(Centers for Disease Control and Prevention, 2005d). However, this bacterial infection is underreported, and many clinics do not have screening kits.
The majority of cases diagnosed in the United States involve a person who has traveled to a country where the disease is more common. Chancroid is one of the most prevalent STIs in many poor countries, such as those in Africa, Asia, and the Caribbean (Trees & Morse, 1995). In places where chancroid is common, the incidence in women is 25 times higher than in men (Trees & Morse, 1995) and higher in men who have multiple sexual partners (Crowe, 2002). Uncircumcised men are also more at risk than circumcised men (D. S. Lewis, 2000). Chancroid has also been found to be associated with HIV transmission and is common in areas with high rates of HIV.
Symptoms Both women and men infected with chancroid develop a small lesion or several lesions at the point of entry. Four to 7 days after infection, a small lump appears and ruptures within 2 or 3 days, forming a shallow ulcer. These ulcers are painful, with ragged edges, and may persist for weeks and even months (D. A. Lewis, 2000). The infection may spread to the lymph nodes of the groin, which can cause swelling and pain.
Diagnosis Diagnosis is often difficult, mainly because of difficulties culturing Hemophilus ducreyi, the responsible bacteria (Schulte et al., 1992). As a result, chancroid may be significantly underdiagnosed. A fluid sample from the ulcers is collected to examine for the presence of Hemophilus ducreyi.
Treatment Chancroids are treated with antibiotics. Counseling about HIV and testing are often recommended because chancroids can increase the risk of HIV infection. Regular follow-ups are advisable until the ulcer is completely healed. All recent sexual contacts should be contacted for testing and treatment.