Soft ulcer

The culprit is Haemophilus Ducreyi, a rod-shaped bacterium about 1-2 microns long, detectable in ulcer secretions in the form of chains in a typical arrangement that has been described as resembling a "fish bank."
It is GRAM negative and makes its way through even very small skin lesions of the genital or cutaneous mucous membranes. It prefers tropical regions for its spread, so it is frequently encountered in African and Southeast Asian countries.

The most common method of transmission is sexual intercourse with infected persons, while infection with contaminated objects is much less common. The latter possibility has been called rare because the bacterium does not resist outside.
Transmission involves all types of sexual intercourse (vaginal, oral, or anal), the exchange and use of contaminated sex toys, and also simple contact between genitals, and from these it can be transmitted to other parts of the body.

The most frequent cases were found in tropical or developing countries.
International literature has described contained outbreaks almost always related to prostitution-related sexual activities, which in history were related to unprotected intercourse of individuals traveling either for tourism or work.
Sporadic cases in sexually abused children or girls have also been described.

The incubation period of chancroid varies from 3 to 5 days, but can be as long as 10 days.
The initial phase is characterized by painful papules that break down to form mushy ulcers with a heavily reddened edge. Deep ulcers tend to result in tissue breakdown.
Symptomatology also leads to involvement of the lymph nodes in the groin area, which swell and lead to the formation of the "boil," an abscessal finding filled with purulent material. The skin in the area above the abscess becomes inflamed and then, in some cases, ruptures, giving rise to a fistulous pathway.
Location varies between male and female individuals. In men it is distributed between the glans, the urethral meatus but also at the scrotum and usually presents a single lesion. In women, on the other hand, it usually presents more than one and is located on the labia majora and labia minora, but also in the region around the anus (rarely vaginal or cervix walls).
The incidence is higher in male individuals. Contact with urine may generate pain as it is characterized by a high degree of acidity, and the individual may then have marked retention.

Chancroid diagnosis is based first on clinical evaluation and later on culture examination or PCR (polymerase chain reaction). Culture examination and microscopic identification are difficult practices when compared to the resident microbial population of ulcers. The PCR test has been certified with a specificity of 99%, but few laboratories in Italy perform the test. Simultaneity with syphilitic infection (by spirochete Treponema pallidum) has often been observed. Of course, one will have to keep in mind the different incubation period and field the fundamental differential diagnosis. It is always important in differential diagnosis to keep in mind herpes simplex, syphilis and lymphogranuloma venereum. Not to forget that Haemophilus infections can increase the risk of HIV.

If this condition is left untreated, the lesions last for several weeks. If treated, the ulcers resolve with determination of depressed scarring. It must then be remembered that in rare cases lymph node evolution may also require surgical drainage. In the absence of treatment, ulcers can degenerate into serious complications.

Drug therapy involves the use of:

• Ciprofloxacin per os
• Azithromycin or erythromycin per os
• Ceftriaxone intramuscularly in case of "giant soft ulcers" (about 2 cm or larger than "dwarf" 0.5 cm or smaller).

Normally a now contained progression can be seen within 3 to 4 days, and within 10 to 14 days definitive healing occurs. Erythromycin is recommended for pregnant or lactating women and ciprofloxacin should be avoided.

Prevention as with other STDs involves:

• avoiding unprotected intercourse with suspected and/or infected persons
• proper condom use
• use of condoms for the full duration of intercourse
• use of condoms in oral sex
• use of condom to protect sex toys as well.

Returning from tropical regions, aware of having faced a sexual risk, it is necessary to go to the dermatologist, to have a precise pathway on the investigations to be addressed, to recognize other possible STDs including chancroid. The presence of current or previous papules that have evolved into mushy ulcers, redness and pain with lymph node enlargement should not be overlooked, just one of the symptoms or previous lesions is important and should be reported to the specialist. Early intervention through accurate diagnosis can ensure a resolution of the chancroid in a short time and without complications. This applies to every STD because every single unprotected intercourse can be a risk, and it is important to travel but also to return safe in our health, for ourselves and for others.