What is Chancroid?
Chancroid is a very rare type of sexually transmitted infection (STI), not just in the United States but also globally. Knowing how common it really is, is challenging due to the unavailability of easy testing methods and its symptoms which look a lot like other more usual genital ulcer diseases.
What Causes Chancroid?
Chancroid is an infection caused by a tiny bacteria called Haemophilus ducreyi. This bacterium is classified as a “gram-negative rod,” a term that describes its shape and how it reacts to certain lab tests. However, growing this bacteria in a lab for tests is tricky. It needs special conditions, which are not readily available in most labs, to develop and thrive.
Risk Factors and Frequency for Chancroid
Chancroid is a very rare disease, especially in the United States and other developed countries. The ability to understand how many people it truly affects worldwide is tricky because it’s difficult to identify the bacterium that causes it and there are limited methods to diagnose and monitor the disease.
In 2016, only seven cases of chancroid were reported to the US Center for Disease Control and Prevention (CDC) across six states. These cases involved a wide range of people, including minority groups, heterosexual individuals, sex workers, and their clients. Since chancroid causes visible genital ulcers, it’s often reported more frequently in men. Men who aren’t circumcised tend to get this disease more often. The chances of passing on the disease to someone else during a single sexual encounter are about 0.35 out of 1.
Interestingly, chancroid has been linked to an increased risk of getting and spreading HIV in heterosexual individuals. Any genital ulcer can increase the risk of getting HIV by a huge amount – anywhere between 50 and 300 times – for each unprotected sexual encounter. This happens because the ulcers break the skin barrier, making it easier for HIV to enter the body. Additionally, these ulcers attract cells that are vulnerable to HIV, promoting more rapid replication of the virus and aiding the acquisition of HIV disease.
Having HIV can also change the way chancroid behaves. The period between exposure to chancroid and appearance of symptoms could increase, multiple ulcerating sores might emerge, healing might take longer, and there might be poor response to common antibiotics, leading to treatment failures.
Signs and Symptoms of Chancroid
Chancroid is a sexually transmitted infection that commonly affects younger adults between the ages of 21 and 30, especially in developing countries. Often, this group includes sex workers and their customers. Women can carry the infection without showing symptoms, which could lead to unknowingly spreading the disease.
After a minor injury during sex, it usually takes between 4 to 10 days for symptoms to appear. For men, common infection sites are around and on the penis, including the corona, prepuce, or glans. For women, the infection often occurs on the labia, at the vaginal opening (introitus), and around the anus.
Generally, an initial red bump, medically referred to as an erythematous papule, forms at the location of infection. This quickly changes into a blister-like bump, and eventually transforms into a very painful ulcer with soft, uneven edges, commonly known as a “soft chancre”. These ulcers can occur singly, or several may appear due to many microtrauma locations, or two adjacent areas touching and forming “kissing ulcers”. The ulcer usually has a breakable yellow-gray base that can bleed easily if scratched, and it ranges in size typically from 1 to 2 cm. If left untreated, these ulcers naturally heal after 1 to 3 months.
In about half of those with chancroid, painful swelling of the lymph nodes in the groin area occurs, usually on one side. About a quarter of these people will, within 1 to 2 weeks of the initial bump appearing, develop pus-filled swellings (suppurative buboes) in the lymph nodes, which can break open. If left untreated, infection can spread to other lymph nodes, causing damage to deep tissues and possibly leading to changes in the appearance of the external genitals.
Testing for Chancroid
Diagnosing chancroid, a type of sexually transmitted infection, can be tricky because its symptoms often resemble those of syphilis and herpes, which are more common causes of genital sores. Because of these similarities, doctors often order tests for syphilis and herpes to make sure they have the correct diagnosis.
A test called a Gram Stain that’s done on the fluid from sores can sometimes detect the presence of the bacteria that causes chancroid, known as H. ducreyi. However, this test is not always reliable.
The Centers for Disease Control and Prevention, a major health agency, suggests that the best way to confirm a chancroid diagnosis is through a special type of culture test that can identify H. ducreyi. However, this test is not always available and it may not work as well as other diagnostic tests. To add to the complexity, there isn’t an FDA-approved test that can be done to confirm chancroid. It is left to individual laboratories to develop suitable tests.
In cases where these tests are not available, doctors might make a diagnosis based on the symptoms. They may diagnose chancroid if a person has one or more painful sores on their genitals, if the sores look like they could be caused by chancroid, and if the person doesn’t seem to have syphilis or herpes. This would be confirmed by tests done at least 7 days after the appearance of the sores and tests that show negative results for herpes.
Treatment Options for Chancroid
Genital lesions from chancroid, a sexually transmitted infection, usually clear up by themselves within one to three months if left untreated. However, there is a risk that the disease could lead to painful swelling in the lymph nodes. In about one quarter of cases, painful pus-filled lumps, known as suppurative buboes, may develop.
In the early nineties, the World Health Organization (WHO) recognized the challenges in identifying the exact cause of diseases with genital ulcers. Hence, they recommended a system of managing these diseases based on symptoms rather than specific diagnoses. By 2000, this approach had significantly reduced the incidence of chancroid. Now, the most common cause of genital ulcer disease is herpes.
Regardless of whether chancroid is a confirmed or suspected diagnosis, it’s crucial to start antibiotic treatment. This is especially important considering that individuals with chancroid often have other infections such as syphilis or herpes. Healthcare providers may recommend treatment for these other infections even before they have been confirmed if there’s concern that a person might not follow through with diagnostic testing. Additionally, if a person has chancroid, there’s an increased likelihood of transmitting or getting HIV, so testing or treatment for HIV should also be considered.
The Centers for Disease Control and Prevention recommends several antibiotic options for treating chancroid, which include Azithromycin, Ceftriaxone, Erythromycin, and Ciprofloxacin.
Symptoms and physical signs should improve within one to two weeks once antibiotics are started. However, the swelling of the lymph nodes may take longer to reduce. If the swollen lymph nodes fill with pus, a medical procedure to drain the fluid may be needed to help with recovery.
If symptoms don’t improve after taking antibiotics, it could be because the initial diagnosis was incorrect, there’s another sexually transmitted infection or HIV, the disease is resistant to the drug, or the treatment plan wasn’t followed correctly.
Sexual partners need to be treated if they were exposed within ten days of the onset of symptoms to prevent reinfection. While it is still possible to get reinfected, a single dose of Azithromycin has been shown to provide protection for around seven weeks after treatment.
What else can Chancroid be?
When a patient presents with certain symptoms, doctors have several possible diagnoses to consider and differentiate from. For the described symptoms, the most common cause is a herpes simplex infection. However, other possibilities might include:
- Syphilis, which is the next most common cause
- Chancroid, which is less common
- HIV co-infection or superimposed bacterial infection, which can make differentiating harder
- Granuloma inguinale, particularly if the patient is from an area where this is common
- Lymphogranuloma venereum, particularly if the patient has a specific symptom called inguinal lymphadenitis.
It is worth mentioning that telling these conditions apart based only on clinical symptoms can be quite difficult and inaccurate.
What to expect with Chancroid
The outlook for recovery with antibiotic treatment is generally very good. This is despite the fact that without treatment, lesions or sores do have a tendency to clear up on their own. However, not getting treatment could lead to the development of pus-filled lymph nodes, also known as suppurative lymphadenitis.
It’s also important to emphasize that if there is no response to the treatment, it should signal the need for further investigation. This may involve looking into what’s causing the disease or determining whether the patient has been properly following the prescribed treatment plan.
Possible Complications When Diagnosed with Chancroid
The key issues caused by chancroid involve the creation of hollow passages or ‘fistulous tracts’ that form as a result of pus-filled swollen lymph nodes and the breaking down of deep genital tissues. This deep tissue destruction can be triggered either by secondary infection or overgrowth of harmful bacteria such as Bacteroides or Fusobacterium.
Key Complications:
- Formation of hollow passages (fistulous tracts) due to pus-filled swollen lymph nodes
- Destruction of deep genital tissues
- Cause can be a secondary infection or superinfection
- Superinfection caused by harmful bacteria like Bacteroides or Fusobacterium
Preventing Chancroid
Patients should be informed about the importance of using barrier methods, such as condoms, during sexual intercourse. This can significantly help in preventing the spread of infections. They should also understand that there’s a chance they can become re-infected and it’s recommended that their sexual partners also seek antibiotic treatment to ensure all sources of infection are addressed.
