Chancroid

Organism
Haemophilus ducreyi is the organism responsible for chancroid. It is an imported infection and is not endemic in Australia.
Clinical presentation
Chancroid ulcers are usually tender and multiple, and may be associated with fluctuant inguinal lymphadenitis. Unusual or large ulcers should be discussed urgently with a specialist because, occasionally, very rapid, extensive and destructive ulceration may occur.

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Investigations
  • Ask the patient about overseas sexual exposure.
  • Diagnosis is by culture of H. ducreyi on specialised media. It is important to ring the laboratory to discuss specimen collection before taking the specimen.
  • In some cases Gram-stained smear may show typical organisms, but this test has low sensitivity compared to culture.
  • Serological tests are not routinely available.
  • NAAT if available.
Treatment

Directly observed single dose therapy is preferred.

  • Azithromycin 1 g orally, as a single dose

        or

  • ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly, as a single dose

        or

  • ciprofloxacin 500 mg orally, 12-hourly for three days.

Pregnancy

Medicines in pregnancy.

Management of Partners
Partners need to be investigated and treated.
Follow up
Review the patient until the ulcers have healed.
Public health issues
Check for other STIs, and perform contact tracing to prevent further transmission and reinfection.
Notification

This is a notifiable infection. Medical practitioners must complete the appropriate notification forms for all patients diagnosed with a notifiable STI/HIV, as soon as possible after confirmed diagnosis.

Epidemiological reports and real time notification data