There are only local signs and symptoms and no systemic manifestations are present [7]. Ulcers appear most commonly on the prepuce and frenulum in men and may erode through tissues.

Other sites in men include:

• Foreskin
• Shaft
• Scrotum

Symptoms include pain during micturation and intercourse, swollen, red genitals with painful pustules and ulcers.

In women, the most commonly affected site is the vaginal entrance and the perineum [1].

Other sites include:

• Labia majora (kissing ulcers)
• Labia minora
• Inner thighs
• Clitoris
• Anus
• Vestibule

The most common symptom in women is pain with urination and intercourse [8].

• Inguinal Lymphadenopathy

  Painful inguinal lymphadenopathy is characteristic of chancroid regardless of the site of the lesion; however, such a presentation occurs in only 40% of cases. [hivguidelines.org]

  Etiology Clinical features Incubation period : typically 4–10 days Clinical features Very painful genital ulcers Deep, small ( ∼ 10–20 mm in diameter), well-demarcated lesions with a grayish necrotic base Painful inguinal lymphadenopathy An asymptomatic [amboss.com]

  Genital trauma is usually suspected by history and less prominent inguinal lymphadenopathy than seen in chanchroid. [clinicaladvisor.com]

  There were two major genital ulcers, one of which was a painful ulcer in the left labia major and the other was a painless ulcer in the cervix uteri; she was also found upon examination to have bilateral inguinal lymphadenopathy. [dx.doi.org]

  Lymphadenopathy Unilateral or bilateral inguinal lymphadenopathy develops in approximately 50% of untreated patients, beginning approximately 1 week after the onset of the initial lesion. [dartmouth.edu]

• Unsafe Sexual Practices

  Unprotected or unsafe sexual practices can dramatically increase your risks of developing a sexually transmitted disease (STD). Many of these STDs have a number of unpleasant side effects and can lead to severe health complications. [epigee.org]

• Skin Ulcer

  This report adds further evidence that cutaneous chancroid should be considered in the evaluation of skin ulcers in the south Pacific. [ncbi.nlm.nih.gov]

  Haemophilus ducreyi associated with skin ulcers among children, Solomon Islands. Emerg Infect Dis 2014 ; 20: 1705 – 1707. Google Scholar | Crossref | Medline | ISI 13. Hawkes, S, West, B, Wilson, S. [doi.org]

  H. ducreyi is increasingly being realized to also cause nongenital skin ulcers in children in certain developing countries (eg, South Pacific islands [1]). 1. [msdmanuals.com]

  H. ducreyi is increasingly being realized to also cause nongenital skin ulcers in children in certain developing countries (eg, South Pacific islands [ 1 ]). 1. [merckmanuals.com]

• Confusion

  Chancroid can be confused with other more common diseases, particularly genital herpes. Differential characteristics are incubation period, location and appearance of lesions, and the presence or absence of associated lymphadenopathy. [ncbi.nlm.nih.gov]

  Terminology Dwarf chancroid: soft, painful, small ulcer Giant chancroid: may extend rapidly and be associated with ruptured inguinal abscess Phagedenic chancroid: may destroy external genitalia if superimposed Fusobacterium infection is present Do not confuse [pathologyoutlines.com]

  Getting a clear diagnosis will assure appropriate treatment, as symptoms of chancroid can be confused with primary syphilis. [goaskalice.columbia.edu]

  It can also be readily confused with syphilis. Please see our separate article on Tropical sexual transmitted infections. [netdoctor.co.uk]

• Syphilitic Chancre

  The diagnosis is primarily based on clinical findings and is probable if genital herpes and syphilitic chancre have been ruled out. Culture confirms the diagnosis but is not widely available. [amboss.com]

  Comparison with syphilis  There are many differences and similarities between the conditions syphilitic chancre and chancroid.  Similarities  Both originate as pustules at the site of inoculation, and progress to ulcerated lesions  Both lesions are [slideshare.net]

  There are many differences and similarities between the conditions syphilitic chancre and chancroid. [en.wikipedia.org]

  A57 virulent A57 (chancroidal) Chancre (any genital site) (hard) (hunterian) (mixed) (primary) (seronegative) (seropositive) (syphilitic) A51.0 ICD-10-CM Diagnosis Code A51.0 Primary genital syphilis 2016 2017 2018 2019 Billable/Specific Code Applicable [icd10data.com]

• Urethral Discharge

  We present here a patient who presented with painful genital ulcers and urethral discharge simultaneously acquired from a single exposure, which turned out to be chancroid and gonorrhea, respectively. [ncbi.nlm.nih.gov]

Work up consists of a detailed history and physical examination.

Laboratory Tests

• Gram staining: Gram staining may be done to check for the organism involved.
• PCR: A Polymerase Chain Reaction test maybe done for more accurate results.
• C/S: Culture and sensitivity of either blood samples, pus or swab samples may be done for accurate results.
• Biopsy: Biopsy may be carried out and 3 distinct histologic zones may be seen.

If the test results come positive, treatment is immediately started.
Other STDs are also checked.

Test Results

The diagnosis is made by isolating H. ducreyi from the ulcer or from pus aspirated from a lymph node [9].

• Hemophilus Ducreyi

  […] chancre) (disorder), Chancroidal bubo, Ducrey's chancre, Soft chancre - chancroid, Soft sore - chancroid, Chancroid (disorder), Haemophilus ducreyi, Hemophilus ducreyi, bubo; Haemophilus ducreyi, bubo; Hemophilus ducreyi, bubo; chancroidal, bubo; soft [fpnotebook.com]

  Copyright © HarperCollins Publishers chancroidal ( chanˈcroidal ) adjective noun an infectious venereal ulcer, usually on or about the genitals, caused by a bacterium ( Hemophilus ducreyi ); soft chancre Webster’s New World College Dictionary, 4th Edition [collinsdictionary.com]

  A soft, venereal, highly infectious ulcer of the genital region, caused by the bacterium Hemophilus ducreyi. Also called soft chancre Related Forms: chan·croi ′ dal (-kroid ′ l) adj. [yourdictionary.com]

  Hemophilus ducreyi, the causative organism, is difficult to culture, so the diagnosis is made on the basis of history, physical exam and exclusion of other ulcerative diseases of the vulva. [brooksidepress.org]

Medications

Because many strains of H. ducreyi produce a plasmid-encoded penicillinase, penicillins cannot be used [9].

CDC recommends antibiotic therapy from 1 of 4 equally efficacious agents, as follows [10]:

• Azithromycin
• Ceftriaxone (drug of choice in pregnant females)
• Erythromycin base 
• Ciprofloxacin

Aspiration

If abscess is present, pus should be aspirated and drained.

Chancroid has an excellent prognosis. If treated with proper antibiotics, such as cephalosporins, or macrolides (azithromycin), the disease shows a positive response. Symptoms regress in just a few days of antibiotic treatment and completely disappear after some time. A 3-antibiotic regime is given to ensure reinfection may not occur as well as any other STDs, like Chlamydia, may also be treated if present.

Complications

Without treatment, lesions may last for weeks to months, and complications such as suppurative lymphadenopathy are more likely [6]. Other complications are rare, but they may include:

• Inguinal lymph nodes involvement
• Epididymisitis in men
• Sterility (extremely rare)
• Pelvic inflammatory disease in women
• Septic abortions in women

Chancroid is an acute, sexually transmitted, ulcerative infection caused by Hemophilus ducreyi [3]. H. ducreyi is a gram-negative streptobacillus that may enter the body by piercing through the skin during sexual intercourse. Once the bacterium enters the genitals, it goes through an incubation period of a few days and then results in the development of soft chancre.

Incidence

Chancroid is relatively uncommon in the United States, with only 24 cases reported in 2010. It is prevalent in Africa, however, and it is thought to be the most common cause of genital ulcers in Kenya, Gambia and Zimbabwe [2].

Sex

Studies reveal that men are affected more than females.

Age

In the US, girls aged between 15-19 have the highest prevalence while men aged between 20 and 24 are the most commonly affected. Uncircumcised males are more prone to contract this disease.

Race

Chancroid shows a clear predilection in non-white people.

Incubation period is of about 1-8 days, after which multiple, irregular tender ulcers may develop [4]. In males, the primary lesion is usually on the penis; in females most lesions occur in the vagina or the periurethral area [5].

Once the incubation period is complete, one or more papules may appear, which then turn into soft, painful pustules. These slowly progress into ulcers by undergoing central necrosis. These ulcers are very painful and may easily bleed. They have sharply demarcated boundaries and a yellowish-grey base. Size ranges from 0.8 inch to 2 inches.

The regional lymph nodes, particularly in the inguinal region, become enlarged and tender in about 50% of cases within 1 to 2 weeks of the primary inoculation [5].

Chancroid, like all other STDs, is easily preventable. By taking appropriate safety measures like using protection such as latex condoms during intercourse, may prevent transmission of the disease. Other measures include avoiding multiple sexual partners, and being tested regularly for STDs.

Chancroid, or soft chancre is an acute sexually transmitted disease (STD) caused by Hemophilus ducreyi. It is common in tropical areas of the world and is endemic in parts of Africa and Asia [1].

Different from syphilis (hard chancre) in causative agent, prevalence and presentation, chancroid (soft chancre) is a relatively uncommon sexually transmitted disease. It rarely causes any complications, and prognosis is excellent.

Cause and Symptoms

Chancroid is caused by having unprotected sex with an infected person. During sexual contact, the bacteria may enter through the genital skin and cause an infection which results in symptoms such as swollen genitals, painful pustules and/or ulcers and pain or burning sensation during urination and intercourse.

Treatment

Treatment is antibiotics and a sex-free period till the disease is cured.

Prevention

It can be easily prevented by taking the right precautionary measures like using latex condoms during intercourse, screening and testing for STDs once a year and not having multiple sexual partners.

1. Parveen K, Michael C, eds. Clinical Medicine. 3rd ed. Infectious diseases, tropical medicine and sexually transmitted diseases. 92-93.
2. Wang CC, Celum CL. Global risk of sexually transmitted diseases. Med Clin North Am. Jul 1998;83(4):975-95 vi. 
3. Lewis DA. Chancroid: clinical manifestations, diagnosis and management. Sex Transm Infect 79:68, 2003
4. Davidson's, Principles and Practice of Medicine. Christopher RWE, Ian ADB, eds. 16th ed. Chap 5, Pg 191 Table 5.44
5. Robbins and Cotran, Pathologic Basis of Disease. 8th ed. Chap 8. Pg 366
6. Bauer ME, Townsend CA, Doster RS, Fortney KR, Zwickl BW, Katz BP, et al. A fibrogen-binding lipoprotein contributes to the virulence of Hemophilus ducreyi in Humans. J Infect Dis. March 1,2009;100(5):684-92
7. Medical Microbiology, The Big Picture. McGraw Hill Professional.p243. ISBN 9780071476614
8. Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive gynaecology, 5th ed. Philadelphia. PA: Moseby Elsevier, 2007. Chap 22.
9. Warren Levinson, Review of Medical Microbiology and Immunology. 11th ed. McGraw Hill. Chap 27, pg 176.
10. Rosen T, Vandergriff T, Harting M. Antibiotic use in sexually transmissible diseases. Dermatol Clin. Jan 2009;27(1):49-61 [Medline]