para>HIV may affect treatment response.
MEDICATION
First Line
- Azithromycin: 1 g PO single dose, or
- Ceftriaxone 250 mg IM single dose (4,5)[A]
Second Line
- Ciprofloxacin 500 mg PO BID for 3 days
- Erythromycin base 500 mg QID for 7 days
- Contraindications
- Allergy to the medication
- Ciprofloxacin during pregnancy and lactation and in patients <18 years
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
- Avoid sexual activity until ulcers are resolved.
- Clinical improvement usually occurs within 48 hours.
- Reexamine patients 3 to 7 days after initiation of therapy and follow until resolved.
- Baseline HIV and syphilis serology, repeat 3 to 6 months posttreatment
PATIENT EDUCATION
- Counseling on safe sexual practices and condom use
- Local wound care
- Treat sexual partners.
- HIV and syphilis testing
PROGNOSIS
- Full clinical resolution with appropriate treatment
- Failure to respond may be due to the following:
- Incorrect diagnosis
- Coinfection with syphilis
- Coinfection with HIV
- Medication nonadherence
- Resistant H. ducreyi
- 5% relapse after treatment
COMPLICATIONS
- Phimosis
- Balanoposthitis
- Rupture of buboes with fistula formation and scarring
REFERENCES
11 Adams DA, Jajosky RA, Ajani U, et al. Centers for Disease Control and Prevention. Summary of notifiable diseases-United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61(53):1-121.22 Lewis DA, Ison CA. Chancroid. Sex Transm Infect. 2006; 82(Suppl 4):iv19-iv20.33 Alfa M. The laboratory diagnosis of Haemophilus ducreyi. Can J Infect Dis Med Microbiol. 2005; 16(1):31-34.44 Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines-2015. MMWR Recomm Rep. 2015;64(3):26-27.55 Kemp M, Christensen JJ, Lautenschlager S, et al. European guideline for the management of chancroid, 2011. Int J STD AIDS. 2011; 22(5):241-244.
ADDITIONAL READING
- Barnes P, Chauhan M. Chancroid-desperate patient makes own diagnosis. Int J STD AIDS. 2014;25(10):768-770.
- Cone MM, Whitlow CB. Sexually transmitted and anorectal infectious diseases. Gastroenterol Clin North Am. 2013;42(4):877-892.
- Janowicz DM, Li W, Bauer ME. Host-pathogen interplay of Haemophilus ducreyi. Curr Opin Infect Dis. 2010;23(1):64-69.
- Janowicz DM, Ofner S, Katz BP, et al. Experimental infection of human volunteers with Haemophilus ducreyi: fifteen years of clinical data and experience. J Infect Dis. 2009;199(11):1671-1679.
- Lewis DA. Epidemiology, clinical features, diagnosis and treatment of Haemophilus ducreyi-a disappearing pathogen? Expert Rev Anti Infect Ther. 2014;12(6):687-696.
- Markle W, Conti T, Kad M. Sexually transmitted diseases. Prim Care. 2013;40(3):557-587.
- Mutua FM, M'imunya JM, Wiysonge CS. Genital ulcer disease treatment for reducing sexual acquisition of HIV. Cochrane Database Syst Rev. 2012;(8):CD007933.
- Roett MA, Mayor MT, Uduhiri KA. Diagnosis and management of genital ulcers. Am Fam Physician. 2012;85(3):254-262.
CODES
ICD10
A57 Chancroid
ICD9
099.0 Chancroid
SNOMED
- Chancroid (disorder)
- Penile chancroid (disorder)
- Vulval chancroid (disorder)
- chancroid - anogenital ulcer (disorder)
CLINICAL PEARLS
- Chancroid is characterized by genital papules that progress to pustules and then open painful ulcers. Chancroid is rare in the United States.
- Azithromycin is the treatment of choice.
- Treat sexual partners (from prior 3 months) even in the absence of signs or symptoms of disease.
- Screen all patients for syphilis and HIV.