- Charles B Hicks, MD
Charles B Hicks, MD
- University of California, San Diego
Chancroid is an extremely uncommon infection in the United States and most other developed countries. However, the true incidence of chancroid is often unknown since a definitive diagnosis requires detection of the causative organism, Haemophilus ducreyi, and few laboratories have the capability for proper microbiologic diagnosis (eg, culture or nucleic acid amplification testing) [1,2]. In addition, many sexually transmitted disease clinics do not attempt to diagnose genital ulcer disease caused by pathogens other than Treponema pallidum or herpes simplex virus.
This topic will review the clinical manifestations, diagnosis, and treatment of chancroid. Topic reviews that discuss the approach to patients with genital ulcer disease, syphilis, and genital herpes are found elsewhere. (See "Approach to the patient with genital ulcers" and "Syphilis: Epidemiology, pathophysiology, and clinical manifestations in HIV-uninfected patients" and "Epidemiology, clinical manifestations, and diagnosis of genital herpes simplex virus infection".)
H. ducreyi is a small, fastidious, gram-negative rod that requires an enriched growth medium containing hemin and usually serum for successful cultivation . Cultures must be delivered expeditiously to the laboratory and incubated at 33º to 35ºC in high humidity with CO2 enrichment. Small, heterogeneous colonies appear on culture medium after 48 to 72 hours. The gray to tan translucent colonies slide intact across the agar plate when pushed.
When examined by Gram stain, organisms from culture often clump in long parallel strands, producing a so-called "school of fish" or "railroad track" appearance. This morphology can occasionally be seen in Gram-stained smears from clinical specimens, but it is not a consistent or reliable clinical finding.
The pathogenesis of chancroid is incompletely understood. In the vast majority of cases, organisms are thought to gain access to tissues via microabrasions in the skin that occur during sexual intercourse, since H. ducreyi does not typically infect intact skin. However, the organism has also been identified as a cause of cutaneous ulcers in children and young adults on islands in the South Pacific Islands and in parts of equatorial Africa where yaws is endemic [4-6]. (See "Yaws, bejel, and pinta".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- United States and developed countries
- Developing countries
- CLINICAL MANIFESTATIONS
- Genital ulcers
- Non-sexually transmitted cutaneous ulcers
- Approach to diagnosis
- Diagnostic criteria
- Tests to identify the organism
- - Gram stain
- - Culture
- - Polymerase chain reaction
- DIFFERENTIAL DIAGNOSIS
- Antimicrobial therapy
- - Preferred regimens
- - Alternative regimens
- - Special populations
- HIV-infected patients
- Pregnant women
- Management of buboes
- Patient monitoring
- SEX PARTNERS
- SUMMARY AND RECOMMENDATIONS