Epidemiology

Chancroid was endemic in most parts of the world well into the 20th century. In Europe and North America, a steady decline was seen after the discovery of penicillin in 1943.[21] Reduction started, however, with changes toward reduced prostitution and improved sanitary conditions. Nowadays, the prevalence of chancroid is less than 1% in developed countries.[22] The few cases that are detected are usually imported from endemic countries or are associated with commercial sex work (CSW) and the use of crack cocaine and other illegal drugs.[7] Periodic health examinations and treatment of sex workers and other high-risk groups have largely contributed to the near-eradication of chancroid in these European coun-tries.[21] In some cities in the United States, however, especially among high-risk communities, the H. ducreyi prevalence can be as high as 20%.[22,23]

Chancroid is still ubiquitous in tropical resource-poor countries located in Africa, Asia, Latin America, and the Caribbean.[6,21] In southern and eastern African countries, the H. ducreyi seroprevalence can be as high as 68% among CSW, but this could be overdiagnosis because in Africa the etiology of ulcers is often clinically directed.[24]

In west and central African countries the prevalence of chancroid among STI patients was significantly lower.[8'24]

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