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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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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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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....