A case of chancroid in a Spanish man returning from an endemic area

A 64 year old cisgender man attended to our genito-urinary clinic with a 1 week history of a painful genital ulcer after travelling to Madagascar. On physical examination, we observed two small ulcers, each with a fibrinous base and erythematous borders, without associated lymphadenopathy. The initial diagnosis was a genital herpes outbreak. Thus, a seven-day course of Valaciclovir 500 mg twice daily orally was prescribed. An ulcer sample was collected for NAATs including C. trachomatis L1-L3, Herpes simplex virus 1 and 2, Varicella-zoster virus, Treponema pallidum and Haemophilus ducreyi. The ulcer NAATs was positive for H. ducreyi. Considering the result and the epidemiological background, diagnosis confirmed chancroid. Ceftriaxone 1 g STAT intramuscular was administered with subsequent improvement. Chancroid, caused by H. ducreyi is very rare in Europe. Its prevalence in STI clinics has varied from 0% to 0.5%. It must be suspected, especially in travellers to endemic countries in the first days of their return due to its short incubation period.