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 Graphic Jump Location Table 144-1Chancroid Treatment Table ||Download (.pdf) 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 |
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.
H. 2017 European guideline for the management of chancroid. Int J STD AIDS.
N. UK National Guideline for the management of Chancroid 2014. Int J STD AIDS.