Abstract
This condition, variously known as chancroid, soft chancre, ulcus molle, chancre mou and Ducrey’s infection, was defined by Sullivan (1940) as “an acute localised autoinoculable genito-infectious disease caused by the streptobacillus of Ducrey (Haemophilus ducreyi), characterized clinically by ulcerations at the sites of inoculation, and frequently accompanied by inflammatory swelling and suppuration of the regional lymph nodes”. In discussing the incidence of this disease, the same writer (ibid) stated that it was very difficult to judge its frequency in various populations, because of lack of information and unreliability of diagnoses. In western countries the incidence of the disease seemed to be consistently low, although minor local outbreaks were reported from time to time. In eastern countries, and in tropical and sub-tropical regions generally, the incidence was far higher, and among troops stationed in such areas it was liable to rise to a level five or ten times as high as in other areas. Asin (1952) working among Service personnel in Korea, found that chancroid was the most prevalent venereal disease, the incidence of chancroid, gonorrhoea and syphilis being in the ratio of 14:8:1 among white troops and 21:11:1 among negroes. One of the striking features of reported figures is the disproportionately low incidence in women, which perhaps reflects the difficulty of making this diagnosis in the female. Rauschkolb (1939), in a study of the condition in Cleveland, Ohio, found that it resulted invariably from promiscuous intercourse among what he described as the socially unenlightened and economically unfortunate. Of 479 patients in his series, 322 were negroes and 157 were white, a ratio of 2:1, whereas the ratio of negroes to whites in the population of Cleveland was 1:12. The disease is nearly always venereally acquired, and therefore extragenital lesions are rare. Infection seems to occur readily at sites of trauma or of other lesions. In Rauschkolb’s series (ibid) there were five instances in which chancroids developed at the sites of scabietic lesions. Lossing and Allen (1956) stated that only 34 cases of chancroid were reported from the whole of Canada in 1954, mainly in seamen and Service men who acquired the infection abroad. Tottie (1956) stated that the reported cases of chancroid in Sweden numbered 3,000 in 1919. The incidence had steadily decreased and now only 10 new cases were reported each year. Willcox (1956) stated that the true incidence of chancroid throughout Africa was unknown but it was apparent that it was the venereal disease next in importance to syphilis and gonorrhoea, and in some places it was more prevalent than primary syphilis. It was a big enough problem to interfere materially with the economic life of the continent.
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References
A. Incidence
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B. The causative organism : I.Characteristics
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II.Experimental infections
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III.Susceptibility in vitro
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C. Clinical findings
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III. Sites of involvement
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IV. Clinical characteristics in the female
Harkness, A. H.: Non-gonococcal urethritis, p. 186. Edinburgh: E. and S. Livingstone 1950.
Heyman, A.: The clinical and laboratory differentiation between chancroid and lymphogranuloma venereum. Amer. J. Syph. 30, 279 (1946).
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V. Extragenital chancroids
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Harkness, A. H.: Non-gonococcal urethritis, p. 185. Edinburgh: E. and S. Livingstone 1950.
Lloyd, V. E.: Case of chancroid of a finger. Brit. J. vener. Dis. 11, 259 (1935).
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Turell, R.: Diseases of colon and rectum. Amer. J. med. Sci. 202, 282 (1941).
VI. Complications
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VII. Associated disease
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Torpin, R., and R. B. Dienst: Chancroidal infection in the female. Amer. J. Syph. 22, 634 (1938).
D. Diagnostic tests: I.Direct smears
I.Direct smears
Barritt, M. M.: An improved Pappenheim stain for detection of gonococci in smears of pus. Brit. med. J. 1943 I, 254.
Dienst, R. B., and S. W. Gilkerson: Evaluation of the Ducrey skin test for chancroid. Amer. J. Syph. 31, 65 (1947).
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Strakosch, E. A., H. W. Kendell, R. M. Craig and G. K. Schwemlein: Clinical and laboratory investigation of 370 cases of chancroid. J. invest. Derm. 6, 95 (1945).
II. Cultures
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III. The intradermal test
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Brandt, R., and R. Torpin: The dependability of the skin test in the diagnosis of lymphogranuloma venereum and chancroid, especially in the colored race. Amer. J. Syph. 24, 632 (1940).
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Robinson, H. M.: Analysis of intracutaneous tests on 309 patients for lymphogranuloma venereum and chancroid. Sth. med. J. (Bgham, Ala.) 33, 144 (1940).
Sanderson, E. S., and R. B. Greenblatt: The cultivation of Hemophilus Ducreyi and preparation of an antigen for intracutaneous diagnosis of chancroidal infection. Sth. med. J. (Bgham, Ala.) 30, 147 (1937).
Strakosch, E. A., H. W. Kendell, R. M. Craig and G. K. Schwemlein: Clinical and laboratory investigation of 370 cases of chancroid. J. invest. Derm. 6, 95 (1945).
Sullivan, M.: Chancroid. Amer. J. Syph. 24, 482 (1940).
Willcox, R. R.: The Ito skin test for chancroid in the adult and juvenile African. Amer. J. Syph. 36, 284 (1952).
IV. Biopsy
Heyman, A., P. B. Beeson and W. H. Sheldon: Diagnosis of chancroid. The relative efficiency of biopsies, cultures, smears, autoinoculations and skin tests. J. Amer. med. Ass. 129, 935 (1945).
McCarthy, L.: Histopathology of Skin Diseases, p. 186. London: Henry Kimpton 1931.
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V. Autoinoculations
Heyman, A., P. B. Beeson and W. H. Sheldon: Diagnosis of chancroid. The relative efficiency of biopsies, cultures, smears, autoinoculations and skin tests. J. Amer. med. Ass. 129, 935 (1945).
Stillians, A. W.: Syphilization. An episode in the evolution of syphilology. Arch. Derm. Syph. (Chicago) 37, 272 (1938).
Sullivan, M.: Chancroid. Amer. J. Syph. 24, 482 (1940).
VI. Complement-fixation test
Sanderson, E. S., R. B. Greenblatt and E. Baethke: The complement fixation test in chancroidal infection. J. Lab. clin. Med. 24, 185 (1938).
VII. Cross reactions
Knott, L. W., L. H. T. Bernstein, H. Eagle, T. E. Billings, R. L. Zobel and E. G Clark: The differential diagnosis of lymphogranuloma venereum and chancroid by laboratory and skin tests. Amer. J. Syph. 27, 657 (1943).
Strakosch, E. A., H. W. Kendell, R. M Craig and G. K. Schwemlein: Clinical and laboratory investigation of 370 cases of chan croid. J. invest. Derm. 6, 95 (1945).
E. Differential diagnosis
Dienst, R. B., and S. W. Gilkerson: Evaluation of the Ducrey skin test for chancroid Amer. J. Syph. 31, 65 (1947).
Heyman, A.: The clinical and laboratory differentiation between chancroid and lymphogranuloma venereum. Amer. J. Syph. 30, 279 (1946).
Leibovitz, A.: An outbreak of pyogenic penile ulcers associated with a microaerophilic streptococcus resembling Hemophilus Ducreyi. Amer. J. Syph. 38, 203 (1954).
Stokes, J. H, H. Beerman and N. R. Ingraham: Modern clinical syphilology, 3rd. edit., pp. 476,.516 and 520. Philadelphia and London: W. B. Saunders Company 1945.
Sullivan, M.: Chancroid. Amer. J. Syph. 24, 482 (1940).
Wall, M. J., A. Heyman and P. B. Beeson: Studies on the complement fixation reaction in Ivmphogranuloma venereum. Amer. J. Syph. 31, 289 (1947).
F. Treatment : I.Prophylaxis
Arthur, R. D., and H. Dermon: Sulphathiazole as a venereal disease prophylaxis. Amer. J. Syph. 27, 261 (1943).
Bergsma, D.: Sulphathiazole prophylaxis for gonorrhoea and chancroid among soldiers in the Caribbean area. Amer. J. Syph. 30, 368 (1946).
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Greenblatt, R. B., E. S. Sanderson, F. Mortara and H. S. Kupperman: Experimental prophylaxis of chancroid disease. Amer. J. Syph. 27, 30 (1943).
Green- Jald, E.: Chancroidal infection. Treatment and diagnosis. J. Amer. med. Ass. 121, 9 (1943).
woses, M.: Sulphathiazole prophylaxis of gonorrhoea and chancroid. U. S. nav. med. Bull.40, 113 (1942).
Keet, E. E.: The oral use of sulphathiazole in the prevention of gonorrhoea and chancroid. Amer. J. Syph. 28, 315 (1944).
Pereyra, A. J., and S. Landy: Experimental prophvlaxis and treatment of chancroidal infection. Inefficacy of penicillin administered intramuscularly. U. S. nav. med. Bull. 43, 189 (1944).
Willcox, R. R.: Effectiveness of antichancroidal drugs tested by autoinoculation of bubo fluid. Amer. J. Syph. 34, 378 (1950).
Willcox, R. R.: Anti-chancroidal drugs tested by the hetero-inoculation of bubo fluid from the treated donor. Brit. J. vener. Dis. 26, 131 (1950).
Willcox, R. R.: Streptomycin in soft sore. Observations on clinical and experimental infections. Lancet 1950 I, 396.
Zeve, H. S., and S. S. Schneierson: Sulfonamide ointment in routine prophylaxis of chancroid disease. U. S. nav. med. Bull. 43, 391 (1944).
II. Established infection : 1.Local treatment
Rauschkolb, J. E.: Circumcision in treatment of chancroidal lesions of male genitalia. Arch. Derm. Syph. (Chicago) 39, 319 (1939).
Sullivan, M.: Chancroid. Amer. J. Syph. 24, 482 (1940).
2.Antimony
Rauschkolb, J. E.: Circumcision in treatment of chancroidal lesions of male genitalia. Arch. Derm. Syph. (Chicago) 39, 319 (1939).
4.Specific vaccine
Andersen, M.: Om vaccinebehandling af ulcus molle og bubo ingvinalis. Ugeskr. Laeg. 101, 1107 (1939).
Batchelor, R. C. L., and R. Lees: Treatment of chancroid with sulphanilamide. Brit. med. J. 1938 I, 1100.
Harrison, L. W.: The modern treatment of venereal diseases. Practitioner 131, 443 (1933).
5.Sulfonamides
Batchelor, R. C. L., and R. Lees: Treatment of chancroid with sulphanilamide. Brit, med. J. 1938 1, 1000.
Cañizares, O., and J. A. Cohen: Treatment of chancroid with sulfanilamide. Arch. Derm. Syph. (Chicago) 42, 649 (1940).
Cole, H. N.: The local use of sulfonamide compounds in dermatology. J. Amer. med. Ass. 123, 411 (1943).
Combes, F. C., O. Cañizares and S. Landy: Treatment of chancroid with sulphathiazole. Amer. J. Syph. 27, 700 (1943).
Culp, O. S.: Treatment of chancroid with sulfanilamide. Amer. J. Syph. 24, 622 (1940).
Fields, R. J., and J. J. Weinstein: The use of sulfanilamide powder locally in the treatment of chancroid. Urol, cutan. Rev. 42, 880 (1938).
Grupper, C.: Infection chancrelleuse et therapeutique sulfamidée a propos de vingt-quatre cas personnels. Rev. frang. Derm. Vénér. 15, 175 (1939).
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Hutchinson, A.: Treatment of bubo with sulphanilamide. Lancet 19381, 1047.
Kornblith, B. A., A. Jacoby and L. Chargin: Chancroid. Treatment with sulfathiazole and sulfanilamide. J. Amer. med. Ass. 117, 2150 (1941).
Kornblith, B. A., A. Jacoby and M. Wishengrad: Treatment of chancroid with sulfanilamide. J. Amer. med. Ass. 111, 523 (1938).
Marin, A.: An epidemic of chancroid. Canad. Med. Ass. J. 49, 120 (1943).
Noojin, R. O., J. L. Callaway and W. Schulze: Sulfadiazine and sulfathiazole therapy in lymphogranuloma venereum and chancroid. Amer. J. Syph. 27, 601 (1943).
Satulsky, E. M.: Management of chancroid in a tropical theater. J. Amer. med. Ass. 127, 259 (1945).
Strakosch, E. A., H. W. Kendell, R. M. Craig and G. K. Schwemlein: Clinical and laboratory investigation of 370 cases of chancroid. J. invest. Derm. 6, 95 (1945).
Trautman, J. A., and D. C. Emenhiser: Sulfanilamide in the treatment of chancroid in the male. Hosp. News U. S. Publ. Hlth Serv. 8, 1 (1942).
Trautman, J. A., and D. C. Emenhiser: Abst. Yen. Dis. Inform. 23, 203 (1942).
6.Penicillin
Day, L. A.: Chancroid of the cervix: Report of two cases. Proc. Mayo Clin. 20, 70 (1945).
Lahiri, K. D.: Penicillin in chancroid. J. Indian med. Ass. 15, 406 (1946).
Mortara, F., R. R. Feiner and E. Levenkron: Activity of penicillin against Hemophilus ducreyi in vitro Proc. Soc. exp. Biol. (N.Y.) 56, 163 (1944).
Norcross, B. M.: Treatment of early syphilis with penicillin. Med. Bull. N. African Theatre of Operations 2, 110 (1944).
Quoted by H. L. Hirsh and S. R. Taggart, Treatment of chancroid with streptomycin. J. vener. Dis. Inform. 29, 47 (1948).
Pereyra, A. J.: Ion transfer of penicillin. U. S. nav. med. Bull. 48, 40 (1948).
Pereyra, A. J., and S. Landy: Experimental prophylaxis and treatment of chancroidal infection. U. S. nav. med. Bull. 43, 189 (1944).
Singer, S., and W. E. Deacon: Effects of penicillin G in vitro on Hemophilus ducreyi. Publ. Hlth Rep. (Wash.) 71, 1112 (1956).
Tung, T., and C. N. Frazier: The in vitro action of penicillin on Hemophilus ducreyi. Amer. J. Syph. 29, 629 (1945).
7.Streptomycin
Asin, J.: Chancroid. Amer. J. Syph. 36, 483 (1952).
Hirsh, H. L., and S. R. Taggart: Treatment of chancroid with streptomycin. J. vener. Dis. Inform. 29, 47 (1948).
Mortara F., and M. T. Saito: Streptomycin in experimental chancroid. Amer. J. Syph. 31, 20 (1947).
Rollier and Maury: Le traitement de la chancrelle par la streptomycine. Ann. Derm Syph. (Paris) 10, 541 (1950).
Taggart, S. R., H. L. Hirsh, F. D. Hendricks, G. R. Gable, M. A. Puzak and A. B. Greaves: The treatment of chancroid with streptomycin. Amer. J. Syph. 33, 180 (1949).
Weber, W. D., J. H. Williams and T. R. Httffines: Streptomycin therapy in a case of sulfonamide-resistant Hemophilus Ducreyi (chancroid) infection. Amer. J. Syph. 33, 58 (1949).
Willcox, R. R.: Effectiveness of antichancroidal drugs tested by heteroinoculation of bubo fluid from untreated donor. Arch. Derm. Syph. (Chicago) 62, 533 (1950).
8.Chloramphenicol
Asin, J.: Chancroid. Amer. J. Syph. 36, 483 (1952).
Deacon, W. E., S. Olansky, D. C. Albritton and W. Kaplan: VDRL chancroid studies. IV. Experimental chancroid. Prophylaxis and treatment. Antibiot. Med. 2, 143 (1956).
Olansky, S., F. W. Harb, C. E. Wood and D. S. Rambo: Intramuscular Chloromycetin (chloramphenicol) in the treatment of venereal disease. Amer. J. Syph. 37, 253 (1953).
Robinson, R. C. V., and H. E. C. Zheutlin: Unpublished work (1949), quoted by Robinson, R. C. V.: Newer antibiotics in the treatment of venereal diseases. Amer. J. Syph. 34, 273 (1950).
Willcox, R. R.: Aureomycin and chloramphenicol in chancroid. Brit. med. J. 1951 I, 509.
9.Chlortetracycline
Asin, J.: Chancroid. Amer. J. Syph. 36, 483 (1952).
Pararella J. A.: The treatment of chancroid infection. Amer. J. Syph. 38, 345 (1954).
Zheutlin, H. E. C., and R. C. V. Robinson: Aureomycin in the treatment of chancroid. Amer. J. Syph. 34, 71 (1950).
10.Oxytetracycline
Gomila, F. R., and W. P. Gardiner: Intramuscular Oxytetracycline (Terramycin) in the treatment of chancroid, lymphogranuloma venereum and granuloma inguinale. Antibiot. Med. 3, 312 (1956).
Mendell, H. E., D. L. Foxworthy and C. G. Wornas: Chemotherapy of chancroid. Amer. J. Syph. 38, 483 (1954).
Niedelman, M. L., H. E. Pierce, L. D. Hoffstein and W. V. Matteucci: Terramycin in the treatment of chancroid, lymphogranuloma venereum and granuloma inguinale. Amer. J. Syph. 35, 482 (1951).
11.Tetracycline
Marmell, M., and A. Prigot: Tetracycline in the treatment of certain venereal diseases. Antibiot. and Chemother. 4, 1117 (1954).
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King, A.J. (1959). Chancroid. In: Inflammation II. Encyclopedia of Urology, vol 9 / 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-87084-2_6
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