Epidemiology of Haemophilus ducreyi Infections

Abstract

The global epidemiology of Haemophilus ducreyi infections is poorly documented because of difficulties in confirming microbiological diagnoses. We evaluated published data on the proportion of genital and nongenital skin ulcers caused by H. ducreyi before and after introduction of syndromic management for genital ulcer disease (GUD). Before 2000, the proportion of GUD caused by H. ducreyi ranged from 0.0% to 69.0% (35 studies in 25 countries). After 2000, the proportion ranged from 0.0% to 15.0% (14 studies in 13 countries). In contrast, H. ducreyi has been recently identified as a causative agent of skin ulcers in children in the tropical regions; proportions ranged from 9.0% to 60.0% (6 studies in 4 countries). We conclude that, although there has been a sustained reduction in the proportion of GUD caused by H. ducreyi, this bacterium is increasingly recognized as a major cause of nongenital cutaneous ulcers.

Keywords: Haemophilus ducreyi; bacteria; chancroid; epidemiology; genital ulcer disease; genital ulcers; nongenital cutaneous infections; sexually transmitted infections; skin ulcers.

Figure 1

Procedure for selecting eligible references on the epidemiology of Haemophilus ducreyi as a causative agent of genital ulcers. GUDs, genital ulcer disease; STI, sexually transmitted infections.

Figure 2

Ulcers caused by infection with Haemophilus ducreyi. A, B) Genital ulcers in adult patients from Ghana (provided by David Mabey). C, D) Skin ulcers in children from Papua New Guinea (provided by Oriol Mitjà).

Figure 3

Trend of proportion of genital ulcers caused by infections with Haemophilus ducreyi, 1979–2010.