Chancroid begins as a papule that evolves into a pustule after
an incubation period of 4–7 days. The pustule then erodes
into the classic nonindurated, painful ulcer with a purulent base
and ragged, undermined borders (see Figure 12–1). The ulcers
can be single or multiple and usually remain confined to the genital
area (see Figure 12–2). Vesicle formation is not a feature
of chancroid. In some cases mild constitutional symptoms have been
associated with infection.
In men ulcers are most likely to be found on the internal or
external surface of the prepuce, coronal sulcus, or frenulum. The
shaft of the penis, prepucial orifice, urethral meatus, and glans
penis may also be involved. In women most lesions are found at the
vaginal entrance, including the labia majora and minora, fourchette,
vestibule, and clitoris. About 50% of male patients present with
a single ulcer, but a study of women with chancroid reported a mean
number of 4.5 discrete ulcers. Smaller ulcers may also coalesce
or merge to form a single giant ulcer or serpiginous ulcers. Other
clinical variants of chancroid have been recognized and are outlined
in Table 12–1. Ulcers have been rarely reported at extragenital
sites such as the thighs, anus, breasts, hands, mouth, abdomen,
and feet, but these lesions are secondary to local contact or autoinoculation
and do not represent hematogenous dissemination from the primary
In HIV-infected patients multiple ulcers are more common, duration
of ulceration is longer, and treatment failure is more often a problem.
Interestingly, no cases of opportunistic, systemic, or disseminated
chancroid have been reported in patients coinfected with HIV.
Unilateral tender inguinal lymphadenopathy is also a characteristic
finding in up to 50% of patients with chancroid. This may
progress to development of buboes or fluctuant lymph nodes, which
can rupture spontaneously or require drainage. H
ducreyi has been isolated from pus removed from these buboes.
Lymphadenitis and subsequent bubo formation have been noted less
frequently in women.