VENEREAL DISEASE : THE SOFT CHANCRE (ULCUS MOLLE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Pathogen - streptobacilli Petersen-Ducrey. Culture first obtained by Russian authors Atamanuik and Akapana.
The pathogenesis. The infection directly from the patient; vnepolovoy infection is very rare. Possible germ-carriers; on the genitals apparently healthy women over a period of months to be virulent bacilli.
Symptoms. After an incubation period (2 - 7 days) at the site of introduction of the bacilli appear ulcers, soft to the touch, painful on palpation. The edge of the ulcer saped, jagged and surrounded by inflammatory rim; the bottom of the ulcer is uneven, resembling a tree, eaten by a wormhole, covered with a purulent discharge. At the cleansing of the ulcer and easily when touched is called bleeding. Increasing in depth and on the periphery, the lesions may coalesce into large ulcers with polycyclic edges. Typically found multiple chancre, different age, resulting from the infection drained pus. Ulcers heal slowly with the formation of scars.
For. Often there are varieties of chancroid: a towering chancre (ulcus molle elevatum), resulting in the formation at the bottom of the ulcer excess of granulation tissue; follicular chancre - with the introduction of the pathogen in tallow-hair follicles. Gangrenizatsiya ulcers due to the associated fusospirochetal causes great destruction of the tissues. Special attention deserves the mixed chancre (ulcus mixtum), caused by the simultaneous or sequential infection with pale spirochete and streptobacilli (see Syphilis).
Complications. Observed the following complications: inflammatory phimosis, paraphimosis, inflammatory lymphangitis and lymphadenitis (single or double), which usually suppurate and break open.
In the application of sulfonamides cure miah is achieved within a few days (6 - 10).The sulfonamides used in combination: orally and topically. The best action has white streptocide taken inwards to 0.5 - 0.6 6 times a day; throughout the course from 21 to 36, Instead of streptocid, you can apply the sulfidine, alfasol, sulfatiazol, just 3 days 12,0 (5,0 + 4,0 + 3,0). Local treatment: after thoroughly cleansing with hydrogen peroxide, hot solutions of potassium permanganate (1:5 000) ulcers fall asleep for 3-4 days powdery white streptocid. Ulcers quickly cleansed of pus. Dry the ulcer, preventing the formation of granulation tissue, is a signal to stop the topical treatment of sulfanilamide, purpose epithelizing ointments - 10 - 15% naphthalan, xeroform. In the treatment of buboes attached to the receiving sulfonamides autohaemotherapy milk or injection in increasing doses (from 2 to 5 ml after 2 to 3 days; 4 to 6 injections). In the presence of fluctuations it is recommended that suctioning pus, an incision and the introduction into the cavity of white streptocid or sulfiding emulsion. In cases where the sulfonamides should not be scheduled for (contraindications, intolerance), used burning the affected tissue with a concentrated solution of carbolic acid (Ac. carbolicum liquefactum). After burning the ulcer covered with iodoform, applied vaseline and a bandage. When phimosis - frequent washing of the prepuce, the introduction streptocide emulsion in oil, cold lotions of lead water. If paraphimosis is an attempt to reposition, cold lotions; on failure - surgery. When complications of gangrene - surgical intervention. When fuzospirilleznogo symbiosis intravenous newarsenal, arsenoxide, pipe sarsala, injections of penicillin 40 000 units in 3 to 4 hours.
Individuals who have chancroidshould be subject to regular clinical and serological monitoring for at least 6 months, as chancroid often delays the development of syphilis.