This voice-annotated PowerPoint will be about the chancroid infection. I am Sarah Dotters-Katz, an OB/GYN physician. By the end of this VAT, you should have an understanding of the epidemiology and pathogenesis of Chancroid infection. We will also discuss the signs and symptoms of chancroid infection, specifically as well as a differential diagnosis for genital ulcers. Finally, we will review the treatment of Chancroid infection. The actual epidemiology of chancroid is unknown, because it is not commonly tested for. And when it is tested for, it is difficult to isolate in the lab. We do not actually know its true instance. We do know that this infection is rare in developed nations. There were less than 50 reported cases in 2010 in the United States, the majority of these are occurring in the Southeast. However, chancroid is a common cause of genital ulcers in the developing world. This disease is more commonly reported in males. Other risk factors for the disease include minority race, prostitution, and cocaine use. The infection itself is caused by a bacteria called Haemophilus ducreyi. This is a gram negative rod. Microscopically, it is described as having a school of fish appearance. It is sexually transmitted. During sexual acts, it is believed that the bacteria gains access to the epidermis via microabrasion, and then it releases a cytotoxin, which causes cell injury. The incubation period for this infection is 7 to 10 days, on average. These lesions appear as multiple erythematous papules, which evolved into pustules. And when the pustules rupture, they become deep ulcers. The ulcers are painful, purulent, and almost always confined to the genitals and inguinal nodes. Once the pustules rupture, the base is red, ragged, and undermined, usually approximately one to two millimeters in size. There is often grayish or yellowish exidate at the base of the ulcer. There are no prodromal symptoms or systemic symptoms prior to the eruption of papules. The caveat to that specific presentation for chancroid is when there is an HIV co-infection. In this setting, there’s often an atypical or extragenital disease, with more numerous lesions, and delusions that are less responsive to therapy. It is important to be able to diagnose genital ulcers correctly. This table outlines the more common cause of ulcers in the genital region. Syphilis also causes ulcers. However, these are painless, and usually there is only one. On the other hand, Herpes Simplex Virus or HSV causes multiple small vesicles, which are always painful. Additionally, patients with HSV also have a viral prodrome. As previously mentioned, chancroid, caused by Haemophilus ducreyi causes multiple painful ulcers. On the other hand, with Lymphogranuloma Venereum, or LGV, the ulcers are much less common. These lesions are caused by chlamydia, and are most notable for painful buboes in the groin region. In more severe disease, chancroid can spread to the inguinal nodes, and cause painful buboes. Buboes are infected, inflamed, liquefied lymph nodes. They are much more common in males and in HIV-infected patients. Generally, they appear one to two weeks after ulcer formation, and if left untreated, can rupture and vistulas. Treatment usually includes aspiration or incision and drainage. As we have previously mentioned, the diagnosis of chancroid is difficult. Clinically, a patient will have painful ulcers. But HSV and syphilis must also be ruled out. Gram stain will often show a school of fish, though the sensitivity is very low, and not recommended as a diagnostic modality. The organism can be cultured, but this is a very labor-intensive process, and the sensitivity is only fair. There are PCR probes up and coming for chancroid, though none of these are readily available at this time. It is very important to also test for other STDs infections at the same time. Chancroid is treated with azithromycin or ceftriaxone. Usually one dose is adequate, and patients improve clinically within 48 to 72 hours. When treating for chancroit, patients should also receive treatment for syphilis. Patients with HIV may need more than one dose of treatment. Partners also need to be treated. As previously mentioned, buboes should be treated surgically. In summary, this is an underdiagnosed but uncommon infection that prevents with painful purulent genital ulcers. It is difficult to diagnose with laboratory testing, and therefore the diagnosis is generally clinical after ruling out HSV and syphilis. However, with treatment, patients often improve within 48 to 72 hours.