Chancroid Flashcards
What is the most common cause of genital ulceration in ALL countries?
HSV-2
What organism causes chancroid?
Haemophilus ducreyi
What type of organism is Haemophilus ducreyi?
gram negative
facultative
anaerobic
cocco-bacillus
What is a facultative organism?
makes ATP if oxygen present but can switch to fermentation, anaerobic respiration if no oxygen
What family of bacteria is Haemophilus ducreyi part of?
Pasteurellacae
How common is Chancroid as a cause of genital ulceration?
Decreasing markedly
38% Asia
56% Africa
Why has chancroid as a cause of genital ulcer reduced?
GUD was identified as an important risk factor for female-to-male HIV
transmission in the late 1980s
more attention was paid to GUD control as a means of limiting the spread of HIV
What specific changes occurred following focus on control of genital ulcer disease?
Change in antibiotics used
- previous resistance to tetracycline and co-trimoxazole
-erythromycin reduced H ducreyi
Behaviour change
- increased condom use
Widespread testing and treatment for syphilis
What is the clinical presentation of chancroid?
Ano-genital ulceration
Lymphadenitis
Bubo formation
How does sexual transmission of chancroid occur?
Sexual transmission through a break in the skin
What is the incubation period chancroid?
4-7 days
Describe the progression of the ulcer in chancroid?
tender papule into a pustule and then ulcer or soft sore
ragged undermined edge with grey or yellow base
contact bleed
painful
single or multiple
Where do chancroid ulcers occur on men?
Prepuce
Coronal sulcus
frenulum
glans
Where do chancroid ulcers occur on women?
Labia MINORA
fourchette
How common are extragenital ulcers in chancroid? Where do they occur?
RARE
Fingers
Breasts
Inner thighs
What proportion of people get painful lymphadenopathy in chancroid?
50% men
less in women
If buboes occur how should they be managed in chancroid?
Aspiration
NOT incision and drainage
What complications may occur from chancroid?
Phimosis
Partial loss of tissue, esp glans
tissue contraction from healed ulcers
mucosal breaks and bleeding
Chancroid - how to diagnose?
DNA PCR (no commercial, research/private lab only) Culture from ulcer base or edge or bubo aspirate
To increase sensitivity of culture for chancroid, what should be performed?
culture on more than one medium
What is identified on microscopy of an ulcer/pus from chancroid?
gram negative coccobacilli
characteristic chaining
How sensitive is culture for chancroid if more than one medium is used?
60 - 80% (endemic areas)
How sensitive is PCR for chancroid diagnosis?
95%
What is the CDC diagnostic criteria of a ‘probable diagnosis’ chancroid?
1 or more painful ulcer no evidence T pallidum OR clinical presentation, appearance of ulcers and lymphadenopathy typical of chancroid AND HSV swab negative
What are the treatment options for Chancroid (4)?
Azithromycin 1gram STAT
Ceftriaxone 250mg IM STAT
Ciprofloxacin 500mg twice daily THREE days
Erythromycin 500mg four times a day SEVEN days
When there is chancroid and HIV co-infection which regimens are advised?
NOT single therapy
Ciprofloxacin OR
erythromycin
What is the cure rate of chancroid with erythromycin?
93%
What are the limitations to use of erythromycin for chancroid?
Side effects
Poor compliance
Why is aspiration preferred over incision and drainage for management of chancroid buboes?
Less risk of sinus formation
When do ulcers resolve following treatment for chancroid?
3 days symptomatic improvement
7 days re-epithelisation
How far back should contact tracing be performed for chancroid?
sexual contact within the 10 days before onset of
the patient’s symptoms
