Chancroid

Chancroid is a sexually transmitted infection (STI) caused by the bacterium Haemophilus ducreyi.1 It attacks the tissue and produces ulcers or open sores on or near the genitals (i.e., the penis/testes, labia).1 Although chancroid is highly contagious, it is curable.1 

While once prevalent across the globe, recent efforts to improve diagnosis and treatment, along with increasing social awareness about safe sexual practice, has mostly eradicated it in developed countries. Overall, the presence of chancroid has decreased in the United States and a similar pattern has also been observed worldwide.1 The regions of Africa and the Caribbean, however, may still be exceptions, where chancroid can be contracted.1 Understanding transmission, symptoms, and how to prevent the spread of this highly contagious infection is necessary for improving sexual health.

Transmission 

The bacteria can be spread through skin-to-skin contact with an infected person. Often, contagious fluid or blood from the ulcer can spread the bacteria during oral, vaginal, or anal intercourse. A person is contagious with chancroid when they have open sores.2 Another person may become infected if they come into contact with these bacteria-containing open sores.2 Chancroid also spreads when fluid from the ulcer, such as pus, comes into contact with another person.1 Transmission of the human immunodeficiency virus (HIV) can occur much more easily if chancroid is left untreated.1

Symptoms

Symptoms often vary in males and females, but they typically appear anytime from four days to ten days after exposure.1 Usual symptoms include ulcers of the genitals along with swollen and painful lymph glands in the groin region. 1 The ulcer can start by looking like an elevated bump, which will eventually become an open sore with ragged edges once it ruptures from being filled with pus.1 Ulcers can remain on the body for weeks or months.2

Symptoms in Males

Ulcers can be much more painful for males when they have chancroid.1 A small red bump may form on any area of the penis or scrotum, which may develop into an open sore within a day or two. Roughly 50% of males who are infected will only have one ulcer.3 Ulcers usually appear in males on the foreskin, the groove behind the head of the penis, the shaft of the penis, the head of the penis, the opening of the penis, or the scrotum.3

Symptoms in Females

Females are usually unaware of ulcers that develop from contracting chancroid, as they are commonly asymptomatic in females.1 The symptoms in females can also vary greatly, with some females developing red bumps on the labia, between the labia and anus, or on the thighs.3 After the bumps become ulcers, females may experience burning or painful urination or bowel movements. When infected, females typically have 4 or more ulcers and may also experience pain when engaging in sexual intercourse.3

The following symptoms may be experienced by both males and females:

  • Ulcers can vary in size from around 1/8 to 2 inches across3
  • Ulcers can be soft and painful3
  • Ulcers may bleed easily if touched3
  • Ulcers may have a soft gray or yellowish-gray center with a defined periphery3
  • Pain during sexual intercourse or urination3
  • Swelling in the groin and/or lymph nodes which could lead to large collections of pus3

Seeing a doctor or medical professional as soon as these symptoms are felt can help people get the proper diagnosis and treatment as soon as possible. 

Diagnosis and Treatment

Chancroid is often treated with antibiotics and the ulcers usually heal within two weeks.2 Antibiotics can help the ulcers heal with little scarring.3

The Centers for Disease Control and Prevention recommends the following regimens for antibiotic treatments of chancroid:4

  • Azithromycin 1 g orally in a single dose 4
  • OR Ceftriaxone 250 mg IM in a single dose
  • OR Ciprofloxacin 500 mg orally twice a day for 3 days 4
  • OR Erythromycin base 500 mg orally three times a day for 7 days 4

A physician may take a sample of the fluid that drains from the sore and analyze it for bacteria. They may also examine the groin lymph nodes to check for swelling and pain, as these are tell tale signs of infection. Currently, chancroid cannot be diagnosed through blood testing. If the lymph nodes have swelled up, a physician may drain them with a needle or through surgery to reduce the swelling and pain.3

After starting antibiotics, the person should be re-examined. If the treatment is successful, the ulcers will usually improve symptomatically within 3 days, while the bacteria will usually clear up within 7 days of starting treatment.4 

Scarring may still result even if the chancroid treatment was successful.4 Treatment for uncircumcised males and people with HIV infections may not be as effective.4 People who are infected with HIV may have ulcers that do not heal as fast.4 They may need a longer treatment that lasts over the course of multiple sessions.4

Prevention  

You can prevent the spread of chancroid in the following ways: 

  • Abstaining from any sexual activity
  • Washing your genitals carefully after engaging in sexual activity 2
  • Getting tested for STIs and STDs frequently
  • Effectively communicating with a sexual partner about the importance of getting tested
  • Limiting the number of sexual partners and practicing safe oral, anal, and vaginal sex through the use of barrier protection (i.e., condoms, dental dams)2
  • Avoid engaging in sexual activity if you think you may be infected with chancroid. Visit a doctor, health clinic, healthcare provider, or medical professional as soon as possible and get tested immediately.2 
  • Alert recent partners you have engaged in sexual activity with so they may also get tested (even if they do not feel symptoms) and receive the proper treatment quickly.2

Engaging in safe sex behavior can effectively prevent the further spread of chancroid to other individuals. 

Concluding Remarks

Chancroid is a sexually transmitted infection (STI) that is highly contagious, but curable. Ulcers that appear on the genital region are usually treated with antibiotics. Swollen and painful lymph glands in the groin region are other symptoms of chancroid. As always, it is important to use protection and treat the infection as quickly as possible, in order to minimize any negative long term effects (i.e., scarring). See a medical professional as soon as possible if you are experiencing symptoms. Limiting sexual partners, washing your genitals, and using condoms and dental dams are a few ways that can help prevent the spread of chancroid. 

 

References

  1. “Chancroid.” Chancroid, Illinois Department of Public Health.
  2. “Chancroid (Soft Chancre).” Department of Health, New York State.
  3. “Chancroid.” Edited by Jatin M. Vayas et al., MedlinePlus, U.S. National Library of Medicine.
  4. “Chancroid.” 2015 Sexually Transmitted Diseases Treatment Guidelines, Centers for Disease Control and Prevention, 4 June 2015.

Last Updated: 14 November 2019.