is contraindicated for pregnant and lactating women; Azithromycin or Ceftriaxone is preferred in these cases.
• Ulcers usually show symptomatic improvement within three days and objective healing within seven days after initiating therapy.
• Sexual partners should be evaluated and treated if contact occurred within 10 days of the patient's onset of symptoms.

References

• CDC: Chancroid Treatment Guidelines
• WHO: Sexually Transmitted Infections (STIs)