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AT-A-GLANCE

AT-A-GLANCE

  • Chancroid is a sexually transmitted acute ulcerative disease usually localized at the anogenital area and often associated with inguinal adenitis or bubo.

  • Haemophilus ducreyi—a Gram-negative, facultative anaerobic coccobacillus—is the causative agent.

  • Chancroid is disappearing even from most countries where H. ducreyi was previously epidemic, with the exception of North India and Malawi. Nevertheless, recent sporadic case reports from Western Europe have been described, often initially misdiagnosed as genital herpes.

  • Painful, soft ulcers with ragged undermined margins develop 1 to 2 weeks after inoculation (usually prepuce and frenulum in men and vulva, cervix, and perianal areas in women).

  • H. ducreyi facilitates the transmission of HIV.

  • In contrast to a sustained reduction in the proportion of genital ulcer disease caused by H. ducreyi, the bacterium is increasingly found in the South Pacific region and in Africa as a common cause of nongenital cutaneous ulcers especially in children.

  • Laboratory culture of H. ducreyi is problematic, but greater sensitivity can be expected by nucleic acid amplification methods, which are not routinely available.

  • Azithromycin and ceftriaxone are recommended as single-dose treatment, enhancing compliance.

EPIDEMIOLOGY

Until the 1990s chancroid was seen most commonly in developing countries, especially in Africa and Asia, where it was isolated from more than 50% of patients with genital ulcers.1-3 A systematic review analyzed 49 studies (35 were published during 1980-1999 and 14 during 2000-2014) on chancroid.4 During 1980-1999, the percentage of genital ulcers caused by Haemophilus ducreyi ranged from 0% in Thailand and China to 69% in South Africa. During 2000-2014, the percentage of genital ulcers caused by H. ducreyi was low (<10%) except for Malawi with 15% of genital ulcer disease5 and North India with 24% of genital ulcer disease.6 A recent report from Cuba described no infection with H. ducreyi in genital ulcer disease patients.7 In the United States, only 11 cases of chancroid were reported in 2015.8 In Europe, chancroid is restricted to rare sporadic cases, often misdiagnosed as genital herpes.9,10 The distinct decrease in prevalence has followed the introduction by the World Health Organization (WHO) of syndromic management for treating genital ulcer disease.4 Nevertheless, the global epidemiology of H. ducreyi is poorly documented because of difficulties in confirming a microbiologic diagnosis. As a result, this condition may be substantially underdiagnosed.8

Lower-class prostitutes appeared to be a reservoir in all previously reported outbreaks of this disease where men had a markedly higher incidence than women. Male circumcision is associated with a reduced risk of contracting chancroid.11 Several studies in Africa show that chancroid ulcer was an important risk factor for the heterosexual spread of HIV.12,13 In West Africa, it has been shown that 2% of female sex workers carry the organism asymptomatically.14 The duration of infectivity in the absence of treatment is estimated to be 45 days for women. The transmission rate from females to males is not known, in ...

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