Chancroid: Background, Pathophysiology, Epidemiology

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Chancroid Updated: May 15, 2017 Author: Joseph Adrian L Buensalido, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more...

OVERVIEW

Background Chancroid is a bacterial sexually transmitted disease (STD) caused by infection with Haemophilus ducreyi. It is characterized by painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy. It is a highly contagious but curable disease. Chancroid was once highly prevalent in many areas of the world, but collaborated efforts in increasing social awareness and subsequent changes in sexual practices, along with improved diagnosis and treatment options, have eradicated chancroid as an endemic disease in industrialized countries. [25] In 2000, the proportion of chancroid among genital ulcerative diseases (GUD) decreased from 69% to 15%. [26] It remains prevalent in certain underdeveloped regions such as Asia, Africa, and the Caribbean. [26] However, despite the presence of joint STD/HIV control programs, prevention control methods have not been consistently implemented. [25] In these areas, outbreaks occur in cities among workers in the sex trade. Individuals traveling to these high-risk areas are at risk of contracting the disease. In addition, individuals from high-risk areas who travel to other countries to work in the sex industry remain a source of outbreaks in the industrialized world. Chancroid is a subclass of sexually transmitted genital ulcerative diseases that are of worldwide concern owing to their role as cofactors in the transmission of HIV. [1, 2, 3, 4] Ulcerative STDs penetrate the skin of the external genitalia, colonize the subcutaneous tissue, and produce tissue damage, causing ulceration. [27] Skin abrasion and microtrauma is necessary to penetrate normal skin. The disruption of the mucosal barrier increases the risk of HIV access to the bloodstream and inflammatory cells and serves as a focus for bacterial and viral shedding. [29] A report from the World Health Organization (WHO) estimates that the presence of ulcerative STDs increases the risk of HIV transmission by 10%-50% in women and 50%-300% in men. [5] Multiple genital ulcers, purulent ulcer base, and multiple genital ulcerative lesions increase the likelihood of HIV shedding. [30] Recently, the etiologic agent of chancroid, H ducreyi, has been isolated among chronic limb ulcers in the Asia Pacific region. H ducreyi should be considered as a cause of chronic limb ulcers in endemic areas. [31, 32]

This photograph shows an early chancroid on the penis, along with accompanying regional lymphadenopathy. Courtesy of the CDC/Dr. Pirozzi.

See 20 Signs of Sexually Transmitted Infections, a Critical Images slideshow, to help make an accurate diagnosis.

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Chancroid: Background, Pathophysiology, Epidemiology

Chancroid Updated: May 15, 2017 Author: Joseph Adrian L Buensalido, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more... OVERVIEW Bac...

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