Chancroid natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Nate Michalak, B.A.; Serge Korjian M.D.

Overview

Chancroid symptoms typically develop 4 to 10 days after infection. Initial indication of infection involves formation of erythematous papules which develop into pustules after several days. Approximately 1-2 weeks after pustule formation, the lesions may ulcerate. Patients typically develop 1 to 4 ulcers. Lymphadenopathy develops in approximately half of patients, predominantly in males, 1 to 2 weeks after appearance of the primary ulcer. In approximately 25% of patients with lymphadenopathy, lymph nodes may swell to form fluctuant buboes which may rupture and form giant ulcers. Prognosis is poor without treatment. Complications from chancroid include: superinfection of lesions, extensive adenitis, development of inguinal abscesses, and nonhealing ulcers.

Natural History

The incubation period for H. ducreyi is typically 4 to 10 days, after which erythematous papules arise.
Approximately 2 to 3 days after symptom onset, papules evolve into pustules.^[1]
Pustules may resolve spontaneously or ulcerate in approximately 1-2 weeks since formation. Patients typically develop between 1 to 4 ulcers.
Inguinal lymphadenitis develops in approximately half of patients, usually unilaterally and more commonly in males than females, 1 to 2 weeks after appearance of primary ulcer.^[2]
In approximately 25% of patients with lymphadenitis, lymph nodes may swell to form fluctuant buboes. Untreated buboes may rupture, discharge exudate, and ulcerate.^[2]

Complications

Superinfection of lesions by other anaerobic bacteria such as Fusobacterium and Bacteroides^[3]^[4]
Phimosis in men^[2]
Extensive adenitis in the absence of treatment
Development of inguinal abscesses which may rupture to form a draining sinus or giant ulcer
Nonhealing ulcers

Prognosis

Chancroid is not lethal.
Prognosis is poor without treatment. Indications of poor prognosis include:

Nonhealing ulcers

Lymphadenopathy, especially with the formation and/or rupture of buboes

Superinfection of lesions (phagedenic chancroid)

References

↑ Spinola, S. M. (2002). “Immunopathogenesis of Haemophilus ducreyi Infection (Chancroid)”. Infection and Immunity. 70 (4): 1667–1676. doi:10.1128/IAI.70.4.1667-1676.2002. ISSN 0019-9567.
↑ ^2.0 ^2.1 ^2.2 Lewis, D A (2003). “Chancroid: clinical manifestations, diagnosis, and management”. Sexually Transmitted Infections. 79 (1): 68–71. doi:10.1136/sti.79.1.68. ISSN 1368-4973.
↑ CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases. McGraw-Hill Companies,Inc. 2007. pp. 69–74. ISBN 9780071509619.
↑ Chancroid. Wikipedia (July 16, 2015). https://en.wikipedia.org/wiki/Chancroid Accessed January 15, 2016.

Template:WikiDoc Sources

[Spinola2002-1] Spinola, S. M. (2002). “Immunopathogenesis of Haemophilus ducreyi Infection (Chancroid)”. Infection and Immunity. 70 (4): 1667–1676. doi:10.1128/IAI.70.4.1667-1676.2002. ISSN 0019-9567.

[Lewis2003-2] 2.0 ^2.1 ^2.2 Lewis, D A (2003). “Chancroid: clinical manifestations, diagnosis, and management”. Sexually Transmitted Infections. 79 (1): 68–71. doi:10.1136/sti.79.1.68. ISSN 1368-4973.

[cur-3] CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases. McGraw-Hill Companies,Inc. 2007. pp. 69–74. ISBN 9780071509619.

[ChancroidWikipedia-4] Chancroid. Wikipedia (July 16, 2015). https://en.wikipedia.org/wiki/Chancroid Accessed January 15, 2016.

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