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

Australian categorisation system for prescribing medicines in pregnancy

Management of Partners

Partners need to be investigated and treated. Partners should be advised no sexual contact for 7 days after completion of treatment and to avoid sexual contact with any partners from the last 6 months until 7 days after they have been tested 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

Epidemiology of STIs and BBVs in Western Australia

Real time chancroid notification data