A Young Patient with Painful Penile Lesions

Abstract

Chancroid is a rare infection in the United States and many other developed countries. Infrequently identified as a cause of genital ulcer disease, chancroid’s atypical presentation has only been reported in approximately 20 cases annually in the United States since 2011. Infection with the causative organism, Haemophilus ducreyi, leads to an erythematous papule that rapidly evolves into a pustule. Infected individuals commonly have more than one ulcer about 2 cm in diameter that is typically noted as painful. The base of the ulcer is usually covered with a gray or yellow purulent exudate and bleeds when scraped.Despite a heavy focus in preclinical medical education, the notably rare chance to see and diagnose chancroid in clinical practice adds to the complicated profile of this infection’s identification and subsequent treatment. Such lack of familiarity contributes to reports of accuracy of clinical diagnosis ranging from 30% to 80%.

A Sore Subject? An Examination of National Case–Based Chancroid Surveillance

“…Because only diagnosed and reported cases can be included in NNDSS, it is likely that national trends are heavily influenced by changes in diagnostic capacity, programmatic response, and adherence to case definitions and reporting practices. Other than NNDSS, there are no national surveillance systems in place to monitor trends in chancroid; therefore, there are no US chancroid prevalence estimates and most recently published studies are limited to case reports 11–13 …”

“…Other than NNDSS, there are no national surveillance systems in place to monitor trends in chancroid; therefore, there are no US chancroid prevalence estimates and most recently published studies are limited to case reports. [11][12][13] There has been no documented evaluation of national case-based chancroid reporting since the surveillance case definition was last updated in 1996. To examine the performance of ongoing national case-based chancroid surveillance and identify areas for improvement, we conducted an evaluation of chancroid surveillance through NNDSS by describing the surveillance system, followed by a critical review of the system's attributes based on available evidence and key informant interviews.…”