Chancroid

Abstract

This condition, variously known as chancroid, soft chancre, ulcus molle, chancre mou and Ducrey’s infection, was defined by Sullivan (1940) as “an acute localised autoinoculable genito-infectious disease caused by the streptobacillus of Ducrey (Haemophilus ducreyi), characterized clinically by ulcerations at the sites of inoculation, and frequently accompanied by inflammatory swelling and suppuration of the regional lymph nodes”. In discussing the incidence of this disease, the same writer (ibid) stated that it was very difficult to judge its frequency in various populations, because of lack of information and unreliability of diagnoses. In western countries the incidence of the disease seemed to be consistently low, although minor local outbreaks were reported from time to time. In eastern countries, and in tropical and sub-tropical regions generally, the incidence was far higher, and among troops stationed in such areas it was liable to rise to a level five or ten times as high as in other areas. Asin (1952) working among Service personnel in Korea, found that chancroid was the most prevalent venereal disease, the incidence of chancroid, gonorrhoea and syphilis being in the ratio of 14:8:1 among white troops and 21:11:1 among negroes. One of the striking features of reported figures is the disproportionately low incidence in women, which perhaps reflects the difficulty of making this diagnosis in the female. Rauschkolb (1939), in a study of the condition in Cleveland, Ohio, found that it resulted invariably from promiscuous intercourse among what he described as the socially unenlightened and economically unfortunate. Of 479 patients in his series, 322 were negroes and 157 were white, a ratio of 2:1, whereas the ratio of negroes to whites in the population of Cleveland was 1:12. The disease is nearly always venereally acquired, and therefore extragenital lesions are rare. Infection seems to occur readily at sites of trauma or of other lesions. In Rauschkolb’s series (ibid) there were five instances in which chancroids developed at the sites of scabietic lesions. Lossing and Allen (1956) stated that only 34 cases of chancroid were reported from the whole of Canada in 1954, mainly in seamen and Service men who acquired the infection abroad. Tottie (1956) stated that the reported cases of chaneroid in Sweden numbered 3,000 in 1919. The incidence had steadily decreased and now only 10 new cases were reported each year. Willcox (1956) stated that the true incidence of chancroid throughout Africa was unknown but it was apparent that it was the venereal disease next in importance to syphilis and gonorrhoea, and in some places it was more prevalent than primary syphilis. It was a big enough problem to interfere materially with the economic life of the continent.