Chancroid

Soft squat introduction Chancroid, also known as the third sexually transmitted disease, is one of the classic sexually transmitted diseases, caused by Haemophilus ducrei, mainly through sexual contact, the disease is characterized by one or more genital pain ulcers, often accompanied by inguinal lymph nodes Suppurative lesions. basic knowledge Sickness ratio: 0.1% Susceptible people: no special people Mode of transmission: sexual transmission Complications: phimosis, incarcerated phimosis, edema, urethral stricture, inguinal granuloma, genital herpes, syphilis

Cause of soft chancre

(1) Causes of the disease

Haemophilus ducreyi belongs to the genus Haemophilus and is a Gram-negative Brevibacterium. The ends are obtuse, 1~1.5m long and 0.5-0.6m wide. The ends of the cells are often connected to each other in a chain. The multiple chains are parallel and are fish-like. The bacteria have no flagella, spores or capsules and cannot move. This bacterium is a facultative anaerobic bacterium. The oxidoreductase system of this bacterium is incomplete, and its growth does not require V factor. However, it is necessary to use hemin, which is the factor X. It must be supplied with fresh blood to grow when artificially cultured. Therefore, it is called Haemophilus. The strain has nitrate reductase, which can reduce nitrate to nitrite, oxidase test and alkali. The phosphatase test was positive, the catalase test and the porphyrin test were negative, and Haemophilus ducrei was sensitive to heat and died quickly at 65 ° C. The sterilization procedure was achieved by boiling disinfection.

(two) pathogenesis

The pathogenesis of soft chancre has not been fully understood. Haemophilus ducrei can enter from the tiny lesions during sexual contact, causing local skin and tissue to cause infection, while lymphatic drainage to the inguinal lymph nodes, the body is clearing the soft In the case of D. serrata in the sacral lesion, polymorphonuclear leukocytes are involved, and complement may be involved in the killing of D. serrata in the serum. This process is mainly dependent on antibodies, complement plays a role in enhancing antibodies, and humans can repeatedly infect Dukele's bacteria. There is clearly no complete protective immunity.

For a long period of time, people confuse soft squats with syphilis. In 1842, the French scholar Basserau first distinguished the two diseases. In 1859, Rollert reported a mixed squat of soft squat and syphilis hard squat, 1889 The bacteriologist Ducrey discovered that the pathogen of the disease is Haemophilus. Unna described the histological changes of the soft chancre and found the pathogens in the lesion. In 1901, Albritton used the Himmel medium to isolate the Ducrey for the first time. Blood bacillus.

Soft squat prevention

As with syphilis and gonorrhea, it is important to use a prophylactic preparation (ie, weak protein silver, calomel ointment) instead of a condom, avoiding sexual confusion, and it is important to check for sexually disordered people and treat them accordingly; You must not have sex before you get cured.

Early diagnosis, early treatment, and complete cure of patients can reduce the source of infection. Because there may be asymptomatic carriers of Haemophilus Ducrey, many scholars recommend that preventive treatment should be carried out for those who lack clinical manifestations, strengthen education, and treat them correctly. Sexual life, the effective prohibition of prostitution activities can cut off the route of transmission of this disease.

Soft chancre complication Complications, phimosis, incarcerated, phimosis, urethral stricture, inguinal granuloma, genital herpes syphilis

1. Inguinal lymphadenitis Also known as painful diaphragmatic hernia, or inflammatory diaphragmatic hernia, 50% to 60% of patients may have this comorbidity within a few days to 3 weeks of onset, usually mostly unilateral, to the left See, there are also those who occur in both sides, the initial development is the induration of broad bean size, the skin surface is red, swollen, tender, can involve multiple lymph nodes, adhesion to each other, forming large clumps, obvious pain, finally suppuration, softening There are fluctuations, which can be broken by themselves. The pus is thick and creamy. It is easy to break down to form a sloping or piercing ulcer. The Chinese medicine called "fish mouth" can form a sinus drainage, usually about 2 to 4 weeks. Healing, scar formation after healing, female patients with less lymphadenitis, such as early treatment can reduce the incidence of lymphadenitis, in recent years due to effective treatment of this disease, such complications are rare.

2. Inflammatory phimosis or incarcerated phimosis Due to local inflammatory edema, phimosis can be formed and even incarcerated phimosis.

3. Urinary fistula and urethral stricture Occurred in the penis can form penile destructive ulcers, such as involving the urethra, urinary pain, and even form urinary fistula and urethral stricture.

4. Mixing the sputum If the spleen is infected at the same time, the mixed sputum may appear. At this time, the soft squat occurs first, and the hard sputum appears after healing. It usually occurs 15 to 25 days after the soft sputum occurs. In recent years, due to the widespread application of antibiotics, hard Lacrimal syphilis is formed by squatting. Therefore, syphilis serological tests should be performed on patients with soft chancre, after 3 weeks of symptoms or 3 months after treatment.

5. Secondary infection with other pathogens This disease can also be combined with LGV, inguinal granuloma, genital herpes, etc., such as infection with fusospriochets, can make the damage more serious. Recently, several studies in Africa have confirmed that genital ulcers increase The risk of HIV-1 transmission in heterosexual populations is the most common cause of genital ulcers in many developing countries. Therefore, it is important to effectively treat soft chancre to prevent the spread of HIV infection. It is pointed out that it is easy to obtain HIV-1 infection from patients with genital ulcer damage. It is reported that concurrent HIV infection has a significant effect on the clinical course of soft chancre, and male patients with HIV-1 seropositive soft sputum often lead to single dose or Short course of treatment failure, the clinical manifestations of soft chancre in HIV-infected patients vary greatly, and controlling the epidemic of this disease is very important to prevent HIV infection from spreading in heterosexual populations in some parts of the world. Therefore, patients with soft chancre should also Detection of anti-HIV antibodies, HIV-positive patients with soft chancre should receive long-term treatment.

Soft chancre symptoms Symptoms Red spleen pustules purulent secretions pus moss herpes heat pain genital ulcer penis glans rubber swollen

The incubation period after infection is 2-3 days on average. Most cases are within about 1 week. Sometimes a few cases can develop after a few weeks. Women are generally milder than men and have a long incubation period.

Inflammatory small papules that originate in the external genital area, pustules form rapidly after 24-48 hours, and ulcers form after ulceration after 3-5 days. The boundary is clear, the ulcer is round or elliptical, and the edges are serrated. It has a latent turbidity on the lower edge, an inflammatory redness around it, a yellow lard-like pus-like moss on the bottom of the ulcer, and a lot of purulent secretions, which can be seen in the pus off, and the pain is obvious. The palpation is soft and soft. Squat.

The number of soft chancre is only 1-2 at the beginning. Because it can be inoculated by itself, new lesions can appear nearby. Most of the soft chancre is in the vulva. Men are mostly in the coronary sulcus, foreskin, glans, foreskin ligament. Most women occur in the labia, vulva, and posterior, and the parts of the genitals such as fingers, lips, and tongue are also visible.

The lymph nodes of the lesion are swollen, and 50% of the patients form ulcers in a few days to two weeks. The lesions are on one side (especially on the left side). Men are more common than women, and this is called Yokohama.

Soft sputum sputum is acute suppurative inguinal lymphadenitis, mostly unilateral, local redness and heat pain, after the sputum collapse, it is a fish-like valgus, commonly known as "fish mouth". In recent years, due to the early use of effective therapeutic agents, Controlled the further development of the infection, so that the typical soft squatting is rare.

Shaped soft squat:

Transient chancroid: soft chancred damage is small, disappear within 4-6 days, but after 2 weeks or so, inguinal lymphadenopathy occurs, easily misdiagnosed as sexually transmitted lymphogranuloma or genital herpes.

Uplifting soft glucoside: The bottom of the ulcer is a depression, and the granulation is proliferated.

Follicular soft squat: a small squat with a large needle, forming an ulcer in the deep part of the genital hair follicle.

Dwarf soft squat: It is very small damage, much like erosion caused by genital herpes, but with irregular base and knife-like hemorrhagic edges.

Erosive soft squat: The ulcer progresses faster and develops deeper. In a few days, there is a large piece of necrosis and shedding in the penis or labia, which often causes massive bleeding. This sputum is caused by a mixture of other bacteria.

Soft squat inspection

1. Smear staining examination The material can be taken from the deep or the base of the ulcer. The affected part is washed with physiological saline first, and the exudate is taken. If the lymph node is used for puncture, the needle should be inserted from the healthy skin to avoid the formation of the fistula. It should be pushed from one end of the slide to the other to maintain the characteristic shape of the bacteria. After the smear is fixed, it can be stained with Gram, Wright, Giemsa or Pappenheim Saathof. About 50% of the dipolar stains with a blunt round length of about 1 to 2 cm can be found. Short bacilli, Gram-negative, single or clustered in the direction of mucus filaments or parallel arranged small clusters, ulcers often have similar short bacillus contamination with Ducrey Haemophilus, but the contaminated bacteria have no "fish-like" characteristics.

2. The pathogen culture can be taken from the diaphragm or ulcer lesions. The commonly used medium is gonococcal fetal bovine serum medium, Mueller-Hinton chocolate medium, etc., inoculated within 2 hours, placed in 5% to 10% carbon dioxide and saturated humidity environment. In the culture at 33-34 ° C for at least 48 h, the colony diameter of Haemophilus Ducrey is 2 mm, which is smooth hemispherical and extremely viscous.

3. Identification test The isolated Ducrey bacilli should be identified by biochemical tests, such as oxidase test and nitrate reduction test.

4. Immunological examination Indirect immunofluorescence assay The smears of genital ulcer secretions were detected by monoclonal antibodies reactive with the outer membrane components of Ducrebacter. The enzyme immunoassay was 93% in culture-positive patients. Screening for large-scale populations.

5. Molecular biological examination includes nucleic acid hybridization technology and nucleic acid amplification technology, the latter is further divided into PCR and LCR. 32P-labeled DNA probe has been used to identify Ducrey bacilli in culture, and PCR is used to detect genital ulcers. Ducrey bacilli have some value in the diagnosis of this disease, but there are also many problems.

6. Histopathological examination:

1. Skin ulcers show 3 layers, which are of diagnostic significance.

(1) Shallow: the basal, narrower, composed of neutrophils, red blood cells, fibrin and necrotic tissue, and Ducrey Haemophilus can be detected by Giemsa or Gram staining.

(2) Middle layer: wide, with most neovascularization, vascular endothelial cells significantly proliferating, can lead to vascular occlusion, thrombosis and secondary necrosis, edema between the shallow and middle layers.

(3) Deep layer: mainly fibroblast proliferation, dense infiltration of lymphocytes and plasma cells.

2. The affected lymph nodes showed severe acute inflammatory reaction with neutrophil infiltration and necrosis.

Soft sputum diagnosis

diagnosis

According to the history of sexual contact before the onset, especially the history of unclean sexual intercourse, typical clinical manifestations and after a short incubation period, soft and flat papules, pustules, ulcers, unilateral suppurative lymphadenitis, direct mirror Detection and culture of Haemophilus ducrei detection, PCR detection of Haemophilus ducrei DNA, you can make a diagnosis.

Diagnostic Basis: Barber's recommendations for the diagnosis of this disease are used as diagnostic criteria:

1 genital ulcer, one or more;

2 dark field microscopy, negative for Treponema pallidum;

3 syphilis serum test was negative;

4 The smear edge of the disease was taken from the smear, and the Novovan corpuscle (C. gingivalis) was not found by Wright's staining, while the short Gram-negative bacilli were found by Gram staining.

Differential diagnosis

Should be identified with syphilis hard sputum, LGV, genital herpes, acute female genital ulcer, Behcet syndrome, tuberculous ulcer and inguinal granuloma.

1. Syphilis is hard to squat.

2. Sexually transmitted lymphogranuloma (LGV).

3. Genital herpes is caused by HSV-2 infection. The damage is cluster herpes, small blisters and erosions. The secretions are serous, with burning sensation and pain.

4. The history of asexual contact with acute female genital ulcers, common in girls and unmarried women, easy to recurrent, often accompanied by oral aphthous ulcers and calf nodular erythema, ulcer secretion smear can be found in crude bacilli.

5. Behcet syndrome is more common in young women, with oral ulcers, eye lesions, skin nodular erythema and acupuncture reaction.

6. Tuberculous ulcers can also be seen in the glans, inflammation is mild, the symptoms are mild, chronic, the surface pus is sparse and less, the damage can be found in tubercle bacilli, and the biopsy tissue is tuberculous.

7. Inguinal granulomatous lesions are proliferative granulomatous ulcers, easy to hemorrhage, lymph node symptoms are mild, do not even occur, consciously painless, take granulation tissue fragments for printing or smear with Giemsa or Wright, staining, can be Donovan bodies were found in enlarged monocytes.

8. Hard squat.

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