Chancroid at a Glance
- 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.
- Although the number of cases is decreasing overall, chancroid is still common in many developing countries (Africa, the Caribbean Islands, and Southwest Asia).
- Painful, soft ulcers with ragged undermined margins develop 1–2 weeks after inoculation (usually prepuce and frenulum in men and vulva, cervix, and perianal area in women).
- Nonsexual transmission has been reported recently.
- Chancroid facilitates the transmission of HIV.
- Laboratory culture of H. ducreyi is problematic, but greater sensitivity can be expected by DNA amplification methods, which are currently not routinely available.
- Azithromycin and Ceftriaxone are recommended as single-dose treatment, enhancing compliance.
Chancroid is most common in developing countries, especially in Africa and Asia, where it was isolated from over 50% of patients with genital ulcers until the 1990s.1–3 These endemic regions also have some of the highest rates of HIV infection in the world, and chancroid is common in all 18 countries where adult HIV prevalence surpasses 8%.4 More recent reports from Southeast Asia and Africa suggest that the incidence of chancroid may be declining in the face of a rapidly rising incidence of genital herpes.5–9 Chancroid outbreaks have been reported in a number of cities in industrialized countries during the last two decades, predominantly in the United States.10 After an epidemic in California in 1981, the number of cases peaked in 1987 at 5,035 cases. In a ten city study, chancroid was confirmed in 12% of genital ulcers in Chicago and 20% in Memphis.11 In contrast, only 23 cases of chancroid were reported to the Centers for Disease Control and Prevention (CDC) in 2007.12 The true incidence in most areas remains unclear and is probably vastly underreported because confirmatory culture media or DNA amplification methods are not commercially available.13 The global epidemiology of chancroid is so poorly documented that it is not included in WHO estimates of the global incidence of curable sexually transmitted diseases.4 Overall, chancroid accounted for 8 cases (3%) of genital ulcers in a sexually transmitted infection (STI) clinic in Paris from 1995 to 2005.14
The prevalence of chancroid is higher in lower socioeconomic groups. Recent epidemics in the industrialized countries have usually been associated with commercial sex work, the use of crack cocaine, with syphilis and an increased risk of HIV infection.15,16 Lower-class prostitutes appear to be a reservoir in all reported outbreaks of this disease and men have a markedly higher incidence of chancroid than women.10 Several studies in Africa showed that chancroid-ulcer is an important risk factor for the heterosexual spread of HIV-1.17,18 In West Africa, it has been shown that 2% of female sex workers were carrying the organism asymptomatically.19 The duration ...