Article 148: Special Types, Complications, and Diagnosis of Chancroid

◇A Guide to Caring for Your Husband's Health as a Good Wife◇

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Treatment and recuperation of common diseases

Special types of chancroid

1. One-time chancroid: It begins as a typical small chancroid lesion that disappears within a few days. Two to three weeks later, it develops into a typical inflammatory bubo in the groin area. The bubo presents as acute suppurative lymphadenitis, accompanied by high fever and headache. Several lymph nodes become infected, fusing into a mass, with the center softening and rupturing to drain pus. The ruptured bubo resembles a fish mouth, and it takes 1 to 2 months for the ruptured bubo to form a scar and heal spontaneously.

2. Erosive chancroid: It begins as a small ulcer, which rapidly develops into extensive tissue necrosis, causing damage to the vulva. Some cases are often caused by Clostridium and spirochetes.

3. Follicular chancroid: It is commonly seen around the genitals and pubic hair, and looks very much like folliculitis. It soon forms ulcers.

4. Papular chancroid: It begins as an ulcer, but later becomes raised, especially at the edges, resembling condyloma latum in secondary syphilis.

5. Giant chancroid: It begins as a small ulcer but rapidly expands, potentially invading a considerable area. When an ulcer forms at the site of a ruptured inguinal abscess, it can spread to the suprapubic region or autoinoculate to the thigh.

6. Minimal chancroid: The lesions are tiny, resembling the erosions caused by genital herpes, but with knife-cut, hemorrhagic edges.

complication

If chancroid is not detected and treated promptly, various complications may occur, the most common of which are as follows:

1. Chancroid lymphadenitis: Also known as chancroid bubo or painful bubo, it occurs in 50%–60% of patients, usually within days of the appearance of a chancroid ulcer. It is most common in the groin area, often unilateral, initially presenting as local lymph node enlargement with mild tenderness. It then gradually involves multiple adjacent lymph nodes, leading to periadenitis, which may merge into a larger mass. The local skin may be red and swollen, with a fluctuating feel upon touch, eventually rupturing to form an ulcer. At this stage, the patient may experience significant pain and fever, and it typically takes 2–4 weeks to heal and form a scar.

2. Balanitis and Paraphimosis: When a chancroid develops under the foreskin, inflammation and edema can cause inflammatory phimosis. The accumulation of pus under the foreskin can lead to balanitis. If the foreskin is severely edematous and cannot be retracted, paraphimosis can occur.

3. Urethral fistula: Because penile chancroid can cause destructive ulcers of the penis and invade the urethra, it can cause severe pain during urination and eventually lead to urethral stricture and difficulty in urination.

4. Secondary infections: In addition to chancroid, a small number of patients may also be infected with syphilis and lymphogranuloma venereum, which can increase the severity of the lesions. In this case, mixed chancroid may occur, which is often difficult to treat.

diagnosis

1. Essential conditions for diagnosing chancroid: This disease is not common at present, but a diagnosis can be made if the following conditions are met.

(1) History of unprotected sex before the onset of the disease.

(2) One or more ulcers appear on the male and female genitals and urethral opening, with a soft base, pain and tenderness.

(3) Unilateral inguinal bubo, pain, ulcer with pus discharge.

(4) Dark-field microscopy examination showed negative results for Treponema pallidum.

(5) No Donovan bodies were found on the smear after Giemsa staining.

(6) Negative syphilis serological test.

(7) Gram staining can detect Gram-negative streptococci, but false positives may occur. If conditions permit, bacterial culture can be performed.

2. Laboratory tests for diagnosing chancroid: Because this disease is currently considered rare, its diagnosis should be approached with extreme caution. Necessary laboratory tests are crucial for diagnosis. The simplest method is Gram staining of smears. If available, bacterial culture and histopathological examination should also be performed.

(1) Smear examination: When taking a smear from the ulcer, the ulcer should be thoroughly cleaned first, as the presence of other bacteria in the purulent discharge can easily confuse the results. The smear can be Gram-stained or Giemsa-stained. *Dukeramella* appears as short (2 μm) bipolar bacteria arranged in parallel straight lines in the smear, and is Gram-negative. If typical symptoms are present and *Dukeramella* can be detected in the laboratory, the disease can be diagnosed.

(2) Bacterial Culture: Commonly used culture media include gonococcal fetal bovine serum agar and chocolate horse blood agar. When collecting specimens, the scabs and debris on the surface of the ulcer should be removed, and secretions and the base of the ulcer should be collected using a sterile swab. The specimen is inoculated onto a Petri dish and streaked to separate the contents. The Petri dish is placed in an environment with 5%~10% carbon dioxide and saturated humidity and incubated at 33~35℃ for at least 48 hours to observe the results. *Dukeramella juvenilee* colonies are small, about the size of a pinhead, smooth, and hemispherical. However, colonies often exhibit different shapes, such as translucent, light gray, and skin-yellow. The colonies are characterized by their compactness; if touched with an inoculation loop, almost the entire colony will slide on the culture medium.

The cultured colonies can be identified using oxidase tests, nitrate reduction tests, and tests for coenzyme I and heme chloride, depending on the specific needs. They can also be identified using catalase, indole, urease, and sugar utilization tests. Identification of the bacterial strain is essential for the diagnosis of chancroid. It is unscientific for some laboratories lacking the necessary equipment to diagnose the disease simply by observing bacterial growth.

(3) Histopathological examination: Necessary histopathological examination of patients with chancroid is helpful for the diagnosis of this disease. Histopathology shows three zones: the upper layer is the base of the ulcer, which is relatively narrow and contains neutrophils, fibrin, necrotic tissue and Gram-negative bacilli; the middle layer is quite wide and contains many neovascularizations, vascular endothelial cell proliferation, vascular lumen closure and thrombosis; the lower layer is in the deep dermis and is densely infiltrated with plasma cells and lymphocytes.

How to self-examine for chancre

Chancroid is mainly transmitted through direct sexual intercourse. After infection, there is usually an incubation period of 2 to 6 days. A small red papule appears on the external genitalia. This papule quickly turns into a pustule. After 2 to 3 days, the pustule ruptures and becomes an ulcer. The ulcer is round or oval, has a creeping nature, soft but irregular edges, and is surrounded by congested skin. The base is composed of vascularized granulation tissue covered with purulent secretions. Patients often experience pain at the ulcer site, which worsens with touch. If it continues to enlarge, 2 to 5 clustered satellite ulcers often appear around it. If left untreated, the lesion can often last for one to two months, eventually healing to form a scar.

Chancroid in men often occurs on the foreskin, penis, coronal sulcus of the glans, and anus, while in women it often occurs on the labia, clitoris, frenulum of the labia, urethra, vagina, cervix, and anus. Occasionally it can occur on the fingers, eyelids, lips, tongue, and breasts.