CHANCROID


Chancroid (Kan-kroid) is also known as:

  • soft chancre
  • venereal sore

Chancroid ( human genital ulcer disease) is an STD caused by exposure to:

Haemophilus ducreyi (a small gram-negative rod organism) which occurs mainly in developing countries, especially the African, Asian and Latin American nations.

Infection from Chancroid related to Haemophilus ducreyi is decreasing in many areas but increasing in infections related to Herpes simplex virus type-2 (HSV-2).

Chancroid is a bacterial disease causing painful, irregularly shaped sores, but is a localized infection which can be treated and cured and has no long-term effects.

The size can vary from 1-2 millimeters to several centimeters but is usually 1-2 centimeters in diameter.

The shape can be:

  • irregular
  • oval
  • round

Unlike the chancre of syphilis:

  • the chancroid ulcer edge is soft\
  • the ulcer changes shape when the edges are squeezed

Over 4,000 cases are reported annually occurring mainly in younger adults, although it can affect any age.

 

Chancroid Symptoms

First signs of infection appear from 3-5 days and up to 2 weeks after contact, and usually a tender, raised bump develops where the bacteria entered the body:

  • inside/outside the vagina or rectum
  • occasionally on hands, thighs or mouth
    on the penis

Within 1-4 days the bump transforms into one or more shallow sores which break open and deepen, becoming:

  • filled with pus
  • inflamed
  • painful
  • ruptured

The next stage may persist for several weeks and may result in:

  • a painful open sore
  • purulent base of the ulcer
  • several lesions merging to form gigantic ulcers

In over half of the untreated cases the chancroid bacteria infects the lymph glands in the groin.

The lymph glands in the groin may

  • swell, creating a pus-filled bulge, known as a bubo
  • enlarge until they burst through the skin
  • drain continuously
  • remain open
  • become infected by other bacteria
  • may be firm or fluctuant
  • may rupture or ulcerate

The typical chancroid bubo:

  • appears about 1-2 weeks after the ulcer forms
  • is unilateral, spherical, and painful

In men

  • 1-4 sores on the penis may develop
  • Buboes appear in about 50% of male patients
  • The foreskin may swell

The ulcers usually are found in:

  • the prepuce near the frenulum
  • coronal sulcus
  • glans

Rectal sores may:

  • bleed
  • cause pain when defecating

In women

  • Buboes are uncommon in women
  • Dyspareunia (painful sex)
  • Dysuria (painful urination)
  • Painless sores can develop on the cervix
  • Several sores may develop around the vagina and rectum
  • Vaginal discharge

The ulcers usually are found on the:

  • Cervix
  • Entrance of the vagina, particularly the fourchette
  • Labia majora and minora
  • Peri-anal area

Rectal sores may:

  • bleed
  • cause pain when defecating

Click here to view photos of Chancroids

Chancroid Transmission

Chancroid is transmitted through the skin by direct sexual contact with an infected individual through

  • anal sex
  • oral sex
  • vaginal sex

The infection is spread to other parts of the body by:

  • minor abrasions
  • physical contact
  • rubbing
  • scratching

Other

An uncircumcised man is more likely to contract the disease than a circumcised man
Any sexually active person can be infected with chancroid
If a person does not practice personal hygiene it is easier for the infection to be transmitted
It is more commonly seen in men than in women

Risk Factors

Contact between scraped or broken infected skin increases the likelihood of transmission
Ejaculation is not necessary for the infection to be spread
Even if using a condom, sores may be present on areas not protected by the latex and can cause infection anywhere they contact receptive tissue
The bacteria are more likely to invade the sexual organs at the point of a pre-existing injury, such as a small cut or scratch

More outbreaks occur in:

  • drug users
  • people with other STDs
  • prostitutes and their clients

Re-infection can occur from:

  • minor abrasions
  • open wounds

The disease is not spread from person to person by casual contact such as:

  • clothing
  • door knobs
  • eating utensils
  • swimming pools
  • toilet seats
  • mothers do not pass it on to babies at birth

 

How are Chancroid Diagnosed

Chancroid is usually diagnosed by:

  • Culture or biopsy
  • Gram Stain
  • Microscopic examination of a smear sample taken from the patient’s sores

Although the disease does not enter the bloodstream a blood sample is usually taken to check for the presence of other STDs.

Culture

Diagnosis requires culturing H ducreyi on special culture medium that is not always available
The sensitivity is not higher than 75%
The organism specimens should be checked out immediately at the clinic or sent rapidly (within 4 hours) to the laboratory

Gram Stain

Sensitivity range from 10-90%
The classic description of H ducreyi is that of a ‘school of fish’ with small, pleomorphic, gram-negative rods
Has limitations in diagnosing chancroid

Serology (blood test):

Inability to distinguish acute from past exposure

Calcium alginate or plastic swabs should be used for collection of samples

New techniques for diagnosis of chancroid are constantly being researched such as:

Antigen-detection techniques involving immuno-fluorescence or radio-isotopic probes
Detection of nucleic acid (DNA) by amplification techniques such as Polymerase Chain Reaction (PCR) which is 95% sensitive compared to a culture specimen

Note

The doctor or health professional should be advised if the patient has a history of HIV infection as HIV seropositivity can be responsible for an atypical presentation of chancroid.

HIV-infected patients have :

  • a larger number of ulcers
  • atypical ulcers and extra-genital lesions
  • longer lasting ulcers

Screening for other possible causes of genital ulcerative disease should be arranged, particularly the diagnosis of:

Donovanosis (Granuloma inguinale)
Herpes simplex virus (HSV)
Lymphogranuloma venereum (LGV) caused by a virus and spread by sexual intercourse and contaminated articles
Treponema pallidum, the organism that causes syphilis

Biopsy of lymph nodes may be required to exclude:

Neoplasia (the presence of new growths or tumors)

 

Chancroid Treatment

Buboes may need to be drained with a needle under local anesthetic.

Although treatment with antibiotics can cure the infection, strains are becoming more common that are resistant to:

  • Ampicillin
  • Chloramphenicol
  • Penicillin,
  • Tetracycline



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Conventional Treatment

Current treatment involves regular doses for up to two weeks of:

  • Ciprofloxacin
  • Erythromycin
  • Trimethoprin

or a single dose of:

  • Azithromycin
  • Ceftriaxone

Chancroid Drug Information

Azithromycin (Zithromax):

Treats Chlamydial and Gonorrheal infections of the genital tract
Treats Mild to moderately severe infections caused by susceptible strains of microorganisms

Contraindications

Concurrent Pimozide treatment (sudden death may occur)
Hepatic impairment
Hypersensitivity

Interactions with other substances
Decreased effects if taking:

Aluminum antacids
Magnesium antacids

Increased toxicity of:

Digoxin
Theophylline
Warfarin

If taking Cyclosporine there is an increased risk of:

Nephrotoxicity
Neurotoxicity

Side Effects

Bacterial or fungal overgrowth with prolonged use
Cholestatic jaundice
May increase hepatic enzymes
Site reactions can occur with IV route

Caution

Care should be used when dealing with patients:

who are debilitated
who are geriatric
who are hospitalized
with pneumonia

During Pregnancy

It has not been established if it is safe for pregnant and lactating women

Ceftriaxone (Rocephin):

Stop bacterial growth by binding to one or more penicillin-binding proteins

Contraindications

Hypersensitivity

Interactions with other substances
Probenecid may increase levels of:

Ceftriaxone

Nephrotoxicity increases if taking:

Aminoglycosides
Ethacrynic Acid
Furosemide

During Pregnancy

Thought to be safe but benefits must outweigh the risks

Caution

Dosage should be adjusted in renal impairment
Should not be used by breastfeeding women
Should not be used if allergic to penicillin

Erythromycin is used to inhibit:

Bacterial growth
RNA-dependent protein synthesis

Note

Erythromycin is used to treat patients allergic to:

Cephalosporines
Quinolones

Contraindications

Hepatic impairment
Hypersensitivity

Interactions with other substances
Increases toxicity of:

Carbamazepine
Cyclosporine
Digoxin
Theophylline

Anticoagulant effects potentiated of:

warfarin

Increased risk of Rhabdomyolysis if taking:

Lovastatin
Simvastatin

Side-Effects

Adverse gastro-intestinal effects
Cholestatic jaundice may occur

During Pregnancy

Thought to be safe but benefits must outweigh the risks

Caution

In liver disease

Discontinue if the following occurs:

Abdominal colic
Fever
Malaise
Nausea
Vomiting

Ciprofloxacin (Cipro)

Is a bactericidal antibiotic that is used to inhibit:

Bacterial DNA synthesis and growth

Contraindication

Hypersensitivity
Should not be used for children and adolescents under 18

Interactions with other substances
Serum concentrations may be increased if taking:

Probenecid

Serum levels may be reduced if taking:

Antacids,
Iron salts
zinc salts

If taking Cimetidine it may interfere with the metabolism of:

Fluoroquinolones

Reduces the therapeutic effects of:

Phenytoin

Increases the toxicity of:

Caffeine
Cyclosporine
Digoxin
Theophylline

Note

Digoxin levels should always be monitored
If it is necessary to take antacids always have them 2-4 hours before or after taking Fluoroquinolones

The effects of anticoagulants may be increased

During Pregnancy

Ciprofloxacin is contraindicated for pregnant and lactating women

Caution

Dosage should be adjusted in renal function impairment
Superinfections may occur with prolonged or repeated therapy

The addition of proteolytic enzymes to antibiotic treatments has been shown to improve the effectiveness of the antibiotics.

Follow-up

An examination should be carried out 7 days after starting treatment. If there is no obvious improvement several possibilities should be considered:

  • Fluctuant lymphadenopathy (swelling and inflammation of the lymph glands) takes longer to heal than ulcers
  • Large ulcers take more time to heal than small ulcers
  • The course of antibiotics was not adhered to properly
  • The H ducreyi strain may be resistant to the prescribed antibiotic
  • The person may have HIV making healing slower
  • The presence of another STD or illness

In HIV-positive patients:

Cure rates using standard antibiotic treatments are lower than in the general population
Longer treatment courses are usually necessary

Naturopathic Treatments

Abstinence from sexual activity while healing from the bacterial infection
To fortify the immune system to increase its ability to fight infection and heal
Direct, local anti-microbial applications

Chancroid can be difficult but not impossible to cure with natural treatments if you are consistent and patient.

Dietary Recommendations

Include:

essential fatty acids, such as olive oil, nuts
fish and poultry
flax seed, (linseed) oil
fresh fruits and vegetables
organic foods where possible
plenty of fresh water ( drink as much as possible)
whole grains

Avoid:

alcohol
carbonated beverages
dairy products
fruit juice
refined white flour, such as pasta, bread, desserts
sugar

Nutritional Supplements

Proteolytic enzymes:

Bromelain 400mg
Wobenzyme N five tablets three to four times a day away from meals

and

Vitamin C 1,000 mg three times a day with meals
Zinc 30 mg daily

Herbal Treatment

Goldenseal (Hydrastis canadensis), strong infusion or poultice applied locally to sores
Goldenseal (Hydrastis)/Vitamin A suppository

Other Treatments

Warm sitz baths with several drops tea tree oil (Melaleuca alternifolia) added

Vaginal douche using one or both of the following herbs which have potent anti-microbial properties:

Goldenseal (Hydrastis canadensis)
Oregon Grape Root (Mahonia aqjuifolium

 

Prevention of Chancroid Infection

Risk Factors

  • Douching or urinating after sex does not prevent STDs
  • Exposure of skin and mucus membranes with a high risk partner
  • If there are any signs or symptoms of chancroid abstain from sex until the infection is cured

Help Factors

  • Carefully washing the genitals with antibacterial soap immediately after sex
  • Limit one’s sexual relationship to a single, uninfected partner
  • Practice safe sex
  • Use latex condoms or gloves put on before sex and disposed of responsibly immediately after sexual contact

Other Precautions

Notify all sexual contacts immediately so they can obtain examination and treatment
Patients should be tested for syphilis and retested 3 months later if initial test result is negative
Testing should be repeated 3 months later if initial test result is negative
Visit your local STD clinic, hospital, doctor or urologist immediately if you have come in contact with chancroid

Prognosis

Chancroid does not seem to have any adverse effects on pregnancy or the fetus

Complications

  • Balanoposthitis, inflammation and partial loss of tissue, particularly of the glans, penis and prepuce
  • Buboes may rupture taking months to heal completely
  • Fistulous tracts, abnormal tube-like passages within the body tissues, may form\
  • Phimosis, tightness of the foreskin
  • Scarring from extensive infection or from burst buboes may occur
  • Untreated chancroid often results in ulcers occurring on the genitals, which can persist for weeks or months

Risk Factors

  • People with open chancroid sores are especially vulnerable to other STDs
  • Re-infection can occur immediately after cure as the body does not build up any natural resistance

In less than 10% of cases sores may return and these may be caused by:

  • Improper use of medication
  • Incomplete cure
  • Re-exposure to the bacteria through recently healed skin
  • Weakened immune system

Note

It has been found that the genital ulcers of chancroid have:

  • been associated with the sexual transmission of the HIV virus
  • occurred as outbreaks in populations with a high incidence of HIV-1 infection