Approach
The aim of treatment following diagnostic confirmation of chancroid is to cure the infection, reduce clinical symptoms, prevent transmission to others, and reduce HIV transmission. However, in spite of successful treatment of the underlying infection, lesions may be slow to resolve and scarring may still occur.[49][55][72]
The management discussed in this section applies to the treatment of chancroid only (genital ulcers). It is not applicable to the treatment of Haemophilus ducreyi cutaneous ulcers.
Antibiotic therapy
Chancroid usually responds well to appropriate antibiotic therapy and relapse after successful treatment is rare.
The Centers for Disease Control and Prevention (CDC) recommend several antibiotic regimens, which are equally effective in most patients:[55][73]
Azithromycin (single-dose regimen)
Ceftriaxone (single-dose regimen)
Ciprofloxacin (multiple-dose regimen)
Erythromycin (multiple-dose regimen).
Ceftriaxone, erythromycin, or azithromycin are acceptable choices for therapy in pregnancy; however, macrolides should be used with caution in the first trimester as population-based cohort studies have found an increased risk of cardiovascular and digestive system malformations. Fluoroquinolones (e.g., ciprofloxacin) are not recommended in women who are pregnant or breastfeeding. No significant adverse effects of H ducreyi itself on pregnancy or the fetus have been reported.[55]
Systemic fluoroquinolone antibiotics, such as ciprofloxacin, may cause serious, disabling, and potentially long-lasting or irreversible adverse events. This includes, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behavior.[74]
Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability).
Consult your local guidelines and drug information source for more information on suitability, contraindications, and precautions.
Patients with HIV are prone to treatment failure, and their ulcers may heal more slowly. Because evidence is limited with the single-dose regimens, drugs with multiple-dose regimens such as ciprofloxacin and erythromycin may be preferred in patients with HIV, especially if follow-up is uncertain.[31][55][72][75]
Patients should be evaluated 3-7 days after the completion of antibiotic therapy to verify symptomatic improvement.[55] Pain usually resolves within 3 days. Ulcers heal in 1-2 weeks, although larger ulcers may take more than 2 weeks to heal. Resolution of fluctuant inguinal lymphadenitis may take longer than resolution of the ulcers. Repeated needle aspiration or incision and drainage may be required in some cases.[76]
Any sexual contacts of the patient within the previous 10 days should be examined and receive treatment, even if they are asymptomatic, to reduce the risk of reinfection.[31][55][77]
No response to initial treatment
If there is no clinical improvement within 3-7 days after completion of treatment, consider:[55]
alternative diagnoses and/or coinfection with another pathogen
whether the patient may have been noncompliant with treatment
antibiotic resistance. Sensitivity testing should be considered to guide selection of an appropriate, alternative agent.
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