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Chancroid

- 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

- 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

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
  • ContraindicationsAllergy to the medicationCiprofloxacin 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 diagnosisCoinfection with syphilisCoinfection with HIVMedication nonadherenceResistant 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.