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Chancroid

Chancroid is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A sexually transmitted infection characterized by painful genital ulcerations and inguinal adenopathy
  • Uncommon in the United States, present worldwide
  • Chancroid is endemic in developing countries, especially sub-Saharan Africa, and is a cofactor for HIV transmission.
  • Synonyms: soft chancre; ulcus molle

Epidemiology

Incidence
  • <50 cases reported to CDC from 2005 to 2013 (1)
  • Actual numbers are likely higher due to lack of testing and underreporting.

Prevalence

Endemic in developing countries; annual estimated global prevalence of 4 to 6 million; actual prevalence is unknown.

  • More common in
    • Sub-Saharan Africa
    • Southeast Asia
    • Latin America

Etiology and Pathophysiology

  • Haemophilus ducreyi enters through abraded skin during sexual activity, attaching to susceptible cells.
  • Cytotoxin secretion facilitates epithelial injury and ulcer formation.
  • The bacterium contains a fimbria-like protein (flp) operon encoding proteins to promote adherence and pathogenesis.
  • Dendritic cells and natural killer cells respond to H. ducreyi. This innate host response determines bacterial clearance versus disease progression.
  • H. ducreyi (gram-negative rod) is a uniquely human pathogen.
  • Following exposure, a local tissue reaction generates an erythematous papule that progresses to a pustule in 4 to 7 days. Central ulceration and necrosis follow, leading to the characteristic clinical chancre.
  • In addition to genital ulcers, H. ducreyi causes chronic skin ulcerations in children from developing countries.

Risk Factors

  • Multiple sexual partners
  • Uncircumcised men
  • Other genital ulcerative diseases (syphilis, herpes simplex)
  • HIV

General Prevention

Proper condom use and safe sexual behavior

Commonly Associated Conditions

  • Syphilis: concurrent in 10% of patients
  • Herpes simplex virus (HSV) or HIV infection

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Citation

Stephens, Mark B., et al., editors. "Chancroid." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116121/all/Chancroid.
Chancroid. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116121/all/Chancroid. Accessed April 21, 2019.
Chancroid. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116121/all/Chancroid
Chancroid [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116121/all/Chancroid.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Chancroid ID - 116121 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116121/all/Chancroid PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -