Advances in the diagnosis and management of chancroid
D'Costa, L.J.; Bowmer, I.; Nsanze, H.; Dylewski, J.; Fransen, L.; Plummer, F.A.; Piot, P.; Ronald, A.R.
Sexually Transmitted Diseases 13(3 Suppl): 189-191
1986
ISSN/ISBN: 0148-5717 PMID: 3532370 DOI: 10.1097/00007435-198607000-00019Document Number: 376550
Physicians paid little attention to chancroid and its causative agent Hemophilus ducreyi until the late 1970s and early 1980s. Therefore diagnoses are insufficient. In addition, physicians do not manage chancroid well and public health officials cannot control its spread. Chancroid is endemic in developing countries, but periodically chancroid epidemics do occur in developed countries. Gram positive cocci which also flourish in chancroid ulcers often overgrow H. ducreyi (a gram negative rod) making it hard to diagnose infection. Besides, for optimal chance of H. ducreyi isolation, a health worker must directly inoculate pus from the ulcer onto either gonococcal or Mueller-Hinton agar in the Petri dish. To further complicate diagnosis, clinical and epidemiological characteristics of patients who are H. ducreyi culture negative are like those of patients who are H. ducreyi culture positive. Moreover genital ulceration varies like it does with Treponema pallidum or herpes simplex virus. In fact, only about 40% of men and 29% of women have an ulcer. Nevertheless a chancroid lesion starts out as papule that soon turns into an ulcer. Around 33% of all patients experience lymphadenopathy. If chancroid is not treated, the lymph nodes swell and exude pus. They eventually burst and drain chronically. Prostitutes and other sexually active females with ulcers tend to be reservoirs of H. ducreyi. As of late 1990, researchers could not culture H. ducreyi from asymptomatic males. Another exacerbation of the problems with chancroid is that H. ducreyi is resistant to most antibiotics. Yet erythromycin, ceftriaxone, and cefotaxime treatment yield positive results. A study in Kenya shows that treatments with 1000 mg, 500 mg, and 250 mg ceftriaxone cured 97% of men with genital ulcer disease. Since diagnosis is difficult; anyone with chancroid and his/her contacts should be treated immediately.