Although uncommon in the United States, chancroid is a common cause of genital ulcer disease in sub-Saharan Africa, Southeast Asia, and South America. The World Health Organization (WHO) estimated 7 million cases in 2001; however, this is thought to be an underestimation due to the difficulty in isolating the organism and subsequent underreporting.
Chancroid is common in communities where there is a high rate of sexual partners such as sex workers, and where there is a human immunodeficiency virus (HIV) prevalence above 8%. Chancroid increases the risk for transmission of HIV. Similarly, HIV infection increases the risk of chancroid and leads to atypical presentations such as a longer incubation period, multiple ulcers, and extended healing times. Extragenital chancroid is also more common in HIV coinfection.
The period of incubation is 3-7 days. Patients rarely present with prodromal symptoms. The earliest form of presentation is a painful genital papule that becomes an ulcer with a shaggy (ragged) border within a few days. If the lesion is neglected and untreated, it can cause significant tissue destruction.
A57 – Chancroid
266143009 – Chancroid
- The incubation period of primary syphilis is much longer than chancroid (3 weeks). In addition, the ulcer of syphilis is firm and painless, except in concurrent HIV when it can be painful. It also has a well-defined border that is not undermined.
- The ulcers of donovanosis (granuloma inguinale) are beefy-red indurated ulcers that heal and scar and then start again in a nearby area.
- Herpes presents with single or crops of multiple painful, punched-out ulcers.
- Lymphogranuloma venereum begins with a painless papule, erosion, or ulcer that heals in a few days, sometimes leaving a small scale that disappears without a scar in a few days. Enlarged, tender lymph nodes (buboes) then appear.
- Behçet syndrome is an inflammatory disease with painful genital ulcers that may heal with scarring, but it is usually preceded by recurrent oral aphthous ulcers and often has associated uveitis and erythema nodosum with recurrent folliculitis.
- Lipschutz ulcer (vulva) or juvenile gangrenous vasculitis of the scrotum: present with sudden onset of painful ulcers following a prodrome of fever and pharyngitis or tonsillitis. Ulcers typically resolve over weeks with atrophic scars.