Chancroid - desperate patient makes own diagnosis

Area of Science:

• Dermatology
• Infectious Diseases
• Urology

Background:

• Genital ulcer disease (GUD) presents a diagnostic challenge, particularly in regions with varying prevalence of sexually transmitted infections.
• Herpes simplex virus (HSV) is a common cause of GUD, often diagnosed via polymerase chain reaction (PCR).

Observation:

• A case of chancroid, a bacterial STI, occurred in a white heterosexual male in the United Kingdom.
• The patient presented with excruciatingly painful penile ulcers over a five-week period, seeking care from multiple health services.
• Despite repeated negative HSV PCR tests and the patient's self-diagnosis of chancroid, he received multiple courses of acyclovir, an antiviral medication.

Findings:

• The patient's persistent genital ulcers were ultimately attributed to chancroid, not HSV.
• Diagnostic delays and inappropriate treatment occurred due to a lack of consideration for alternative GUD etiologies.

Implications:

• This case emphasizes the critical need for clinicians to maintain a broad differential diagnosis for GUD, especially when initial investigations are negative.
• Increased awareness of chancroid and other less common causes of GUD is essential for timely and accurate diagnosis and treatment.
• Healthcare providers should be vigilant for GUD presentations that do not respond to empirical antiviral therapy.