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Chancroid is a sexually transmitted disease caused by the organism Haemophilus ducreyi.1,2 It is characterized by painful genital ulcers and tender inguinal adenopathy that may suppurate. Also known as “soft chancre,” chancroid is one of the three major causes of genital ulcer disease among young sexually active patients in the United States; the other major causes are genital herpes and syphilis.

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Epidemiology

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Chancroid is a common cause of genital ulcer disease throughout the world but is not commonly reported in the United States. Although the prevalence of chancroid is low in the United States, the reason for this low prevalence may be due to underdiagnosis. Most clinicians do not have clinical experience with chancroid and thus do not consider it in the differential diagnosis. Most laboratories do not have the capability of isolating H ducreyi. Chancroid was more prevalent in the past (eFig. 258.1).3 Chancroid cases peaked to a high of 5001 in the United States in 1988; however, cases have steadily declined with the lowest number, 17, in 2005, and only 33 cases reported in 2006.3 In comparison, there were 9756 cases of primary or secondary syphilis reported in 2006.3 Of the cases in 2006, 12 were in males and 21 were in females. They were reported from just 8 states with most (82%) from southern states: 14 from South Carolina, 5 from North Carolina, 5 from Texas, and 1 case each from Louisiana, Virginia, and Florida. The remaining 6 cases were from New York and Michigan.

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eFigure 258.1.
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Reported chancroid cases in the United States, 1983–2006.

(Centers for Disease Control and Prevention. Summary of notifiable diseases, United States, 2006 MMWR. 2006;55(53).)

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Other data suggest that the disappearance of chancroid in the United States may be due to lack of testing and underreporting.4-11 In a survey of 405 sexually transmitted disease (STD) clinics, only 32 (8%) tested patients for chancroid.4 Surveys in California from 1996 to 2003 found that less than 300 tests for chancroid were done, accounting for less than 0.1% of all tests done for STDs.5 However, in genital ulcer studies where testing for H ducreyi was done, chancroid has frequently been found. In a study in Brooklyn, New York, H ducreyi was identified in 27 of 65 (42%) cases in which a microbiologic diagnosis was established.6 Coinfection with syphilis was common. In New Orleans, Louisiana, similar findings were found in 299 men with nonsyphilitic genital ulcer disease; 39% had H ducreyi, 19% had herpes simplex virus (HSV), and the culture was negative in 41%.11 Using the sensitive polymerase chain reaction (PCR), it appears that chancroid may be even more common than previously thought. In a PCR study in Jackson, Mississippi, 59% of genital ulcer cases were due to H ducreyi...

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