Genital Ulcers: Chancroid Diagnosis

  • Diagnosis

    Chancroid is a sexually transmitted disease characterized by genital sores and swollen glands. Chancroid is one of several sexually transmitted diseases characterized by genital sores. Chancroid is very uncommon in the U.S. Syphillis and herpes also cause genital sores. Because chancroid is difficult to recognize, many people probably have it unknowingly. In areas of Africa and Asia, chancroid is a significant public health problem.

    Chancroid is caused by Hemophilus ducreyi bacteria. Chancroid is spread through direct contact with open sores that contain contagious H. ducreyi bacteria. After direct contact, the bacteria multiply, causing skin lesions and infection within lymph nodes. The open sores of chancroid make the patient more vulnerable to other infections spread by direct contact, including syphilis and HIV.

    Chancroid causes painful sores on the genitals Table 01. Two to five days after infection with chancroid, a small pimplelike sore appears (usually on the external genitalia, but possibly on the anal region, depending on sexual activity). The small pimple becomes filled with pus, and then opens and enlarges. This open sore, also known as an ulcer, has irregular, ragged, soft edges. More sores may develop, and may join together to form a larger sore. Sores may become infected with other bacteria, and emit a foul-smelling discharge.

    Tender, swollen glands are common in chancroid. About half of patients with chancroid develop swollen and tender glands in the area of the sore within one to three weeks after infection, usually on one side of the body. The overlying skin may become red and warm, indicating that the gland is infected, filled with pus, and has formed an abscess. In some cases, the infection opens through the skin, draining the abscess.

    Some people feel mildly ill. A moderate fever and malaise sometimes occur with chancroid.

    Table 1.  Symptoms of Chancroid

    Sores on the genitals or in the anal region (closed pimple, then open sore)
    Tender, swollen glands, especially in the groin, that may open through the skin
    Fever and malaise

    Other sexually transmitted diseases cause genital sores.. Possible causes of these sores include chancroid, genital herpes, or syphilis. These diseases are present in the population at different rates throughout the country, but in most areas genital herpes is most common.

    Engaging in unprotected sexual activity places you at increased risk for contracting sexually transmitted diseases such as chancroid.

    Having sexual relations with multiple partners or sex workers increases your risk for chancroid. Chancroid is more common in certain tropical countries than in the U.S. Engaging in sexual activity without condoms, with multiple partners, or with people who have multiple partners increases your risk of acquiring any sexually transmitted disease.

    Your doctor will examine you for genital sores. If you have an open sore on your genitals, your doctor will suspect that you have chancroid, herpes, or syphilis. Your doctor will have to investigate further to determine which illness is responsible for your sores. Your doctor will be more likely to suspect chancroid if you live in or have recently traveled in a region where chancroid is known to occur, if the sore is painful with soft edges, or if you also have swollen and tender lymph nodes.

    Laboratory tests can help determine if you have chancroid. Usually a clinical diagnosis is made on the basis of physical symptoms along with various laboratory tests that will rule out syphilis, herpes, and other diseases.

    Sometimes fluid from a sore can be examined under a microscope to look for the bacteria that cause chancroid. The fluid should also be examined for the organisms that cause syphilis.

    Often no definitive diagnosis can be made. In about one out of four patients with a genital sore, the diagnosis is uncertain despite a complete evaluation. In such cases, many experts recommend treating for chancroid with antibiotics..

    Avoid sexual relations with people who have multiple partners, or with people whose sexual health history you do not know.

    Avoid having sexual relations while under the influence of alcohol and drugs. Using alcohol can impair your judgment and ability to practice safer sexual practices, thus increasing your chances of acquiring a sexually transmitted disease.

    In the U.S., chancroid has been associated with prostitution in certain urban areas. Chancroid is also common in some areas of Africa and Asia.

    Regular condom use can significantly reduce the transmission of STDs. Use condoms consistently and correctly to reduce the likelihood of disease transmission.

    The U.S. government's Centers for Disease Control and Prevention recommend the following:

    • Use a new latex condom with each act of intercourse. Do not use condoms made of animal products, as they offer inadequate protection. If you have a latex allergy, consult your doctor for help in choosing a safe condom.
    • Handle the condom carefully to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect and before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of K-Y Jelly or glycerine. Never use oil-based lubricant such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.
    • Avoid having sex while under the influence of alcohol or drugs, as doing so will impair your judgement and ability to practice safe sex.
    • Never have intimate relations with someone who has a suspicious sore on or near the genitals. If you have had such contact, or have had a partner who was diagnosed with syphilis, ask your doctor to test and treat you.

  • Prevention and Screening

    Avoid sexual relations with people who have multiple partners, or with people whose sexual health history you do not know.

    Avoid having sexual relations while under the influence of alcohol and drugs. Using alcohol can impair your judgment and ability to practice safer sexual practices, thus increasing your chances of acquiring a sexually transmitted disease.

    In the U.S., chancroid has been associated with prostitution in certain urban areas. Chancroid is also common in some areas of Africa and Asia.

    Regular condom use can significantly reduce the transmission of STDs. Use condoms consistently and correctly to reduce the likelihood of disease transmission.

    The U.S. government's Centers for Disease Control and Prevention recommend the following:

    • Use a new latex condom with each act of intercourse. Do not use condoms made of animal products, as they offer inadequate protection. If you have a latex allergy, consult your doctor for help in choosing a safe condom.
    • Handle the condom carefully to avoid damaging it with fingernails, teeth, or other sharp objects.
    • Put the condom on after the penis is erect and before any genital contact with your partner.
    • Ensure that no air is trapped in the tip of the condom.
    • Ensure adequate lubrication during intercourse, possibly requiring use of K-Y Jelly or glycerine. Never use oil-based lubricant such as petroleum jelly, shortening, mineral oil, massage oils, body lotions, or cooking oil. Oil can weaken latex, leading to tears in the condom.
    • Hold the condom firmly against the base of the penis during withdrawal. Withdraw while the penis is still erect to prevent slippage.
    • Avoid having sex while under the influence of alcohol or drugs, as doing so will impair your judgement and ability to practice safe sex.
    • Never have intimate relations with someone who has a suspicious sore on or near the genitals. If you have had such contact, or have had a partner who was diagnosed with syphilis, ask your doctor to test and treat you.

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