Chancroid Fact File
It’s odd to write about something that, frankly, most of us in the UK barely ever think about. Chancroid is so rare in the UK, almost like a medical mythology but it’s worth a glance, especially if you’re curious about STIs that are fading out from our local clinics yet still persist elsewhere.
This article takes a gentle tour through what chancroid actually is, how it’s handled, and why even in the UK context, knowing how to prevent it still matters.
What Is Chancroid?
Chancroid is a bacterial sexually transmitted infection caused by Haemophilus ducreyi, a Gram‑negative coccobacillus that thrives in poorer settings and is notably rare in high‑income countries like the UK. It typically shows up as painful, soft ulcers, the term “soft chancre” comes from that, often multiple, shallow, ragged‑edged lesions that ooze a grey or yellowish discharge.
These ulcers are the hallmark; unlike syphilis’s hard, painless chancre, chancroid doesn’t hang about quietly, it’s sore, inflamed, and usually comes with tender swelling of the nearby lymph nodes in about 30 to 60 percent of cases.
Most affected individuals are either in or have returned from regions with higher prevalence, such as parts of sub‑Saharan Africa, the Caribbean, or South‑East Asia. In the UK, chancroid is exceedingly rare, there are only a handful of cases each year, usually linked to travel, and some years might pass without any reported at all. It's largely a historical concern for many medical practitioners nowadays.
Still, understanding the nature of chancroid remains relevant. In a world of increasing travel and migration, rare infections occasionally re‑emerge in places that had long since stopped thinking about them. So while it may not be on the radar for most clinicians or patients in the UK, it’s worth keeping tucked away in the mind when unusual symptoms appear after overseas exposure.
Causes and Mode of Transmission
Chancroid arises when H. ducreyi finds its way through micro‑abrasions in the skin or mucous membranes during sexual contact. The incubation period is typically 4 to 7 days, although in some cases, it might stretch up to two weeks. Once the bacteria gain entry, they trigger a local reaction that begins as a red bump and progresses into a painful ulcer.
The infection can be spread through vaginal, anal or oral sex, although genital contact is by far the most common transmission route. Because the lesions are ulcerative and disrupt the natural skin barrier, they significantly increase the risk of acquiring or transmitting other infections, particularly HIV. This is one reason chancroid used to be considered a co‑factor in areas with high HIV prevalence.
In global terms, chancroid was once a major cause of genital ulcer disease, particularly in low‑income countries where access to healthcare was limited. It often spread in concentrated outbreaks, especially among commercial sex workers and in environments where STI treatment was inconsistent or unavailable.
Over time, with improved diagnosis, widespread antibiotic availability, and greater sexual health awareness, chancroid declined significantly in many regions.
In the UK, it remains a genuine rarity. Most local cases are imported, either identified in individuals who recently travelled to higher‑risk regions or in partners of those who have.
The risk in the UK is less about endemic transmission and more about travel‑related importation. Even then, the risk is minimal, and most genitourinary clinics in the UK rarely, if ever, encounter a case.
Nonetheless, the pathway of transmission follows the same pattern: sexual contact with an infected partner, particularly in areas where chancroid is still circulating.
Signs and Symptoms
By now, you're expecting the list: pain, ulcers, lymph node swelling. But there’s a bit more nuance here, especially depending on sex.
Many men present with a solitary painful ulcer; women, on the other hand, often have multiple, less symptomatic lesions, sometimes more than four, that may go unnoticed and only found incidentally.
The ulcer itself is typically shallow with ragged, undermined edges and often bleeds when touched. That’s one of the features that sets it apart from syphilis, which tends to produce a hard, painless sore. However, there’s always overlap in clinical presentation, so tests are usually needed to distinguish chancroid from syphilis, herpes or even trauma.
Roughly half of those infected will develop swollen lymph nodes in the groin. These nodes can become extremely tender, and in some cases, they rupture through the skin to form draining abscesses known as buboes. It’s a distinctive but painful complication, often accompanied by fever and general discomfort.
Some people, particularly women, may not notice any symptoms at all. In these cases, chancroid can go undiagnosed for weeks or longer, potentially increasing the chance of transmission.
For this reason, sexual health screening, particularly after high‑risk encounters or overseas travel, is crucial.
Left untreated, chancroid can lead to long‑term scarring and other complications. In men, phimosis or urethral strictures may develop. In women, labial abscesses or persistent ulcers are possible. While these complications are now extremely rare in the UK, they reflect the importance of early recognition and treatment.
Diagnosis and Treatment
Diagnosing chancroid can be tricky, particularly in a country where it’s so rarely seen. Culturing H. ducreyi requires special media and lab expertise, and even then, sensitivity is far from perfect.
Most UK labs won’t routinely test for it unless specifically requested, and the bacteria itself is fastidious, meaning it’s difficult to grow and identify.
Because of that, diagnosis in the UK is often clinical, especially in patients with recent travel to high‑risk regions. If a patient presents with one or more painful genital ulcers, and other more common infections like syphilis and herpes have been ruled out, chancroid may be suspected. Some centres may use molecular testing if available, though this is uncommon.
Fortunately, treatment is straightforward. Several antibiotics are effective against H. ducreyi. The most common regimens include a single oral dose of azithromycin or a single intramuscular injection of ceftriaxone. Both are effective and easy to administer. Alternatives like ciprofloxacin or erythromycin are used for those with allergies or in special situations.
Symptoms typically begin improving within three days of treatment, with ulcers healing over a couple of weeks. In more severe cases, particularly when abscesses or extensive ulcers are present, healing may take longer. Pain relief and wound care may also be needed in the interim.
It’s important that recent sexual partners, within the past 10 days are also notified and treated, even if they show no symptoms. This helps prevent reinfection and controls further transmission. Given the ulcerative nature of chancroid, treating both partners is especially crucial to reduce the risk of complications.
Follow‑up is generally recommended to ensure that ulcers have healed fully and that there are no lingering infections or secondary issues.
In the UK, these reviews typically take place in sexual health clinics, where support and further testing for other STIs can be arranged.
Prevention
Even though chancroid is rare in the UK, the principles of STI prevention apply universally. At the centre of that is condom use. Proper, consistent use of condoms offers one of the most effective protections against chancroid and many other sexually transmitted infections.
Ulcerative STIs like chancroid are particularly high‑risk because the broken skin makes transmission easier, not just of the primary infection, but also of others, like HIV. Condoms create a physical barrier that helps reduce this risk dramatically, even during sexual contact with an infected partner.
While the risk of contracting chancroid in the UK is low, the real prevention value lies in broader STI protection.
In 2023, the UK reported a rise in gonorrhoea and chlamydia cases, particularly among young adults. Syphilis also continues to rise year‑on‑year. These infections are far more common, and consistent condom use helps protect against all of them, including chancroid, if exposure were ever to happen.
In addition to condom use, regular STI testing is strongly recommended for those with new or multiple partners, particularly if engaging in unprotected sex or travelling to areas with higher STI prevalence.
Early detection means early treatment, which reduces complications and limits transmission.
In essence, while chancroid might not be on most people’s minds in the UK, the behaviours that protect against it are just as important now as ever.
Condoms may seem basic, but they remain one of the most effective tools in maintaining sexual health - simple, accessible, and proven.
Chancroid is essentially a medical footnote in modern UK healthcare, extremely rare, barely encountered, and unfamiliar even to many clinicians. But that doesn’t mean it should be forgotten.
Understanding infections like chancroid sharpens our broader awareness of sexual health and the importance of good protective habits.
The UK continues to battle more common STIs - syphilis, gonorrhoea, herpes and the same preventive measures that work for those apply here too. Condoms, regular testing, open communication, and access to sexual health services make a tangible difference, not just for individual health but also for public health at large.
So while chancroid might seem like a relic of the past or something happening “somewhere else,” it still serves as a reminder.
STIs don’t respect borders, and sexual health is something we all share responsibility for. The better informed we are, the better equipped we are to keep ourselves and our partners healthy.
