Can Chancroid Cause Scarring?
Yes, chancroid ulcers can cause scarring, particularly when healing is delayed or complicated, which is more likely in HIV-infected patients who experience slower healing and higher treatment failure rates.
Understanding Chancroid Ulcer Characteristics
Chancroid presents with deep, necrotizing genital ulcers that have purulent bases, ragged and undermined edges, and highly inflamed borders 1. These are not superficial lesions—they represent significant tissue destruction that disrupts the genital epithelium 2. The depth and purulent nature of these ulcers inherently carries scarring potential, especially when:
- Healing is delayed: HIV-infected patients experience slower ulcer healing and may require prolonged therapy beyond standard regimens 3, 2
- Multiple ulcers are present: Chancroid often presents with multiple painful ulcers rather than a single lesion 1
- Suppurative lymphadenopathy occurs: Fluctuant buboes resolve more slowly than ulcers and may require drainage, creating additional sites for potential scarring 3
Critical Factors Affecting Scarring Risk
HIV co-infection significantly increases scarring risk because treatment failures occur more frequently and healing is substantially slower in HIV-positive patients 3, 2. Given your concern about possible HIV infection in this patient:
- All patients with chancroid must receive immediate HIV testing at presentation 3, 2
- Repeat HIV testing at 3 months is recommended if initial testing is negative, given the window period for seroconversion 2
- HIV-infected patients should receive the 7-day erythromycin regimen (500 mg orally four times daily) with close follow-up rather than single-dose therapy 2
Treatment to Minimize Scarring
Immediate treatment is essential to reduce tissue destruction and scarring potential:
- First-line options include azithromycin 1 g orally as a single dose or ceftriaxone 250 mg intramuscularly as a single dose 3
- Single-dose therapy ensures compliance and allows treatment at first presentation, which is critical for limiting tissue damage 3
- Symptomatic improvement should occur within 3 days, and objective improvement within 7 days 3
- Patients must be re-examined 3-7 days after initiating therapy to assess treatment response 3
Common Pitfall to Avoid
Do not delay treatment while awaiting diagnostic confirmation, as chancroid is difficult to culture and diagnostic capabilities are often limited 1. The CDC notes that even after complete diagnostic evaluation, at least 25% of genital ulcers have no laboratory-confirmed diagnosis 1. If the patient resides in a community where H. ducreyi is prevalent and diagnostic capabilities are limited, treat empirically for both syphilis and chancroid 1.