Chancroid is on the wane in the United States, but it could very well return. While its prevalence appears to have dropped in the last decade, major outbreaks have occurred in Jackson, Miss., and New Orleans in the mid-1990s, and pockets of disease still remain, notably in New York and Memphis. About 200 cases per year are now diagnosed, down from a peak of about 5,000 per year in the late 1980s.
Researchers are unsure why chancroid has declined in the United States, given that the behaviors most often associated with it--the exchange of sex for money and the use of crack cocaine--are still widespread. About 5%-10% of patients with chancroid are coinfected with HIV. The genital ulcers caused by Haemophilus ducreyi are a significant problem in Africa and other developing parts of the world where HIV is epidemic.
Laboratory tests for chancroid are not generally available in the United States, so the diagnosis is usually made clinically. Typically, chancroid lesions are large, painful, and purulent. Tender inguinal adenopathy occurs in a third of patients. Chancroid can be very difficult to differentiate visually from herpes or syphilis because many lesions present atypically Misdiagnosis is common, and H. ducreyi is often missed when the patient is coinfected with the herpes simplex virus or with Treponema pallidum.
The four currently available antimicrobial regimens for treating chancroid are equally effective. The choice of agent is made primarily on the basis of convenience, cost, and coinfection. One of the agents--ciprofloxacin--is contraindicated in pregnant and breast-feeding women.
(*.)Cost is based on the average wholesale price for a 10-unit container as listed in the 2000 Red Book.
(**.)Cost is based on the average wholesale price for a 100-unit container of the generic formulation, unless otherwise indicated, as listed in the 2000 Red Book.
(+.)The comments reflect the viewpoints and expertise of the following sources: Dr. George Schmid, medical epidemiologist, division of STD prevention, Centers for Disease Control and Prevention, Atlanta.
Dr. David H. Martin, chief of the division of infectious diseases, Louisiana State University, New Orleans.
Dr. Stanley Spinola, director of the Midwest STD Collaborative Research Center and chief of the division of infectious diseases at Indiana University, Indianapolis.
COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group
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