Chancroid

How chancroid spreads

H. ducreyi enters through tiny breaks in the skin of the genitals during vaginal, anal or oral sex. It spreads by direct contact with ulcers or pus. Uncircumcised men, commercial sex work and travel or sexual networks linked to endemic areas raise the risk. Chancroid ulcers make it much easier to catch and pass on HIV, which is why it remains a public health concern where it is common.

Symptoms

Ulcers

• start as a small red bump that becomes a pustule within a day or two, then breaks open
• painful, often very tender to touch
• soft edges (unlike the firm syphilis chancre), irregular or ragged borders
• base covered with gray or yellow pus; bleeds easily
• one or several; size from a few millimeters to several centimeters
• may join together or appear in "kissing" pairs on opposing skin surfaces

In men: on the foreskin, groove behind the head of the penis, shaft or head. In women: at the vaginal opening, labia, perineum or around the anus. Women may have fewer symptoms and only notice pain with urination, sex or bowel movements.

Swollen glands (buboes)

About half of people develop tender, swollen lymph nodes in the groin, usually on one side, within 1 to 2 weeks. These buboes can fill with pus and rupture through the skin if untreated.

Chancroid vs herpes vs syphilis

Other causes of genital ulcers include lymphogranuloma venereum and granuloma inguinale. For an overview, see genital sores.

Diagnosis

A definitive diagnosis needs special culture media or a PCR test, which are not widely available in the US. The CDC describes a probable diagnosis when all of these apply:

1. one or more painful genital ulcers
2. the appearance of the ulcers and any gland swelling fits chancroid
3. no evidence of syphilis on testing of the ulcer or a blood test done at least 7 days after ulcers appeared
4. a negative herpes test of the ulcer

Everyone with chancroid should also be tested for HIV, syphilis, chlamydia and gonorrhea, with HIV and syphilis retested 3 months later if negative.

Treatment

Chancroid is cured with antibiotics. CDC-recommended options include a single dose of azithromycin by mouth, a single injection of ceftriaxone, or a short course of ciprofloxacin or erythromycin. Your clinician will choose based on pregnancy, allergies and local resistance. Ciprofloxacin is not used in pregnancy or while breastfeeding.

• Symptoms usually improve within 3 days and ulcers heal within about 7 to 14 days. Large ulcers can take longer.
• Buboes may need drainage with a needle or a small incision.
• People with HIV or who are uncircumcised may heal more slowly.
• Avoid sex until treatment is complete and ulcers have healed.

Partners

Anyone who had sex with the infected person within the 10 days before symptoms started should be examined and treated, even without symptoms.

Complications

• scarring of the foreskin, which can cause phimosis (a tight foreskin)
• ruptured buboes with draining sinuses
• tissue destruction and secondary infection
• increased risk of acquiring or transmitting HIV

Prevention

• Use condoms consistently, though they do not cover all areas that can be affected.
• Limit the number of sexual partners and get tested regularly if you have new partners.
• Seek prompt testing for any genital sore and avoid sex until it is assessed.
• Male circumcision reduces risk.

Frequently asked questions

What does chancroid look like?

Chancroid usually appears as one or more painful, soft, ragged ulcers on the genitals with a gray or yellow base that bleeds easily. Ulcers start as small red bumps that become pus-filled and break open. Tender, swollen groin glands often develop and can fill with pus.

How is chancroid different from herpes?

Both cause painful genital ulcers, but chancroid ulcers are usually deeper with soft, ragged edges and pus, while herpes starts as clusters of small blisters that become shallow sores. Chancroid often causes large pus-filled groin glands. Tests for herpes and syphilis help tell them apart.

Is chancroid curable?

Yes. Chancroid is cured with antibiotics, such as a single dose of azithromycin or a single ceftriaxone injection. Ulcers usually improve within days and heal within 1 to 2 weeks. Partners from the 10 days before symptoms began also need treatment.

How common is chancroid in the US?

Chancroid is very rare in the US, with only a handful of cases reported most years. It is more common in parts of Africa, Asia and the Caribbean. Some cases may be missed because testing is not widely available.

Does chancroid increase the risk of HIV?

Yes. Open genital ulcers make it easier to catch and transmit HIV. Anyone diagnosed with chancroid should have an HIV test, and repeat testing 3 months later if the first test is negative.