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The following is an extract from Sexplained One – Sex & Your Health, by Helen J Knox
What is chancroid?
Chancroid is a sexual infection, caused by the bacteria called Haemophilus ducreyi, which results in genital ulcer disease (GUD).
The other name for chancroid is “H ducreyi” but it may also be called ‘Ducrey’s disease’, ‘soft sore’, ‘soft chancre’ or ‘ulcus molle’.
When was chancroid first discovered?
Chancroid was first discovered by a scientist called Ducrey in 1889.
Why is it such an important infection?
Chancroid is a common sexual infection in tropical parts of the world.
Although it is most commonly found in developing countries, particularly amongst male and female commercial sex workers (prostitutes) and their clients, it is not unheard of in developed countries.
With increased international travel and associated sexual activity abroad, chancroid should be considered whenever an ulcer develops in the genital area.
Chancroid is important because, like genital herpes and syphilis, LGV (lymphogranuloma venereum) and Donovanosis, it is an ulcerative condition which can easily facilitate the transmission of HIV.
How is chancroid passed on?
Chancroid is passed through unprotected sexual activity and skin to skin contact with an infected and open, ulcerated area.
How long does chancroid take to show?
After transmission, the common incubation period for chancroid to show ranges between three and 10 days. Men commonly get only one ulcer while women usually develop more.
What might I notice if I have chancroid?
If you have chancroid, you may notice either a single or multiple ragged-edged sores, one day to two weeks after exposure.
Chancroid produces sharply defined sores or ulcers that grow to various sizes and may become painful.
Sores consist of a soft centre with a necrotic base (base of dead tissue) that contains pus-like exudate (fluid), which bleeds easily if scraped.
There may be one-sided adenitis — i.e. painful, swollen lymph glands in the inguinal (groin) area and buboes (inflamed, enlarged lymph nodes) may form and burst, sometimes resulting in a considerable amount of thick pus/discharge and ulceration of infected broken areas of skin.
In other words, chancroid produces distinct, painful, irregular ulcers. They are caused by the premature death of cells and living tissue, with the build up of fluid from the circulatory system when that can’t escape from the pus-producing inflamed area.
The area can be made to bleed easily.
Several lesions may merge to form gigantic ulcers.
NOTE: Unlike genital herpes, there is no ‘prodrome’ (sensations to alert that an ulcer is coming) and it is easy to mistake the initial ulcer as the typically “hard” painless chancre of syphilis; but chancroid produces a “soft chancre” that is painful, although this may be more so in men than in women.
What tests are there to check if I’ve got chancroid?
The main tests for chancroid are a swab test, taken of the discharge/exudate and/or scrapings taken from the base of the ulcer to see which bacteria grow in the laboratory.
Tests may also be performed to rule out syphilis (Treponema pallidum), Hepatitis C, genital herpes, LGV (lymphogranuloma venereum), and Donovanosis. (See each of these infections for more information.)
To be safe, depending on the type of setting, a biopsy or tissue sample from the swollen lymph glands may be taken to rule out cancerous lymph enlargement.
Do any other infections/conditions present in a similar way as chancroid?
Yes. Syphilis, Donovanosis, Herpes, Bejel, Pinta and Yaws can present in a similar way.
What might men notice if they have chancroid?
Men with chancroid may notice:
* a single ulcer or sometimes ulcers around the foreskin (especially if they have not been circumcised), on the glans penis or the coronal sulcus
(head of the penis);
* enlarged glands in the groin, which may be painful, or ulcers around
the anal area.
What might women notice if they have chancroid?
Women with chancroid may notice:
* four or more ulcers in the lower genital area (the fourchette or lower end of the entrance to the vagina) or the labia minora (the thin inner lips that guard the entrance to the vagina);
* ulcers on the labia majora (outer, fatter lips), perhaps opposite each other and as if they are ‘kissing’ when they are in contact with each other — and may merge together to form gigantic ulcers;
* the inner thigh and the perineal area (between the vagina and the anus) may be affected;
* pain passing urine; and
* pain during sex.
What complications can happen if chancroid is not treated?
Left untreated, chancroid does not appear to cause major problems throughout the body but it does increase the risk of contracting other infections.
Men with chancroid who have not been circumcised are at risk of developing phimosis — when the foreskin becomes swollen, painful and cannot retract or move normally.
Chancroid ulcers may spread rapidly and the affected skin can slough (cast) off and the glans penis may also become involved.
Scarring may occur at the site of infection.
What treatment is there if I’ve got chancroid?
As Chancroid is caused by a bacteria rather than a virus, specific antibiotics can be given to treat it.
Can chancroid be cured?
Yes. Chancroid can be cured but you can get it again.
What should I do after I finish the treatment for chancroid?
After treatment for chancroid has been started, you should be seen by the person/clinic treating you three to seven days later to make sure it is working as expected.
if the ulcer is not extremely large, your skin should appear back to normal within two weeks.
Any lymph glands that remain swollen may take a little longer or require different treatment before they return to normal.
if you haven’t started healing as expected at your check-up you may need further investigations.
Will my partner(s) need to be treated, too?
Yes. Your partner should be seen, fully screened and treated appropriately because it is possible to have chancroid without realising.
Anyone you have had sex with, particularly in the last two weeks, should be screened.
How soon can I have sex again after treatment for chancroid?
You should avoid sex during treatment and be guided by the person monitoring your progress about when you are safe to resume sexual activity after you have chancroid.
NOTE: Remember that you should also wait until any partner(s) have also been told it is safe to resume sexual activity after treatment.
What about sex and chancroid?
Since chancroid is usually transmitted through unprotected sex or intimate contact, including mutual masturbation/foreplay with an infected person, take the time to get to know someone and always use a condom to protect yourself.
How can I avoid chancroid?
The best way to prevent chancroid is to avoid having casual sex.
Reduce the number of people you have sex with.
Always use a condom or oral dam during intimate sexual activity.
Get checked regularly, but in particular before you have sex with a new partner, and ask them to do so too.
Non-sexually: if you are giving first-aid to someone who has an open pus-filled wound, make sure you wear protective gloves or another barrier. Wash your hands carefully afterwards.
See the chapter on Safer Sex
If I am using hormonal contraception, will the treatment interfere with my protection?
See the section on Safer Sex