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Epidemiology, clinical features, diagnosis and treatment of Haemophilus ducreyi – a disappearing pathogen?

Pages 687-696 | Published online: 06 Mar 2014
 

Abstract

Chancroid, caused by Haemophilus ducreyi, has declined in importance as a sexually transmitted pathogen in most countries where it was previously endemic. The global prevalence of chancroid is unknown as most countries lack the required laboratory diagnostic capacity and surveillance systems to determine this. H. ducreyi has recently emerged as a cause of chronic skin ulceration in some South Pacific islands. Although no antimicrobial susceptibility data for H. ducreyi have been published for two decades, it is still assumed that the infection will respond successfully to treatment with recommended cephalosporin, macrolide or fluoroquinolone-based regimens. HIV-1-infected patients require careful follow-up due to reports of treatment failure with single dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.

Financial & competing interests disclosure

The author has a PEPFAR grant from the US Centers for Disease Control and Prevention (CDC) to support STI surveillance activities in South Africa, although this is not relevant to the current review. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

  • A number of studies and surveillance reports have reported marked declines in the prevalence of chancroid in many countries where it was previously endemic.

  • There have been some recent reports of Haemophilus ducreyi causing chronic skin ulceration in patients visiting or from the South Pacific islands.

  • The current prevalence of chancroid is unknown for most countries as they lack the required laboratory diagnostic capacity and surveillance systems to report on this.

  • The optimal diagnostic method involves H. ducreyi-specific nucleic acid amplification, but few molecular assays are commercially available.

  • H. ducreyi culture is technically challenging and requires freshly made specialized vancomycin-containing media and strict incubation conditions.

  • It is still assumed that chancroid will usually respond successfully to treatment with recommended cephalosporin, macrolide or fluoroquinolone-based regimens, despite the absence of recent antimicrobial susceptibility data for H. ducreyi.

  • HIV-1-infected patients require careful follow-up due to reports of treatment failure with single-dose regimens.

  • Fluctuant buboes may require aspiration or excision and drainage.

Notes

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