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At least 19 recordsLinked to original sources
PubMed1992

Chancroid in the United States, 1981-1990: evidence for underreporting of cases.

Chancroid, a bacterial sexually transmitted disease (STD) characterized by genital ulceration, has reemerged in the United States during the last decade. From 1950 to 1980, cases were infrequently reported. After an epidemic in California in 1981, however, the numbers of cases increased, peaking in 1987 at 5,035. Despite a subsequent decline in numbers of reported cases to 4,223 in 1990, new areas continue to report outbreaks. Interpreting chancroid surveillance data is difficult because confirmatory culture media are not commercially available. In addition, states may not require that unconfirmed or even confirmed cases be reported. To determine if chancroid is more widely distributed than surveillance figures indicate, CDC contacted STD clinics in 115 health departments, located in 32 states, the District of Columbia, and Puerto Rico--areas chosen because they had reported five or more cases of chancroid in any single year during 1986-1990--to determine if cases might be occurring but not reported. Only 16 of the 115 clinics had culture media available for Haemophilus ducreyi, and only nine had laboratory facilities complete enough to definitively diagnose chancroid, syphilis, or genital herpes, the most common STDs characterized by genital ulcers. Five or more clinically likely cases occurring in 1990 were identified in 24 states, seven more than surveillance figures indicated. Surveillance can be improved if a) states utilize the definitions for chancroid cases adopted for use in 1990 and b) microbiology laboratories utilize enhanced diagnostic methods.

Chancroid↗
PubMed1990

Sulphaphenazole, streptomycin and sulphaphenazole combination, trimethoprim, and erythromycin in the treatment of chancroid.

One hundred and thirty six patients with chancroid were treated with four different treatment regimens; (A) Sulphaphenazole 1 g 12 hourly by mouth x 10 days (B) Inj streptomycin 1 g intramuscularly daily with sulphaphenazole 1 g 12 hourly orally x 10 days; (C) trimethoprim 200 mg 12 hourly by mouth x 7-10 days, and (D) erythromycin 500 mg 6 hourly orally x 7-10 days. Cure rates of 9% with sulphaphenazole alone, 48% with streptomycin and sulphaphenazole combination, 93% with trimethoprim and 100% with erythromycin were obtained. Sulphaphenazole alone or in combination with streptomycin were thus inferior in the treatment of chancroid. There is need for modification of treatment regimens recommended for chancroid in the textbooks of dermatology and venereology. Trimethoprim can be recommended as first line of treatment for chancroid in developing countries like India where resistance to trimethoprim is uncommon and erythromycin is suggested as a second line of therapy because by that time syphilis can be easily ruled out.

Administration, Oral↗
PubMed1991

Cultural diagnosis of chancroid.

Culture of Haemophilus ducreyi remains the definitive way to diagnose chancroid. Since its discovery in 1889, cultural isolation of this fastidious organism has been a challenge for clinicians and microbiologists. A recent chancroid epidemic in our locale prompted a review of available culture techniques. Despite the development of various selective solid media in the last 20 years, cultural diagnosis of chancroid remains problematic. Many pitfalls may complicate this procedure, such as concomitant syphilis, syphilis, or herpes progenitalis simulating chancroid, strain differences in nutritional requirements, improper handling and delayed inoculation of clinical specimens, use of suboptimal growth conditions, and vancomycin hydrochloride-sensitive organisms. Highest cultural yield will be obtained by using enriched gonococcal agar base and enriched Müeller-Hinton agar in a biplate fashion. As most isolates are sensitive to vancomycin, incorporation of this antibiotic should be routine. However, screening for vancomycin-sensitive organisms is indicated when negative cultures are repeatedly obtained from clinically typical cases originating from the same community. Development of immunodiagnostic and DNA probe tests is underway.

Bacteriological Techniques↗
PubMed1991

Isolation of anaerobes from clinical chancroid associated with fluctuant bubo in men.

Microbial flora especially anaerobes were studied in 67 patients with genital ulcers due to chancroid (diagnosed clinically) and 53 controls with genital ulcers due to other causes. The aerobic flora was similar in patients of chancroid with or without associated bubo and in controls. Anaerobes were however, isolated with higher frequency from chancroid ulcers associated with fluctuant bubo compared to those without bubo (P less than 0.01) and with non-fluctuant bubo (P less than 0.05). Anaerobic bacteria like Bacteroides melaninogenicus, B. fragilis and anaerobic cocci may play a role in the perpetuation of genital ulcers and development of bubo in chancroid.

Adolescent↗
PubMed1992

A randomized, double-blind study of the efficacy of fleroxacin versus trimethoprim-sulfamethoxazole in men with culture-proven chancroid.

Chancroid is linked to the spread of human immunodeficiency virus type 1 (HIV-1) in East Africa. Effective, easily administered therapy is a priority for the control of Haemophilus ducreyi. The efficacy of a single oral dose of fleroxacin, 400 mg, was compared to a 3-day oral course of trimethoprim-sulfamethoxazole (TMP-SMZ), 160/800 mg, twice daily for the treatment of chancroid in 98 HIV-1-seronegative men in Nairobi, Kenya. No differences were noted between the two groups with respect to demographic characteristics, sexual behavior, and clinical characteristics. Culture-proven failure occurred in 1 (3%) of 36 fleroxacin-treated patients and in 11 (30%) of 37 TMP-SMZ-treated patients (P = .005). Fleroxacin, as a single oral dose, is an effective treatment for culture-proven chancroid in patients who are HIV-1 seronegative. TMP-SMZ is no longer predictably effective due to the recent emergence of resistance to both sulfonamides and to trimethoprim.

Administration, Oral↗
PubMedDate not supplied

Treatment of chancroid with a single dose of spectinomycin.

Fifty patients with lesions characteristic of chancroid were enrolled in an open-label prospective study to examine the efficacy of a single 2-gm dose of spectinomycin for treatment of chancroid. Only those patients (41 men; aged 18 to 49 years) with positive culture results for Haemophilus ducreyi were included in the analysis. Patients each received a single 2-gm dose of spectinomycin intramuscularly. The recovery process began on the third day of follow-up, as evidenced by the occurrence of epithelialization and a decrease in inflammation. By the seventh day after treatment, only one patient had ulcers; 40 patients experienced eradication of all ulcers (P less than 0.0001). The condition of nodes affected by infection also indicated efficacy of treatment (P less than 0.01); only one patient still had a swollen node by the fourteenth day after treatment. Of the 41 patients, 37 (90%) had negative culture results for H. ducreyi on the third day after treatment. Only 4 patients (10%) required a second dose of spectinomycin on the seventh day to affect a cure. Treatment with spectinomycin resulted in a 98% cure rate 14 days after treatment. The minimum inhibitory concentration (MIC) of spectinomycin was 1 microgram/mL to 3 micrograms/mL in the 15 strains studied. The drug was well tolerated and no adverse reactions were reported. It is concluded that a single 2-gm dose of spectinomycin is a safe and effective alternative drug for treatment of chancroid.

Adolescent↗
PubMed1991

Isolation of anaerobes from bubo associated with chancroid.

Ten men with bubo associated with chancroid were studied for bacterial flora especially anaerobes. Anaerobes were isolated from all 10 buboes and eight out of 10 ulcers of chancroid. Anaerobic cocci, B melaninogenicus and B fragilis were the most common isolates. anaerobes probably play a role in the pathogenesis of bubo in chancroid.

Adult↗
PubMed1991

Intravenous single-dose ceftriaxone treatment of chancroid.

The antimicrobial susceptibility of Haemophilus ducreyi varies according to the geographic region. Increased resistance to trimethoprim and/or sulfamethoxazole led the Centers for Disease Control to recommend 250 mg ceftriaxone as a single intramuscular dose for chancroid. Intravenous or muscular routes of administration result in equivalent bioavailability. To avoid side effects such as syringe abscess and lidocaine intolerance, we prefer intravenous ceftriaxone therapy. The efficacy of this regimen is reported in 3 cases of chancroid. The intravenous administration of 1 g of ceftriaxone in chancroid seems to be as effective as administration by the intramuscular route, but it may lower the risk of syringe abscess, lidocaine intolerance and the emergence of resistant strains.

Adult↗
PubMed1991

Chancroid in Dallas: new lessons from an old disease.

In June 1986, an unusual number of cases of darkfield negative, nonvesicular, painful genital ulcers were noted in men presenting to the Sexually Transmitted Diseases Clinic of the Dallas County Health Department. Serologic findings were routinely nonreactive in these patients. This clinical presentation was consistent with a diagnosis of chancroid, and empiric therapy with erythromycin proved quite efficacious. A retrospective review of charts revealed several similar presentations in May. After 3 weeks of experimentation with culture media, positive cultures for Haemophilus ducreyi were obtained and confirmed by the Centers for Disease Control, definitively establishing the presence of chancroid in Dallas. By year's end, 383 cases of chancroid had been diagnosed.

Adolescent↗
PubMedDate not supplied

Treatment of chancroid with spectinomycin or co-trimoxazole.

Chancroid, the third most prevalent venereal disease in Thailand, was treated with a single 2-gm dose of spectinomycin, or two tablets of co-trimoxazole (trimethoprim-sulfamethoxazole) twice daily for seven days. The differences in cure rates between the two groups were statistically significant. The chancroidal ulcers were cured in 93.7% of 175 patients treated with spectinomycin, and in 48.2% of 168 co-trimoxazole-treated patients (P less than 0.01). The in vitro susceptibility of Haemophilus ducreyi to spectinomycin was 4 to 16 micrograms/ml and to co-trimoxazole 32 micrograms/ml or higher. Thus we found that a single-dose regimen of spectinomycin was significantly more effective than the standard seven-day regimen of co-trimoxazole for the treatment of chancroid.

Adolescent↗
PubMed1978

Ultrastructural detection of Haemophilus ducreyi in biopsies of chancroid.

During an endemic appearance of chancroids (26 cases) in Berlin (West) coccobacilli were disclosed in biopsies by electron microscopy. The bacteria were aggregated predominantly in groups in the extracellular space. Their cell wall is approximately 120 A thick and trilaminar as in Gram-negative bacteria. Concerning the cell wall structure and the cytoplasmic composition, the detected coccobacilli are identical to culturally grown Haemophilus ducreyi obtained from chancroids.

Chancroid↗
PubMed1979

Epidemic of chancroid in Greenland 1977-78.

In Greenland there has been a rapid increase in the incidence of gonorrhoea and syphilis during past decades. In 1977 there was an epidemic of chancroid along the west coast of Greenland, with 975 cases reported from some 32,500 adults. The number of reported cases increased until October, 1977, and subsequently decreased. 186 patients were studied. Many of these had previously had gonorrhoea and syphilis. Male patients were both Eskimoan and Danish but female patients were solely Eskimoan. The sex ratio (M/F) was 1.6/1. The incubation period was 4 days in men and 13 days in women. Symptom-free female carriers did not seem to be an important reservoir of infection. 15% of the patients were admitted to hospital with buboes or extensive lesions. The clinical course was uncomplicated in most cases. Ulcers healed within a week of treatment with sulphonamide. Chancroid can be expected to disappear in Greenland within a short time.

Adolescent↗
PubMedDate not supplied

Treatment of chancroid, 1989.

Since recommendations for the treatment of chancroid were made in 1985, in vitro and in vivo data indicate that the two drugs recommended, erythromycin (500 mg four times a day for 7 days) and ceftriaxone (250 mg intramuscularly in a single dose), remain effective. The alternative therapies of trimethoprim-sulfamethoxazole (160/800 mg twice a day for 7 days) and amoxicillin-clavulanic acid (500/125 mg three times a day for 7 days) also appear to be effective, although there has been little experience with these drugs in the United States. Single-dose trimethoprim-sulfamethoxazole (640/3,200 mg) now lacks the efficacy of other regimens. The experience with ciprofloxacin (500 mg twice a day for 3 days) has been favorable, and other quinolones may prove useful. Concurrent infection with human immunodeficiency virus appears to result in an increased rate of failure of treatment for chancroid, and such cases may require more prolonged therapy.

Anti-Bacterial Agents↗
PubMed1979

Rising incidence of chancroid in Rotterdam. Epidemiological, clinical, diagnostic, and therapeutic aspects.

The incidence of chancroid in Rotterdam has increased by more than five-fold during 1977-78. In a retrospective study of 53 patients with chancroid seen at this clinic during this period, the results of smears were positive in 82% and of cultures in 84% (of those for whom cultures had been performed). Symptoms were generally mild. Treatment with co-trimoxazole was highly effective clinically, as confirmed by in-vitro sensitivity studies.

Adult↗
PubMed1977

A case of chancroid.

After a visit to Hong Kong, a 27-year-old salesman developed penile ulceration which failed to respond to three weeks' penicillin therapy. He then presented to hospital with acute paraphimosis. A clinical diagnosis of chancroid was confirmed by isolation of Haemophilus ducreyi. The ulcers healed after sulphonamide and streptomycin therapy. Although chancroid is an uncommon venereal disease in Australia, its incidence is still high in many tropical countries. It should be considered as a possible cause of genital ulceration in patients who have travelled overseas.

Adult↗
PubMed1992

[The reappearance of chancroid in Algeria].

After 35 observations of the chancroid observed in the department of dermato-venereology of the University Hospital of Tlemcen (West Algeria) from August 1988 to December 1991, we are led to analyze the flare of this sexual transmitted disease. The principal affected subjects are single male no older than 30 years, having had sexual intercourse with prostitutes (30/35). Less than 10 days (19/29) after the sexual contacts, the ulcer appears, and most often unique (25/35), mildly painful, accompanied frequently by adenopathies (31/35). The contamination took place mainly in Bel Abbès--city located at 90 km from Tlemcen--(12 cases), in Tlemcen (4 cases) and Morocco (5 cases). The treatment based on sulfonamides, erythromycin and tetracycline or doxycycline, has been constantly efficient. No concomitant HIV infection has been revealed. The chancroid is the first STD observed in our department in 1991, and also, the first cause for genital ulcer.

Adult↗
PubMed1990

Chancroid.

Although chancroid is still one of the minor sexually transmitted diseases in the United States, the incidence has increased, with over 3000 cases in 1986. Cases have been reported in 21 states, primarily among black and Hispanic heterosexual men. Patients may be asymptomatic, but frequently both primary and secondary sexual contacts have ulcers. Because confirmation of the diagnosis requires special laboratory conditions, diagnosis usually is based on characteristics of the lesions. Chancroid can be confused with other more common diseases, particularly genital herpes. Differential characteristics are incubation period, location and appearance of lesions, and the presence or absence of associated lymphadenopathy. A simple regimen of antibiotic therapy is highly effective, but control of outbreaks requires prompt identification, treatment of a patient's sexual contacts, and patient education about prevention.

Anti-Bacterial Agents↗
PubMed1979

Chancroid.

The mobility of our society may play an important part in the epidemic proportions of sexually transmitter diseases in the United States. Chancroid, one of the major venereal diseases, is caused by Hemophilus ducreyi and can be recognized clinically. Because the morbidity of chancroid is related to delay in treatment, awareness of this disease is mandatory. Definitive laboratory proof can be obtained in only 50 percent of the cases. Sulfisoxazole is the drug of choice.

Chancroid↗