Chancroid


Chancroid

Description, Causes and Risk Factors:

An infectious, painful, ragged venereal ulcer at the site of infection by Haemophilus ducreyi, beginning after an incubation period of 3-7 days; seen more commonly in men; Gram-negative streptobacilli (A genus of nonmotile, non-spore-forming, aerobic to facultatively anaerobic bacteria (family Bacteroidaceae) containing Gram-negative, pleomorphic cells that vary from short rods to long, interwoven filaments that have a tendency to fragment into chains of bacillary and coccobacillary elements. These organisms can be pathogenic for rats, mice, and other mammals. The type species is Streptobacillus moniliformis) may be identified by staining material from the ulcer.

Chancroid is a sexually transmitted disease (STD) caused by a bacterium. It is common in tropical countries but rare in other parts of the world. Chancroid is contagious as long as the infected person has any open sores. The open sores contain bacteria and any contact with these sores can result in infection.

The advent of DNA amplification tests has recently demonstrated both to be inaccurate measures of the true prevalence of H ducreyi infection among patients with genital ulcer disease.

Preventive Measures:

    Limit the number of your sex partners.

  • Use a condom.

  • Carefully wash the genitals after sexual relations.

  • If you think you are infected, avoid any sexual contact and visit your local STD Clinic, a hospital or your doctor. Notify all sexual contacts immediately so they can obtain examination and treatment.

Symptoms:

Within 1 day - 2 weeks after getting chancroid, a person will get a small bump in the genitals. The bump becomes an ulcer within a day of its appearance.

The ulcer ranges in size from 1/8 inch to 2 inches across.It may be painful, soft, sharply defined borders, has a base that is covered with a grey or yellowish-grey material, has a base that bleeds easily if it is banged or scraped.

Diagnosis:

Chancroid

Only a healthcare provider can diagnose chancroid. Chancroid symptoms can be confused with other infections, such as herpes and syphilis. Your healthcare provider will examine the discharge from the sore with a microscope to make a diagnosis.

H ducreyi is a fastidious bacterium requiring a relatively expensive nutritive base to grow on and is an extremely difficult organism to culture from clinical specimens in the hands of inexperienced laboratory staff. As a result, conventional laboratory culture facilities are often not available in STD clinics or simply not affordable in resource poor countries. In those clinical settings with laboratory support, clinicians are often faced with the dilemma of whether to treat a patient empirically for chancroid at the first visit or whether to request staff in their microbiology laboratory to provide a suitable medium with which to culture H ducreyi on a subsequent day in the hope that the patient is not lost to follow up. Even if culture facilities are available, it often takes several days for results to become available.

Several DNA amplification based techniques have been developed in an attempt to improve the sensitivity of the laboratory diagnosis of chancroid.The technique of M-PCR (Multiplex PCR) involves the addition of multiple primer pairs to the reaction mixture in order to simultaneously amplify distinct DNA sequences from different targets in the processed lesion material. The research based M-PCR described by researchers offer a highly sensitive and specific way to detect the three most common etiological agents of genital ulcer disease—namely, HSV, Treponema pallidum, and H ducreyi. Specimens for M-PCR may easily be transported from the STD clinic to a remote laboratory and can be stored at ?70°C if required for batch testing. The ability to perform DNA amplification based techniques requires access to laboratories with specialized molecular biological expertise. As such, this expensive technology will continue to have a role in research and outbreak investigation but is not likely to be made available to clinicians in most worldwide settings where patients with chancroid seek STD care.

Treatment:

Recommended and alternative treatment regimens from the WHO, the Centers for Disease Control and Prevention (CDC), and the United Kingdom's Clinical Effectiveness Group are presented a debate concerning the duration of ciprofloxacin therapy for chancroid; the WHO recommends a single 500 mg oral dose whereas the CDC recommends 500 mg twice daily for 3 days. A recent double blind randomized controlled trial in Kenya demonstrated comparable cure rates for both single dose ciprofloxacin (92%) and a 1 week course of erythromycin (91%). Pregnant women should be treated with either erythromycin or ceftriaxone regimens. Patients with underlying immunosuppression due to HIV infection should be carefully followed up as reduced healing of genital ulcers and persistence of H ducreyi in the lesions has been reported in this group. There also appears to be an increased likelihood of treatment failure in uncircumcized individuals with chancroid. Treatment failures have been reported in African patients treated with single doses of either intramuscular ceftriaxone or oral fleroxacin. Co-existing HSV infection, particularly in immunosuppressed HIV seropositive patients, may also account for some of the observed cases where treatment has failed to cure chancroid.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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