STDs in Men (Sexually Transmitted Diseases in Men) (cont.)

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Chancroid is a bacterial infection with the bacteria Hemophilus ducreyi. The infection initially manifests in a sexually exposed area of the skin. The infection typically appears on the penis but also occasionally occurs in the anal or mouth area. Chancroid starts out as a tender bump that emerges 3 to 10 days (the incubation period) after the sexual exposure. The bump then erupts into an ulcer (an open sore), which is usually painful. Often, there is an associated tenderness of the glands (lymph nodes), for example, in the groin of patients with penile bumps or ulcers. Chancroid is a relatively rare cause of genital lesions in the U.S., but is much more common in many developing countries.

The diagnosis of chancroid is usually made by a culture of the ulcer to identify the causative bacteria. A clinical diagnosis (which is derived from the medical history and physical examination) can be made if the patient has one or more painful ulcers and there is no evidence for an alternative diagnosis such as syphilis or herpes. The clinical diagnosis justifies the treatment of chancroid even if cultures are not available. Incidentally, the word chancroid means resembling a "chancre," which is the medical term for the painless genital ulcer that is seen in syphilis. Chancroid is also sometimes called "soft chancre" to distinguish it from the chancre of syphilis, which feels hard to the touch.

Chancroid is almost always cured with a single oral dose of azithromycin (Zithromax) or a single injection of ceftriaxone (Rocephin). Alternative medications are ofloxacin (Cipro) or erythromycin. Whichever treatment is used, the ulcers should improve within 7 days. If no improvement is seen after treatment, the patient should be reevaluated for other causes of the ulcers. HIV-infected individuals are at an increased risk of failing treatment for chancroid. They should therefore be followed especially closely to assure that the treatment has worked. In addition, someone diagnosed with chancroid should be tested for other sexually transmitted diseases (such as chlamydia and gonorrhea), because more than one infection can be present at the same time.

A health-care professional should evaluate anyone who has had sexual contact with a person with chancroid. Whether or not the exposed individual has an ulcer, they should be treated if they were exposed to their partner's ulcer. Likewise, if they had contact within 10 days of the onset of their partner's ulcer, they should be treated even if their partner's ulcer was not present at the time of the exposure.

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