Chancroid

Question 1

Definition

Answer 1

STI caused by bacterium HAEMOPHILUS DUCREYI
- Bacteria invade the epithelium of the gential region, resulting in inflammation, necrosis and ulceration.

Question 2

Epidemiology

Answer 2

• Rare in the UK and MC in Africa and SE Asia
• Unprotected sexual intercourse
• Multiple sexual partners
• Men are affected more often than women

Question 3

Signs

Answer 3

• Painful ulceration
• Solitary ulcers on the penis or vulva
• Tender unilateral inguinal lymphadenopathy: fluctuant lymphadenitis (bubo formation)

Question 4

Symptoms

Answer 4

• Genital pain
• Genital ulcer
• Painful groin swelling

Question 5

Diagnosis

Answer 5

• Swab of ulcer base: PCR testing for H.ducreyi
• HIV serology: co-infection common
• Treponema pallidum particle agglutination (TPPA), treponemal enzyme immunoassay (EIA)

Consider doing:
- Bubo aspirates: fluid may be collected from fluctuant buboes

Question 6

Treatment

Answer 6

FIRST LINE:
- ABx: single dose azithromycin (macrolide)
= If CI ceftriaxone, erythromycin or ciprofloxacin
- Partner notification and treatment: sexual contacts within the preceding 3 weeks
SECOND LINE:
- Abscess drainage: if buboes (swollen lymph nodes) are fluctuant, needle aspiration can provide symptomatic relief.

Question 7

Complications

Answer 7

• Genital scarring and stricture
• Abscess formation in inguinal lymph nodes (buboes)
• Spread of the infection to other areas of the body: rare but can be severe.