Chancroid (Ulcus Molle, Soft Chancre)


Chancroid is an infectious disease caused by Haemophilus ducreyi, a small gram-negative bacillus.

It is common in the tropics, especially in Africa, the Far East, and the Caribbean.
Persons may present with chancroid outside endemic regions; sporadic outbreaks of infection occur in Europe and North America.

Clinical features

  • Incubation period is about 3-7 days
  • It begins as a small, tender papule, changing into a pustule which rapidly progresses to a painful ulcer with a bright red areola.
  • Neither the edge nor base of the ulcer is indurated (unlike syphilis)
  • The ulcer feels soft, hence the name ‘soft sore’ (ulcus molle)
  • With superimposed bacterial infection, it often feels indurated
  • Sites of predilection in men are the prepuce, frenulum, glans or shaft of the penis
  • The ulcers may be multiple due to auto inoculation
  • In women the labia, fourchette, vestibule, clitoris, cervix, or perineum are favored sites.
  • Lesions may cause dyspareunia, pain on voiding or defaecation and vaginal discharge
  • Women may be asymptomatic carriers
  • About 7 – 14 days after the appearance of the ulcer, a bubo appears
  • A mass of gland smatted together, of tenad herent to the overlying skin
  • The glands above the inguinal ligament are usually affected, and often there is a unilateral enlargement.
  • Central softening is often found and if untreated the bubo may rupture and discharge through a fistula
  • The combination of a painful genital ulcer and suppurative inguinal adenopathy is almost pathognomonic of chancroid
  • Patient may present with bubo, the initial ulcer having healed
  • Atypical lesions have been reported in HIV infected individuals
  • More extensive, or multiple lesions
    sometimes accompanied by systemicmanifestations such as fever and chills


  • Progressive ulceration and amputation of the phallus, particularly in HIV patients

Differential diagnoses

Other causes of genital ulcers:

  • Syphilis
  • Herpes
  • Granuloma inguinale
  • Lymphogranuloma venereum
  • Fixed drug eruption
  • Erythema multiforme
  • Behcet’s disease
  • Trauma
  • Tuberculous ulcer
  • Cancers


  • Microscopy, culture and sensitivity of discharge from ulcer
  • Serological tests e.g. complement fixation (CF); microimmuno-fluorescence (MIF) test; PCR

Treatment objectives

  • Eliminate the organism in the patient and sexual partner(s)
  • Prevent re-infection
  • Prevent complications
  • Counsel and screen for possible co-infection with HIV so that appropriate management can be instituted

Drug therapy

Recommended regimen:

  • Ciprofloxacin 500 mg orally every 12 hours for 3 days


  • Erythromycin 500 mg orally every 6 hours for 7 days


Azithromycin 1 g orally as a single dose

Alternative regimen:

  • Ceftriaxone, 250 mg by intramuscular injection, as a single dose

Adjuvant therapy

  • Keep ulcerative lesions clean
  • Aspirate fluctuant lymph nodes through the surrounding healthy skin, preferably from a
    superior approach to prevent persistent dripping and sinus formation
  • Incision and drainage, or excision of nodes may delay healing and is not recommended


  • All patients should be followed up until there is clear evidence of improvement or cure
  • In patients infected with HIV, treatment may appear to be less effective, but this may be a
    result of co-infection with genital herpes or syphilis
  • Chancroid and HIV infection are closely associated and therapeutic failure is likely to be seen with increasing frequency
  • Patients should therefore be followed up weekly until there is clear evidence of improvement

Notable adverse drug reactions, caution and contraindications


Counselling, Compliance, Condom use and Contact treatment.

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