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NSW Department of Health

CHANCROID

RESPONSE PROTOCOL FOR NSW PUBLIC HEALTH UNITS
Public health priority
Routine

PHU response time
Enter on NDD within 5 working days of notification.

Case management
Responsibility of treating doctor.

Contact management
Responsibility of treating doctor. PHUs should assist if requested.

Last updated: 06 September 2004


1. Reason for surveillance

  • To monitor the epidemiology of the disease and so inform prevention strategies.

2. Case definition

A confirmed case requires:

  • Isolation of Haemophilus ducreyi from a lesion exudate.

Factors to be considered in case identification
Diagnosis is made by isolation of the organism on a specific medium. The laboratory should be notified if chancroid is suspected.

3. Notification criteria and procedure

Chancroid is to be notified by:

  • Laboratories on diagnosis (ideal reporting by routine mail).

Only confirmed cases should be entered onto NDD.

4. The disease

Infectious agent
The bacillus Haemophilus ducreyi.

Mode of transmission
By direct sexual contact with discharges from open lesions and pus from buboes. Autoinocculation to nongenital sites may occur in infected people.

Timeline
The typical incubation period is 3 to 5 days, but can be up to 14 days.

Chancroid may be communicable from infection until the lesions are healed. Discharging lymph nodes can persist for several months without treatment. Effective antibiotic therapy eradicates the organism, and lesions heal in 1 to 2 weeks.

Clinical presentation
The usual clinical presentation is characterised by single or multiple painful necrotising ulcers in the genital area, frequently accompanied by painful swelling and suppuration of the regional lymph nodes (buboes).

5. Managing single notifications

Response time
Data entry
Within 5 working days of notification enter confirmed cases on NDD.

Response procedure
Where a case is reported in a child <16 years old, the PHU must send a letter to the treating doctor outlining his/her obligation to notify the Department of Community Services.

Case management
Investigation and treatment
In general, the attending medical practitioner is responsible for treatment. Specialist advice is usually required. Refer to Therapeutic Guidelines: Antibiotic.

Education
In general, the case's doctor provides education and counselling. The medical practitioner should provide information to the case about the nature of the infection and the mode of transmission.

Contact management
Identification of contacts
Sexual contacts in the 2 weeks before the ulcer appeared or since arrival from an endemic area.

Investigation and treatment
The treating doctor is responsible for contact tracing. PHUs should work with Sexual Health Service staff to assist if requested. Contacts require counselling, examination, and culture and treatment of any lesion.

6. Managing special situations

Case clustering
Case clustering, for example among clients of a sex industry establishment, may indicate the need to initiate an education and/or screening program to meet local requirements.


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