Chancroid-Induced Vaginal Fissure

Abstract

Female genital tract ulcers in women of reproductive age most often are caused by either Herpes ducreyi or Treponema pallidum. However, the recent increase of Haemophilus ducreyi in the United States now adds chancroid to the list of differential diagnoses of genital ulcers. Most cases of chancroid, when correctly diagnosed, have been treated easily. In the past, treatment consisted primarily of oral erythromycin. Most recently, however, the Centers for Disease Control (CDC) guidelines have advocated a single i.m. 250 mg dose of ceftriaxone for therapy. Due to the relative rarity of this disease in the past and the recent changes in first-line therapy, physicians do not have significant experience with the outcome of patients with chancroid following ceftriaxone therapy. This case demonstrates an unusual consequence of the disease, a vaginal fissure, which was misinterpreted as a failure of therapy, resulting in overtreatment and a delay in definitive treatment. Symptomatic relief finally was accomplished after excision of the chronically inflamed lesion. Understanding the natural history and course of the properly treated patient will eliminate delay of definitive treatment of chancroid and its consequences. (J GYNECOL SURG 8:49, 1992)