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Chapter 144: Chancroid

Ziyang Xu; Emily Baumrin

CHANCROID

Therapeutic Approach

Chancroid is a sexually transmitted infection caused by Haemophilus ducreyi and predominant in sub-Saharan Africa, Southeast Asia, and Latin America. Chancroid presents as painful ulcers of the genitalia with associated inguinal lymphadenitis. Therapeutic approach should be selection of antibiotic regimen based on expert guidelines, patient factors, and local susceptibility patterns. See Table 144-1.

Table 144-1Chancroid Treatment Table
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Table 144-1 Chancroid Treatment Table
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Systemic Therapy      
Azithromycin Primary infection, sexual contactsa (first-line) 1-5 Macrolide antibiotic, inhibition of bacterial 50S ribosomal subunit 1 g orally in a single dose GI upset, QTc prolongation None IB1-4,6-8
Ceftriaxone Primary infection, sexual contactsa (first-line)1-5 Third-generation cephalosporin antibiotic, inhibition of bacterial cell-wall synthesis 250 mg intramuscularly in a single dose Rash, GI upset None IB1-4,9-12
Erythromycin Primary infection (second-line)1-4 Macrolide antibiotic, inhibition of bacterial 50S ribosomal subunit 500 mg orally 4 times daily for 7 db GI upset, QTc prolongation, medication interactions (Cyp450 inhibitor) None IB1-4,6,8,13,14
Ciprofloxacin Primary infection (second-line)1-4 Fluoroquinolone antibiotic, inhibition of bacterial DNA topoisomerase and DNA-gyrase 500 mg orally twice daily for 3 db GI upset, tendonitis, C diff colitis, QTc prolongation, contraindicated in pregnancy and lactation None IB1-4,15
Procedural Therapy      
Incision and drainage Presence of fluctuant buboes Mechanical   Infection, bleeding None IB16

aTreatment of sexual contacts is indicated if sexual contact with the patient occurs within 10 days of symptom presentation.

bPreferred treatments in patients with HIV according to UK guidelines.3 All patients with HIV should be monitored for symptom resolution.

Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ≥1 randomized controlled trial; level IIA evidence includes evidence from ≥1 controlled study without randomization; level IIB evidence includes evidence from ≥1 other type of experimental study; level III evidence includes evidence from nonexperimental descriptive studies, such as comparative studies, correlation studies, and case control studies; and level IV evidence includes evidence from expert committee reports or opinions or clinical experience of respected authorities, or both.

REFERENCES

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1. +
Lautenschlager  S, Kemp  M, Christensen  JJ, Mayans  MV, Moi  H. 2017 European guideline for the management of chancroid. Int J STD AIDS. 2017;28(4):324–329.  [PubMed: 28081686]
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2. +
Centers for Disease C. Chancroid—Sexually Transmitted Infections Treatment Guidelines. https://www.cdc.gov/std/treatment-guidelines/chancroid.htm. Published 2021.
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3. +
O’Farrell  N, Lazaro  N. UK National Guideline for the management of Chancroid 2014. Int J STD AIDS. 2014;25(14):975–983.  [PubMed: 25080286]
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4. +
Workowski  KA, Bachmann  LH, Chan ...

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