Chancroid Diagnosis

Chancroid is one of the highly contagious diseases caused by a gram negative bacterium - Haemophilus ducreyi. This genital ulcerative disease is more prevalent in the developing nations of Asia, Africa and Caribbean. Approximately, 6 million people fall prey to this painful sexually transmitted disease (STD). Chancroid affects men (sexually active and aged above 30) more than women. People get infected with chancroid due to direct sexual contact with an infected person. Even rubbing, scratching on minor abrasions can lead to a contagion of this disease. This disease apparently is an aggravating factor that promotes spread of HIV AIDS.

Chancroid - A Sexually Transmitted Disease
The actual symptoms of chancroid set in after an incubation period of a week in the form of lesions in the infected genital area. The lesions culminate into painful ulcers in a period of time, rimmed by erythema. The base of the ulcers are covered in a grayish fibrinous membrane. The symptoms are further noted by swelling of the inguinal lymph nodes between lower abdomen and leg. If not treated on time, inflammation of lymph nodes can aggravate leading to popping of the nodes through the skin causing buboes (abscess).

Chancroid in Men
The symptoms are most prominent in uncircumcised men, promiscuous heterosexual men and men who indulge in unsafe sex with infected females. The signs in men, can be observed as an appearance of lesions on the foreskin/glans/urethral meatus of penis. The lesions may also be seen on scrotum. The ulcers, if not treated on time, can start turning into open sores thereby leading to more ulcerations.

Chancroid in Women
Women are asymptomatic carriers of chancroid. Hence, it has been observed that this sexually transmitted disease is more severe in men than in women. However, the symptoms in women are also evident with ulcerations. Infected females may experience excruciating pain during urination (dysuria) and penetration (dyspareunia). The ulcers mostly develop in genital regions of vagina, labia majora, labia minora, anus and inner thighs. They are also nicknamed as "kissing ulcers".

Diagnosis of Chancroid
In most of the cases, the clinical diagnosis is mostly based on the appearance of ulcers in the genital areas which also happen to be prominent symptoms in other STDs like syphilis. Hence, for chancroid diagnosis, culturing the bacterium - Haemophilus ducreyi has been acknowledged as an accurate method to confirm the symptoms. This basically helps in understanding the characteristics of the bacteria and how it is responsible for causing this disease. Culturing Haemophilus ducreyi is an elaborate process that requires an expensive nutritive base to grow the bacterium. These bacteria grow best in a humid temperature of 33ºC in an atmosphere containing 5% carbon dioxide. So based on the culturing conditions for Haemophilus ducreyi, the diagnosis for this sexually transmitted disease is carried out by following ways:

• Microscopic Examination of the Ulcer Smear: Calcium alginate swabs are used to collect smears of the ulcerations. These swabs are then put into a mixture of chocolate agar, isovitalex (1%) and vancomycin. After a period of 2 days, under controlled humid conditions with 10% carbon dioxide, appearance of colonies of this bacterium can be seen. This is the apt time to start with the diagnosis for chancroid.
• Gram Stain: Here the sensitivity of the culture is maintained between 10-90%. A school of small pleomorphic gram negative bacterium are cultured by this process for diagnosis.
• Culture: Culturing this bacterium is difficult as the environment suiting the growth of this bacterium is not always available. The sensitivity is kept at 75% if this bacterium is to be grown in a special culture medium.

Modern antigen detection techniques such as immnuofluorescence, radio isotopic procedures are also used in this diagnostic process. Amplification techniques like detection of nucleic acid (DNA) is gaining more popularity in diagnosis as it exhibits 95% sensitivity to a culture sample.

Chancroid Treatment
There is no specific procedure of blood tests for prognosis of chancroid. Treatment immediately starts once the ulcers are observed in the genital areas. Being a bacterial infection, it is treated well with antibiotics. Azithromycin, ciprofloxacin, ceftriaxone and erythromycin are the antibiotics recommended post diagnosis. CDC (Centers for Disease Control and Prevention) recommends an oral dosage of azithromycin (1 gm)/ceftriaxone (1 M) for a week. Local surgeries are done to subdue the enlarged lymph nodes and drain them before they get infected with the bacteria. In most cases, chancroid diagnosis and treatment also speculates the possibility of other genital ulcerative diseases such as Genital herpes (HSV - herpes simplex virus), donovanosis, treponema pallidum (Cause of syphilis) and LGV(Lymphogranuloma venereum). In situations, where there is inflammation in lymph nodes, biopsy is advised to check for the possibility of neoplasia (growth of lumps).

Chancroid Prevention Measures
This bacterial disease can be prevented by taking some precautionary measures:

• Men are advised to use latex condoms while indulging in sexual activities like vagina, oral or anal sex.
• Water based spermicides are advised to be used specially for vaginal intercourse though there aren't any concrete facts illustrating its effectiveness.
• Men and women are both advised to contain themselves in mutual monogamy to prevent any chances of getting affected by an infected partner.

Chancroid is definitely a painful ailment at times leading to severe groin pain. Once clear about the symptoms, one should also be aware of where to get tested for STDs. With the above stated measures, such afflictions can definitely be prevented. After all, prevention is better than cure.