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Chancroid

Queensland Health Guidelines for Public Health Units

Revision History

Version Date Changes
 2.0 January 2015  Full revision of guideline. 

Infectious Agent

The causative agent is Haemophilus ducreyi (a gram-negative coccobacillus).

Notification and Reporting Criteria

Laboratory notification only. Laboratory reporting to Notifiable Conditions System.

For case definitions see Queensland Notification Criteria: Guidelines for Laboratories (PDF, 459kB)

Public Health Significance and Occurrence

Chancroid is a sexually transmitted disease, causing genital ulcers with/without bubo formation, and is rarely seen in Australia. Chancroid is most commonly found in sub-Saharan Africa, Asia, Latin America and the Caribbean. Chancroid infections have been associated with commercial sex workers and drug use in countries outside of Australia.

Chancroid is diagnosed more frequently in men, and uncircumcised men appear to be at greater risk. Only 10 per cent of reported cases occur in women. The genital lesions are usually painful, particularly on the penile shaft, but may be minimally symptomatic in the vagina, cervix or anus, which could facilitate transmission in those unaware of lesions or asymptomatic. Women are more likely to be asymptomatic than men. The presence of genital ulceration and inflammation substantially increases the risk of contracting and transmitting HIV infection.

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Clinical Features

Chancroid has an incubation period of 3-7 days, and infection with chancroid progresses from papule/pustule to ulcers. The ulcers are painful with serosanguinous discharge and undermined edge. It extends to regional lymph nodes causing unilateral lymphadenitis, with no systemic symptoms. The sequela of the infection is bubo formation and its complications. See Australian STI Management Guidelines and/or Primary Clinical Care Manual. A doctor's fact sheet is available in the Australasian Contact Tracing Manual.

Mode of Transmission

Transmission occurs through direct contact with the lesions. Sexual partners exposed by vaginal, oral or anal sex, without using a condom or dam, are at high risk of infection.

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Investigation

Through clinical history and examination. Swabs from the genital ulcers and bubo viewed through microscopy and cultured with special media. An in house polymerase chain reaction test is also available with some pathology laboratories. See Australian STI Management Guidelines and/or Primary Clinical Care Manual.

Management

Cases

All persons with genital ulcers should also be tested for syphilis, herpes simplex 1 and 2, Chlamydia trachomatis serovars L1-L3 and donovanosis if indicated. All persons with genital ulcer disease should be offered an HIV test. See Australian STI Management Guidelines and/or Primary Clinical Care Manual.

Contacts

Contacts for males and females with chancroid should be traced back for two weeks before the ulcer appeared or since arrival in an endemic area. Seek specialist support if local acquisition or transmission is possible. Contact tracing can be conducted by the index case, the treating service provider, a referral agency (following consent by the index case), or a combination of these. For further information and assistance with STI contact tracing go to www.health.qld.gov.au and search 'contact tracing'. See Australian STI Management Guidelines and/or Primary Clinical Care Manual.

Preventive Measures

General promotion of safer sex practices, including the consistent use of condoms or dams with all sexual partners and for oral sex. Provision of education and counselling regarding sexually transmissible infections and negotiating safer sex.

Avoidance of any sexual contact when anogenital ulcers are present or for seven days after treatment has been administered for a confirmed infection

Contact Details of Queensland Health Sexual Health Services

References

Australasian Society for HIV Medicine, 2010. Australasian Contact Tracing Manual (4th ed).

Australasian Society for HIV Medicine (2014). Australian STI Management Guidelines for use in Primary Care. http://www.sti.guidelines.org.au/ Accessed 14 October 2014.

Cohen J & Powderly WG, 2003. Infectious Diseases (2nd ed). Mosby: Washington.

Heymann D (Ed), 2008. Control of Communicable Diseases Manual (19th ed). 2008 American Public Health Association: Washington.

Holmes KK et al, 2008.  Sexually Transmitted Diseases (4th ed). McGraw, New York.

McMillan A & Scott GR. 2008. Sexually Transmitted Infections (2nd ed.).

Russell D, Bradford D, and Fairley C, 2005. Sexual Health Medicine (2nd ed.).

The State of Queensland (Queensland Health) and the Royal Flying Doctor Service (Queensland Section), 2013. Primary Clinical Care Manual. Cairns.

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Last updated: 15 January 2015