Chancroid medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Nate Michalak, B.A.; Serge Korjian M.D.

Overview

The mainstay of therapy for chancroid is antimicrobial therapy. Azithromycin and Ceftriaxone are preferred because these agents offer the advantage of single dose therapy. Ceftriaxone is the drug of choice for pregnant women. Patients with HIV may require longer and repeated courses of therapy.

Medical Therapy

Successful treatment for chancroid cures the infection, resolves the clinical symptoms, and prevents transmission to others. All patients need antimicrobial therapy.

Antimicrobial Regimen

• Chancroid

• Preferred Regimen (1): Azithromycin 1 g PO in a single dose
• Preferred Regimen (2): Ceftriaxone 250 mg IM in a single dose
• Preferred Regimen (3): Ciprofloxacin 500 mg PO bid for 3 days
• Preferred Regimen (4): Erythromycin base 500 mg PO tid for 7 days
• Note (1): Patients should be tested for Human Immunodeficiency Virus (HIV) infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
• Note (2): Avoid ciprofloxacin among pregnant and lactating women due to risk of toxicity. Ceftriaxone may be considered among pregnant women.
• Note (3): HIV-positive patients should be monitored more closely due to high risk of treatment failure. Repeated or longer regimens may be required.

Follow-up

• Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether:

1. The diagnosis is correct
2. The patient is coinfected with another STD
3. The patient is infected with HIV
4. The treatment was not used as instructed
5. The H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.

• Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.

Treatment of Sex Partners

• Sex partners of patients with chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.