Possible Complications of Chancroid: severe outcomes if this STD is left untreated

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What is Chancroid?

This disease is a sexually transmitted infection (STI) caused by the bacterium Haemophilus ducreyi. This STI is found throughout the world, but is relatively uncommon in the United States. It presents as a tender bump or pimple-like spot on the genitals, which becomes a painful ulcer over the course of several days.

Signs and Symptoms

The presentation of this infection can differ between men and women. In men, there is often a single ulcer found on the foreskin, coronal sulcus (a groove between the shaft and glans of the penis), or the frenulum. However, men do present with multiple ulcers in about 50% of cases, and these ulcers can occur on any part of the penis. Women present with an average of 4-5 ulcers, usually at the vaginal opening (including the labia major, labia minora, and clitoris). Small, overlapping ulcers may merge into large ones. Rarely, ulcers are found in extragenital areas of the body.

When do Complications Occur?

Though many patients present simply with the aforementioned ulcer, which is fully treatable with antibiotics, some patients suffer further sequelae. Complications of chancroid can occur in patients who delay or do not seek treatment, or in immunocompromised patients.

Lymphoid Complications

Up to half of patients with this STI experience lymphadenopathy (swollen lymph nodes) in the inguinal lymph nodes on one side of the groin region; these swollen nodes can be painful and may become infected, or even rupture. This is most common in men. Inguinal lymphadenopathy can also progress to form an abscess; this can be avoided by draining or aspirating large swollen glands (termed “buboes”).

Secondary Infections

Another possible consequence of this infection is the development of secondary infections in the ulcers. Because the ulcers are open wounds, they are susceptible to infection by other bacterial species, including fusobacterium and bactereoides. If these so-called “superinfections” are not promptly treated with appropriate antibiotics and wound debridement, the ulcers can become very large, destroying genital tissue and normal architecture, and resulting in permanent scarring.

Scarring

One of the other potential outcomes of this infection is phimosis. Phimosis occurs late in untreated disease, when severe ulceration thickens and scars foreskin tissues; if phimosis is severe, surgical circumcision (removal of the foreskin) may be necessary.

HIV-positive patients

Finally, as with many infectious diseases, this STI can have more severe outcomes and a longer recovery period in immunocompromised patients, such as those with HIV. HIV-positive patients often have multiple ulcers, a longer course of illness, and failure of standard treatments. The presence of an ulcer also increases the risk of acquiring HIV during sexual contact with an HIV-infected person.

References

Taylor SN, Martin DH. “Chancroid.” Current Diagnosis & Treatment of Sexually Transmitted Diseases, Mc-Graw Hill, 2007.

Lautenschlager S. “Chancroid.” Fitzpatrick’s Dermatology in General Medicine, Seventh Edition, Mc-Graw-Hill, 2008.