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chancroid carrier?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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chancroid carrier?

I need to know if there is ANY chance that a male can be an asymptomatic carrier of Chancroid, and be able to pass it on to a woman if there are no visible sores or ulcers on his penis.  I can find no research on this on the internet.  I just found out that I MAY have Chancroid and my current partner is the ONLY person I could have got it from.  He travels to Asia/Korea a lot on business and tells me that he did visit massage parlours there (for a massage) - and did wake up to find the masseuse giving him a 'happy ending' once (hand job).  The last time he was in Asia was several months BEFORE I met him and I have seen no sores or open areas on his penis.  He is uncircumsised.  My symptoms are burning, swelling, redness, some itching and 3-4mm shallow round ulcers with a whitish base over my inner and outer labia, clitoral hood and vestibular area. They are very painful and look exactly like oral canker sores.  My doctor is 95% certain that this is not herpes and that it could be Chancroid - but we are still awaiting test results to rule out herpes.  Meanwhile I am on antibiotics (Augmentin).  If he is a carrier - then will he be a carrier his whole life or could they wipe it out with treatment?  This is a really nice, older gentleman and he is going to be devastated if he has an STD.  He was in a monogamous marriage for 30 years and divorced for the past 4 years.  I was in a monogamous marriage for 26 years and divorced/celibate for the past 3 years.   I have never had an STD before, and I don't ever get cold sores - although I did have chicken pox as a young adult and have been run down by stress at work recently.  What else could this be?

Thankyou so much!
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Welcome to the STD forum.  I'll try to help.  The bottom line is that despite your doctor's assurance, your story is much more suspicious for herpes than chancroid.

Let's start with your description, "My symptoms are burning, swelling, redness, some itching and 3-4mm shallow round ulcers with a whitish base over my inner and outer labia, clitoral hood and vestibular area. They are very painful and look exactly like oral canker sores."  If I had to teach medical students about genital herpes, I could take this quotation without any change whatsoever.

Further, chancroid is a rare STD these days; I have not seen a case for over 20 years.  And the large majority of genital ulcers that look like chancroid in fact have other causes, especially herpes.  Among other things, chancroid generally causes a single ulcer, not multiple ones.  This is not to say your diagnosis of chancroid is wrong.  But you can understand my skepticism, even if your doctor is pretty certain about it.

The inflamed lymph nodes -- which you mention in the follow-up comment below -- don't help much one way or the other.  Herpes or any genital ulcer or skin infection can do that.  But your use of the plural ("nodes") also is a clue against chancroid, which typically causes a single enlarged node that softens and become filled with pus, often needing needle drainage.

Finally, to go to your original question:  As you seem to already know, chancroid rarely is present without overt genital ulceration.  Chancroid also is uncommon currently in most parts of Asia.  (Perhaps more likely if your partner is from south Asia, e.g. India, Pakistan, etc.)  On the other hand, most genital herpes is transmitted by people don't know they have it and who have no symptoms of genital lesions, at least not at the time sex occurs.

I hope your doctor took a swab specimen from your genital lesions for HSV testing by culture or PCR.  That test is recommended for every person with genital ulceration, regardless of whether the provider suspects herpes.  If so, that result may answer the question.  If not, or if such a test is negative, you should go on to have a blood test.  If you have a negative IgG antibody test for HSV that becomes positive in a few weeks, that also would nail down a herpes diagnosis.

Most likely this isn't what you were hoping (and perhaps not expecting) to hear.  But I hope you find the information helpful.  Please return with a follow-up if and when a definite diagnosis is established.

Good luck--  HHH, MD
11 Comments
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P.S. I did have swollen and painful inguinal lymph nodes, but these have improved a lot since I started the antibiotics 24 hours ago.
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Sorry - keep remembering more info:  When it started I thought it was a yeast infection, so I used Monistat1-day and about 3 kinds of topical creams for the burning, including Benzocaine and Hydrocortisone.  Could this be a simple bacterial cellulitis because I compromised my skin by using so many creams?
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239123_tn?1267651214
Bacterial cellulitis doesn't usually cause overt skin ulceration.  If anything, this sort of story goes along even more with herpes, since steroid creams can make HSV infections worse.  As to the lymph nodes or other symptoms improving on antibiotics, that could be true -- even with herpes, there could be a component of a secondary bacterial infection.  Or the lymph node inflammation was on the verge of getting better anyway.
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My inner labia are getting increasingly swollen and are puffed up like balloons and there are even more of the ulcers appearing on the inside of them.  If it is a viral herpes then the antibiotics aren't going to be doing anything for that, and I won't get test results for herpes back until Wednesday.  Should I go to my local urgent care now or wait until Wednesday?  It still hurts so much to pee that it makes me cry - I can only pee if I pour a jug of water over the area while I'm on the toilet....and I'm supposed to be working tonight and tommorrow night (I'm an RN).

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239123_tn?1267651214
Every additional piece of information you provide bolsters the probability of herpes.  Painful urination relieved in the way you describe. or when sitting in a tub of warm water (same idea), is a classical herpes symptom.

Antibiotics are active only against bacteria, not viruses.  That new lesions are appearing on treatment is strong evidence against any bacterial cause, including chancroid and yet additional evidence in favor of herpes.

You should request on a prescription for an anti-herpes drug like valacyclovir (Valtrex) or acyclovir.  Indeed, I would go beyond "request":  if I were you I would insist on it.  The standard recommendations are that such treatment should be routine whenever herpes is suspected or even if it's only a modest possibility.  Do not wait until Wednesday or even tomorrow; do it today.  In addition, lidocaine or other local anesthetic cream would probably help with the lesion pain.

If your provider remains doubtful about herpes or resists a prescription for an antiviral drug, consider printing out this entire thread and showing him or her my responses.
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Thanks - I am heading to urgent care now.  I looked up pictures of herpes lesions and they do look exactly like what I have.  Now I just have the problem of telling my partner that he gave me herpes....
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239123_tn?1267651214
Your diagnosis, while highly probable, isn't yet confirmed.  You can present it as a suspicion, not definite.  And in a senstive manner, please; most people who transmit genital herpes are unaware they are infected, so the issue should not be one of blame.  He should have a blood test for HSV-1 and 2.  
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Absolutely - he is a very sweet, kind, caring gentleman and I have absolutely no doubt that he probably didn't know he even had herpes.  I am hoping it is HSV-1 as that would be easier to explain to him if it's oral-genital transmission.  If it's HSV-2 then he has to think where HE caught it from - and he says he was completely faithful to his ex-wife.  Thankyou so much for all your help!   I am feeling somewhat devastated right now, but many people cope with this and I know I'm not alone.  I am heading out the door to go to the urgent care of the hospital where I work - they will give me extra good care as I'm 'one of their own' :)   Thanks again :)
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Update - I am now on Valtrex, and they did a second set of swabs.  Thanks :)
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239123_tn?1267651214
That's good news.  I hope things go well for you.  I look forward to hearing how things go, but my access to the internet and the forums will be intermittent and unpredictable as I travel in Africa the next couple of weeks; absence of a reply won't mean I'm not still interested.  Good luck.
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