172: Chancroid Flashcards
What is the typical incubation period for chancroid?
The incubation period (IP) for chancroid is typically 3 to 7 days, rarely exceeding 10 days.
What are the common clinical findings associated with chancroid ulcers?
Chancroid ulcers typically begin as a soft papule with surrounding erythema. After 24-48 hours, they progress to pustular, then eroded, and finally ulcerated. The edges are ragged and undermined, covered by a necrotic, yellow-gray exudate, and are usually tender and/or painful.
What factors are associated with the transmission of chancroid?
Factors associated with the transmission of chancroid include:
1. Lower-class prostitutes as reservoirs in outbreaks.
2. Male circumcision is associated with a reduced risk of contracting chancroid.
3. Chancroid ulcer is an important risk factor for the heterosexual spread of HIV.
4. Transmission rate from males to females is approximately 70% per sex act.
What are the classic etiologic agents for genital ulceration?
The three classic etiologic agents for genital ulceration are:
1. H. ducreyi
2. Treponema pallidum
3. Herpes simplex
What is the significance of painful inguinal adenitis (bubo) in chancroid?
Painful inguinal adenitis (bubo) occurs in up to 50% of patients within a few days to 2 weeks after the onset of the primary lesion. It is typically unilateral, with erythema of the overlying skin, and can become fluctuant and may rupture spontaneously. The pus of the bubo is usually thick and creamy and is less common in females.
A female sex worker in West Africa is asymptomatic but tests positive for H. ducreyi. What is the significance of this finding?
Asymptomatic carriage of H. ducreyi in female sex workers is significant because it can contribute to the spread of chancroid. Approximately 2% of female sex workers in West Africa carry the organism asymptomatically.
A patient presents with a single genital ulcer that is tender, non-indurated, and covered by a necrotic yellow-gray exudate. What is the most likely diagnosis?
The most likely diagnosis is chancroid. The ulcer’s characteristics, including tenderness, non-induration, and necrotic yellow-gray exudate, are typical of chancroid.
A patient with chancroid has systemic symptoms. Is this common, and what should be considered?
Systemic symptoms are rare in chancroid. If present, consider the possibility of co-infection or another underlying condition.
A patient with chancroid has a lesion on the vulva. What are the common sites for chancroid lesions in females?
In females, chancroid lesions are most commonly localized on the vulva, especially on the fourchette, the labia minora, and the vestibule.
A patient with chancroid has a lesion that has spread to the groin. What is this phenomenon called?
The phenomenon of chancroid lesions spreading to the groin is referred to as ‘kissing ulcers’ or serpiginous ulcers.
A patient with chancroid has a lesion on the penis shaft. Is this a common site for chancroid lesions in males?
The shaft of the penis is less frequently involved in chancroid lesions compared to other sites like the prepuce, frenulum, or glans.
A patient with chancroid has a lesion localized in the urethra. What additional symptom might be observed?
If the chancroid lesion is localized in the urethra, purulent urethritis may be observed.
A patient with chancroid has a lesion that bleeds easily on manipulation. What does this indicate about the ulcer’s base?
The ulcer’s base is composed of granulation tissue that bleeds easily on manipulation, which is characteristic of chancroid.
A patient has a lesion with ragged and undermined edges on the genital area. What does this suggest about the ulcer?
Ragged and undermined edges are characteristic of chancroid ulcers.
A patient with chancroid has a lesion covered by a necrotic yellow-gray exudate. What does this indicate?
The necrotic yellow-gray exudate covering the lesion is a typical feature of chancroid ulcers.
A patient with chancroid has a lesion that is tender and painful. How does this differ from syphilitic ulcers?
Chancroid ulcers are tender and painful, whereas syphilitic ulcers are typically non-tender and indurated.
A patient with chancroid has a lesion with a diameter of 2 cm. Is this within the typical size range for chancroid ulcers?
Yes, chancroid ulcers typically have a diameter ranging from 1 mm to 2 cm.
A patient with chancroid has a single ulcer. Is this common in males?
Yes, half of the males with chancroid present with a single ulcer.
A patient with chancroid has a lesion on the glans penis. Is this a common site for chancroid lesions in males?
Yes, the glans penis is a common site for chancroid lesions in males.
A patient with chancroid has a lesion on the anus. Is this a common site for chancroid lesions?
The anus is less frequently involved in chancroid lesions.
A patient with chancroid has a lesion on the breast. What does this suggest about the mode of transmission?
A lesion on the breast suggests extragenital transmission, possibly due to trauma or abrasion.
A patient with chancroid has a lesion inside the mouth. What does this suggest about the mode of transmission?
A lesion inside the mouth suggests extragenital transmission, possibly due to trauma or abrasion.
A patient with chancroid has painful inguinal adenitis. How common is this symptom?
Painful inguinal adenitis occurs in up to 50% of patients with chancroid.
A patient with chancroid has unilateral inguinal adenitis. Is this typical?
Yes, inguinal adenitis in chancroid is unilateral in most patients.
A patient with chancroid has erythema of the overlying skin. What does this indicate about the adenitis?
Erythema of the overlying skin is typical of inguinal adenitis in chancroid.
A patient with chancroid has fluctuant inguinal adenitis. What is the risk if left untreated?
If left untreated, fluctuant inguinal adenitis may rupture spontaneously.
A patient with chancroid has thick and creamy pus from a ruptured bubo. Is this typical?
Yes, the pus from a ruptured bubo in chancroid is usually thick and creamy.
A patient with chancroid has mild systemic symptoms. Is this common?
Mild systemic symptoms are rare in chancroid.
What is the significance of male circumcision in relation to chancroid risk?
Male circumcision is associated with a reduced risk of contracting chancroid.
Describe the progression of a chancre in chancroid after 24-48 hours.
After 24-48 hours, from a papule with surrounding erythema, a chancre progresses to:
1. Pustular
2. Eroded
3. Ulcerated
Vesicles are not seen, and the edges are ragged and undermined.
What are the common locations for lesions in males with chancroid?
In males, lesions are commonly found on:
- The external or internal surface of the prepuce
- The frenulum
- The glans
Half of the males present with a single ulcer.
What is the typical presentation of painful inguinal adenitis (bubo) in chancroid?
Painful inguinal adenitis (bubo) occurs in up to 50% of patients within a few days to 2 weeks after the onset of the primary lesion. It is typically:
- Unilateral in most cases
- Characterized by erythema of the overlying skin
- Can become fluctuant and may rupture spontaneously
- The pus is usually thick and creamy.
What is the transmission rate of chancroid from males to females?
The transmission rate of chancroid from males to females is approximately 70% per sexual act.
What are the common extragenital sites for chancroid lesions in females?
In females, extragenital lesions of chancroid have been reported on:
- The breasts
- Fingers
- Thighs
- Inside the mouth
Trauma and abrasion may be important factors in these cases.
What is the duration of infectivity for women with chancroid in the absence of treatment?
The duration of infectivity for women with chancroid in the absence of treatment is 45 days.
What are the characteristics of ulcers in chancroid?
Ulcers in chancroid are typically:
- Tender and/or painful
- Not indurated (in contrast to syphilis)
- Covered by a necrotic, yellow-gray exudate
- The base is composed of granulation tissue that bleeds easily on manipulation.
What is the primary cause of isolated painful chancres in industrialized countries?
Isolated painful chancres are most likely caused by herpes simplex virus.
What is required for the definitive diagnosis of H. ducreyi?
Definitive diagnosis requires identification of H. ducreyi on culture media. The sensitivity of culture reaches only 75% at best, which is particularly important when testing for antimicrobial susceptibility patterns.
What are the most active drugs against H. ducreyi?
The most active drugs against H. ducreyi are azithromycin, ceftriaxone, ciprofloxacin, and erythromycin.
What should be considered if no clinical improvement is evident one week after starting therapy for H. ducreyi infection?
Consider the following if no clinical improvement is evident:
1. Incorrect diagnosis
2. Coinfection with another STI
3. Concomitant HIV infection
4. Poor compliance
5. A resistant strain of H. ducreyi
What are the consequences of treatment delay for H. ducreyi infections?
Consequences of treatment delay can include:
- Spontaneous resolution without complications in half of untreated patients
- Potential for persistent genital ulcer and inguinal abscess for years
- Local pain as the most frequent complaint.
A patient presents with a painful genital ulcer and unilateral inguinal adenitis. What steps should you take to confirm a diagnosis of chancroid?
To confirm a diagnosis of chancroid, collect a specimen from the ulcer for culture or nucleic acid amplification techniques. Microscopy is not routinely recommended due to low sensitivity and specificity.
A patient with chancroid has a fluctuant bubo. What is the recommended management for this condition?
Fluctuant buboes should not be incised. Instead, they can be punctured with a large syringe laterally through normal skin to prevent spontaneous rupture and sinus tract formation.
A patient with chancroid is pregnant. What is the preferred treatment?
The preferred treatment for a pregnant patient with chancroid is ceftriaxone, although azithromycin can also be used.
A patient with chancroid has a lesion that resolved spontaneously. How common is this outcome?
Spontaneous resolution without complications occurs in half of untreated patients with chancroid.
A patient with chancroid has a lesion that persisted for years. Is this typical?
While rare, genital ulcers and inguinal abscesses in chancroid can persist for years without treatment.
What is the primary cause of isolated painful chancres in industrialized countries?
Isolated painful chancres in industrialized countries are most likely caused by herpes simplex virus.
What is the significance of identifying H. ducreyi in culture media for diagnosis?
Identifying H. ducreyi in culture media is crucial because the sensitivity of culture reaches only 75% at best, which is particularly important when testing for antimicrobial susceptibility patterns in cases of therapeutic failure.
What are the most active drugs against H. ducreyi?
The most active drugs against H. ducreyi are azithromycin, ceftriaxone, ciprofloxacin, and erythromycin.
What is the prognosis for untreated chancroid?
The prognosis for untreated chancroid is that the disease is usually self-limited, but without treatment, genital ulcers and inguinal abscesses can persist for years, with local pain being the most frequent complaint.
What is the importance of bedside inoculation of culture plates in diagnosing H. ducreyi?
Bedside inoculation of culture plates is important because it involves using 2 different selective, enriched culture media followed by immediate incubation to reduce the loss of viable bacteria during transport.
What is the clinical significance of reinfections in patients treated for chancroid?
Reinfections are possible in patients treated for chancroid, highlighting the importance of instructing patients to use condoms properly to avoid reinfections.
What is the recommended treatment for patients with phimosis related to chancroid?
For patients with phimosis related to chancroid, circumcision may be necessary.
Are reinfections with chancroid possible after treatment or spontaneous resolution?
Reinfections are possible, highlighting the importance of instructing patients to use condoms properly to avoid reinfections.
What is the recommended treatment for patients with phimosis related to chancroid?
Circumcision may be necessary when all active lesions have healed.
What is the relationship between HIV infection and chancroid?
Effective treatment of genital ulcers has been shown to reduce the incidence of HIV. Concomitant HIV infection significantly affects the course of chancroid disease.
What preventive measures should be taken to avoid chancroid?
Patients should abstain from sexual activity until all clinical lesions have cleared. Sexual contacts should be examined and treated within 10 days of symptom presentation, regardless of symptoms.
What should be done if a patient presents with an isolated small ulcer and painful matted gland?
The patient should be treated for lymphogranuloma venereum, chancroid, and syphilis. (SLC)
What management approach should be followed for a patient with a history of recent blisters and a small genital ulcer?
Herpes management should be followed.
What infections should be treated for a patient with a painful matted gland and an isolated small ulcer?
Lymphogranuloma venereum, chancroid, and syphilis should be treated.
Why is it important for patients with chancroid to abstain from sexual activity?
To prevent the spread of the infection until all clinical lesions have cleared.
What preventive measures can be taken to avoid reinfection in patients with chancroid?
Patients should use condoms properly, and sexual contacts within 10 days of symptom presentation should be examined and treated.
What is the likely cause of recurrence in a patient with chancroid?
Reinfection by an untreated sexual partner.
What alternative treatment should be considered for a patient with chancroid not responding to single-dose therapy?
A multiday regimen should be considered, especially in HIV-seropositive patients.
What should be done if a patient presents with small blisters or an ulcer with a history of recent blisters?
Herpes management should be followed.
What should patients with chancroid be tested for?
Patients should be tested for HIV antibodies.
What is recommended for sexual contacts of a patient with chancroid?
Sexual contacts should be examined and treated within 10 days of symptom presentation, regardless of whether symptoms are present.
What is the significance of azithromycin in the treatment of chancroid?
A single dose of azithromycin may provide protection from reinfection and lasts as long as 2 months after treatment.
What is the most frequent complaint associated with chancroid?
The most frequent complaint is local pain.
What is the association between HIV-1 seropositivity and treatment failure in chancroid?
Failure of single-dose or short-course therapy for chancroid in men is associated with HIV-1 seropositivity.
What is the recommended approach for HIV-seropositive patients with chancroid?
HIV-seropositive patients should be monitored closely and treated with a multiday regimen.
What is the potential for asymptomatic carriage of H. ducreyi?
Asymptomatic carriage of H. ducreyi is possible, and sexual contacts should be treated regardless of symptoms.
What is the reservoir for H. ducreyi cutaneous infection?
The reservoir for H. ducreyi cutaneous infection remains to be elucidated.
What is the clinical picture of chancroid in HIV-infected patients?
There is a wide variation of the clinical picture in these patients.
If only an ulcer is present, the patient should be treated for what diseases?
If only an ulcer is present, syphilis and chancroid should be treated.
What is the implication of chronic limb ulcers in adults and children?
H. ducreyi should be considered as a cause of chronic limb ulcers in adults and especially in children.
How should the patient with chancroid be monitored?
Patients should be monitored closely, especially if they are HIV-seropositive.
What is the treatment approach for fluctuating buboes in chancroid?
Fluctuating buboes are entered by a large syringe through normal skin for treatment.
What is the clinical significance of treating sexual partners of patients with chancroid?
Treating sexual partners is crucial to prevent reinfection and further spread of the disease.
What factors appear to be associated with increased likelihood of H. ducreyi infection and treatment failure?
Lack of circumcision and HIV infection.
What is the recommended action if relapse occurs in chancroid treatment?
If relapse occurs (5%), treatment with original regimen is required.
What is the clinical implication of the variation in the clinical picture of chancroid in HIV-infected patients?
The variation indicates the need for careful assessment and tailored treatment for HIV-infected patients with chancroid.
What is the role of antibiotics in preventing reinfection of chancroid?
Antibiotics may provide some protection from reinfection after treatment.
What is the microscopic morphology of Haemophilus ducreyi?
Small gram-negative rods
What are the different antibiotic regimens for the treatment of chancroid?
