[Question #13517] Chancroid

1 days ago

Hello doctor

I’m a 33 years old male

Just had some question needed a straightforward answer.

1. Is it possible to have Chancroid without symptoms?

2. Is there a need to test people for chancroid if they don’t have symptoms?

3. I have read that testing for chancroid is not reliable and if you do you absolutely need to have a visible ulcer, is this correct ?

Thanks

H. Hunter Handsfield, MD

1 days ago

Welcome to the forum. Thanks for your question.

THIS IS AN EDITED VERSION OF MY REPLY; please read it again if you saw the earlier version.

In most areas where chancroid is common or where outbreaks have occurred -- e.g. some South Pacific Islands, parts of Africa (a recent outbreak occurred in Malawi) and elsewhere -- it still is a less frequent cause of genital ulcer than herpes or syphilis. To your specific questions:

1. The definition of chancroid includes ulceration -- usually genital but sometimes in other body areas. From that standpoint, there is no such thing as asymptomatic chancroid. However, Hemophilus ducreyi (the cause of chancroid) has sometimes been identified in the genital area in absence of a genital ulcer.

2. Testing is not recommended and normally not done in absence of symptoms.

3. Testing for chancroid usually is done only for genital ulcers if chancroid is known to be common in that geographic area. (There have been few if any cases of chancroid in the United State for many years, except perhaps in a few persons who acquired it elsewhere.) Traditional testing by culture -- attempting to grow H. ducreyi -- indeed are difficult to perform and often do not work well. Nucleic acid amplification tests (NAATs) have been developed which are more accurate and can be used to test genital ulcers for herpes, syphilis and chancroid.

Unless you live in an area known to have an ongoing chancroid outbreak, chancroid testing usually is not done , even in people with genital ulcers.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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1 days ago

It’s mostly clear and I thank you for taking the time to explain.

Coming back to your 3rd answer,

Excuse my ignorance in the medical field but What does testing by culture mean ? And finally for the Nucleic acid amplification tests (NAATs) : they are done only if an ulcer is present correct ? Meaning if there is no ulcer the Nucleic acid amplification tests cannot be performed?

I’m just trying to know if chancroid is one of those infections that you need to test for to make sure you don’t have it even if there is no symptoms.

Thanks appreciate your time

H. Hunter Handsfield, MD

19 hours ago

Culture is among the most common test methods for infectious diseases. It's a laboratory method to actually grow the bacteria in order to identify it. However, H. ducreyi, the bacteria that causes chancroid, is hard to grow and culture isn't very sensitive, i.e. it often fails to grow and culture-based testing is negative even when the bacteria is present in the sample. (In contrast to things like streptococcus [for strep throat], the gonococcus [for gonorrhea] and many more.) For many infection, and especially for chancroid and H. ducreyi, NAAT is much more likely to successfully detect it.

Chancroid definitely is NOT "one of those infection you need to test for to be sure you don't have it." If you don't have open genital sore (ulcers), you do not have chancroid and do not need testing for it. Period, no exceptions. (Very different than gonorrhea, chlamydia or syphilis, for example.) I'm pretty surprised it's even on your mind. Why?

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5 hours ago

Thanks for asking, It actually came up on my mind as I was looking at different STi’s and wanted to know more.

To followup- I just wanted to clarify on your first answer to make sure I understand correctly and avoid confusion. You mentioned that there’s no such thing as asymptomatic chancroid but then noted that hemophilus ducreyi has sometimes been identified in the genital area without an ulcer. Could you please clarify how these two statements fit together?

I I now understand that If you don't have open genital sore (ulcers), you do not have chancroid and do not need testing for it. - I don’t have ulcers. So thanks for clarifying that up

H. Hunter Handsfield, MD

4 hours ago

There's nothing to "tie together". That's just a statement of fact based on very limited research. Nothing more I known about asymptomatic carriage of H. ducreyi. Your statement of understanding is correct, which is satisfying to hear.

That completes the two follow-up comments and replies included with each question and so ends this thread. I hope the discussion has been helpful. Best wishes and stay safe.

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