Chancroid


Written by : Dr.M.D.Mazumdar, MD

Chancroid, also called 'soft sore', is a relatively rare sexually transmitted disease (STD). Caused by the organism, Haemophylus ducreyi. It is highly contagious. The annual global incidence is about 6 million cases per year.

Chancroid is more common in places with a high incidence of HIV and AIDS. Risky and promiscuous sexual behaviour contributes to a wider incidence of chancroid or soft sore.

The disease is more common in men than in women. The symptoms may be very mild or even absent in women, making them unaware that they are carrying the organism.

Chancroid spreads easily, especially if one of the couple has an open sore. It often spreads through microabrasions which occur during sexual intercourse.

Signs and Symptoms

The disease appears 3 - 10 days after sexual intercourse with an infected partner.

Vaginal bumps

The first sign of the disease is a vaginal bump or swelling which is very tender. This breaks down into a painful ulcer within 1-2 days. There may be a single large bump or multiple large and small bumps in the vagina as well as on the vulva.

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Vaginal Ulcers

The bumps break down to form shallow, painful ulcers with foul smelling greyish pus. Occasionally a single large ulcer (about 2 inches across) may be the only evidence of infection by haemophylus ducreyi. The ulcers feel soft to the touch and the disease is thus also called soft sore or soft chancre.

The ulcers are acutely painful, making it dificult for the affected person to sit or walk. In women, they are mostly seen on the labia majora, labia minora, around the introitus (opening of the vagina) and sometimes around the anus. They bleed easily on touch and on gentle cleansing.

Sometimes, the ulcers occur on the opposing parts of the two labia majora so that they touch each other. These are then called 'kissing ulcers'.

There may be difficulty in passing urine due to the pain caused by the soft sores.

Bacteria which causes chancroid
Haemophylus ducreyi bacilli causing Chancroid

Vaginal Swelling

The areas surrounding the ulcer may be bright red with congestion of the tissues. The tissues are also oedematous with conspicuous and uncomfortable swelling of the affected area.

Lymph Nodes

In 50% of cases with chancroid, the inguinal lymph nodes, situated between the thighs and the abdomen on either side, may become infected, producing swollen and painful lumps. Normally only one side, either the right or left side is affected. These swellings are called 'bubo' or 'buboes'. Sometimes the nodes may be matted together to form a single, large, painful swelling. Secondary bacterial infection of the bubo can occur and they can break down to form a large abscess discharging foul smelling pus.

Fever

The patient may have mild fever and general physical discomfort.

Diagnosis of Chancroid

  • Chancroid can be suspected from the signs and symptoms of the condition. For health personnel used to seeing patients with chancroid, the clinical signs and symptoms are reliable indicators of the disease.

  • The diagnosis is confirmed by demonstrating the bacilli in smears made from the pus. Culture of the discharge or pus from the ulcers can show the typical Gram negative bacilli.

  • Immunochromatography: This is a rapid diagnostic test that can be performed in 15 minutes. It demonstrates the presence of antibodies in the blood.

    Treatment

    Chancroid is easily curable by antibiotic therapy. The common antibiotics used in order of their efficacy are :

  • Azithromycin: A single dose of 1 gm after food.
  • Ceftriaxone : A single injection of 250 mg.
  • Ciprofloxacine : 500 mg given twice daily after food for 5 days.
  • Erythromycin: 500 mg 4 times a day for 7 days.

    Other Treatment Procedures

  • Pain is relieved by analgesics (painkilling medicines).
  • Buboes (infection of the lymph nodes of the groin) may need to be surgically drained.


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