Can Chancroid Cause Urethritis?
No, chancroid does not typically cause urethritis—it is a disease characterized by painful genital ulcers and inguinal lymphadenopathy, not urethral inflammation. 1, 2, 3
Clinical Presentation of Chancroid
Chancroid, caused by Haemophilus ducreyi, manifests with distinct clinical features that do not include urethritis:
- Painful genital ulcers are the hallmark feature, appearing as deep ulcers with purulent base, ragged and undermined edges, and highly inflamed borders 4, 2
- Tender inguinal lymphadenopathy occurs in approximately one-third of patients, often unilateral and may progress to suppurative adenopathy (buboes) 1, 4
- The combination of painful ulcer with tender inguinal adenopathy that suppurates is almost pathognomonic for chancroid 1, 4
- Lesions develop after an incubation period of 24 hours to 15 days (average 5 days), starting as a small papule that rapidly evolves into the characteristic ulcer 2
Urethritis: Different Etiology and Presentation
The CDC guidelines clearly distinguish urethritis as a separate clinical entity with different causative organisms:
- Primary bacterial causes of urethritis are Neisseria gonorrhoeae and Chlamydia trachomatis, not H. ducreyi 1
- Chlamydia trachomatis accounts for 15-55% of non-gonococcal urethritis cases 1, 5
- Other recognized causes include Ureaplasma urealyticum (20-40%), Trichomonas vaginalis (2-5%), HSV, and Mycoplasma genitalium 1
- Urethritis is confirmed by: mucopurulent/purulent discharge, ≥5 WBCs per oil immersion field on Gram stain, or positive leukocyte esterase test on first-void urine 1, 5
Critical Diagnostic Distinction
Haemophilus ducreyi is not mentioned in any CDC guideline as a cause of urethritis 1, 5. The organism causes necrotizing genital ulceration, not urethral inflammation 3, 6.
Important Clinical Pitfall
- While chancroid ulcers may occur near the urethral meatus and cause dysuria due to urine contact with the painful ulcer, this is not urethritis but rather pain from an external ulcer 2, 3
- Do not confuse painful urination from an external genital ulcer with true urethritis, which involves inflammation of the urethral mucosa itself
Appropriate Diagnostic Workup for Genital Ulcers
When evaluating a patient with genital ulcers, the CDC mandates specific testing:
- Darkfield microscopy or direct immunofluorescence for Treponema pallidum 4
- Serologic testing for syphilis (VDRL or RPR) performed at least 7 days after ulcer onset 4
- Culture for H. ducreyi on special media (though sensitivity is limited to ≤80%) 1, 4
- HSV testing to exclude herpes 4
- HIV testing is mandatory, as both chancroid and syphilis are cofactors for HIV transmission 1, 4