CHANCROID

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: A sexually transmitted disease (STD) caused by the bacteria Haemophilus ducreyi. It is clinically characterized by single or multiple painful, necrotizing ulcers at the site of infection. It is frequently accompanied by painful inflammatory swelling and suppuration of regional lymph nodes. Minimally symptomatic lesions may occur on the vaginal wall or cervix; asymptomatic infections may occur in women. Chancroid ulcers, like other genital ulcers, are associated with increased risk of HIV infection.

B. REPORTING CRITERIA: Laboratory confirmation.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Isolation of Haemophilus ducreyi on a selective medium.

D. WISCONSIN CASE DEFINITION: A laboratory confirmed infection.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

• Acute and Communicable Diseases Case Report (DPH 4151).
• Sexually Transmitted Diseases Morbidity and Epidemiologic Case Report (DPH 4243).

C. PUBLIC HEALTH INTERVENTIONS: Patients treated for chancroid should be counseled regarding their risk for HIV infection and in methods to reduce their risk for STDs.

• Investigation of contacts and source of infection: Identify sexual contacts within 2 weeks before and after onset of symptoms and refer them for evaluation and treatment. Women without visible signs may be carriers. Sexual contacts without signs or symptoms should receive prophylactic treatment.
• Follow-up schedules are individualized but should be at weekly intervals until the lesion(s) are clearly resolving. Follow-up should continue until complete resolution has occurred. Patients should understand the importance of abstaining from having sex while any lesion is present. Current sexual partners should receive a routine STD evaluation and treatment with a regimen adequate for uncomplicated chancroid.
  

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE STD UNIT: (608) 266-7365.

B. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

C. WSLH / BACTERIOLOGY: (608) 262-1616.

D. MILWAUKEE BUREAU OF LABORATORIES: (414) 286-3526.

IV. PREVENTION MEASURES

A. Patients treated for chancroid should be counseled regarding their risk for HIV infection.

B. Follow-up of all patients with genital ulcerations and perform serologic test for syphilis.

C. Treatment - Successful treatment cures infection, resolves clinical symptoms, and prevents transmission to others. In extensive cases, scarring may result despite successful therapy.

Recommended Regimens

	Azithromycin 1 g orally in a single dose, OR
	Ceftriaxone 250 mg intramuscularly (IM) in a single dose, OR
	Erythromycin base 500 mg orally 4 times a day for 7 days

All three regimens are effective for the treatment of chancroid in patients without HIV infection. Azithromycin and ceftriaxone offer the advantage of a single-dose therapy. Antimicrobial resistance to ceftriaxone and azithromycin has not been reported. Although two isolates resistant to erythromycin were reported in Asia a decade ago, similar isolates have not been reported.

Alternative Regimens

	Amoxicillin 500 mg plus clavulanic acid 125 mg orally 3 times a day for 7 days, OR
	Ciprofloxacin 500 mg orally 2 times a day for 3 days
	**Note : Ciprofloxacin is contraindicated for pregnant and lactating women, children, and adolescents under 17 years of age.
	These regimens have not been evaluated as extensively as the recommended regimens and neither regimen has been studied in the United States .

V. RELATED REFERENCES

1. Heymann DL, ed. CHANCROID. Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:92-94.

2. Pickering LK, ed. Chancroid. In: Red Book: 2003 Report of the Committee on Infectious Diseases. 26 th ed. Elk Grove Village , IL : American Academy of Pediatrics, 2003:234-237.

3. Sexually Transmitted Diseases Treatment Guidelines --- 2002. MMWR 2002;51(RR06):1-80   4. Wisconsin Administrative Code, Chapter HSS 145, 1991, No. 430.