Pubic ulcer

Introduction Most genital ulcers occur in the scrotum, glans, female labia, vaginal wall, and even the cervix and urethra. The shape of the ulcer is similar to that of the oral ulcer, but the repetitiveness is not as strong as the oral ulcer. Physical examination revealed scars after vulvar ulceration or ulcer healing. Pusal ulcer is one of the main clinical manifestations of Behcet's syndrome. There is no effective cure. The purpose of treatment is to relieve symptoms and reduce organ damage. For those who are not affected by important organs, colchicine is the drug of choice. For those with visceral involvement, especially those with eye lesions, it is necessary to use a combination of drugs.

Cause

The cause of genital ulcers:

First, the infection:

1. Virus: Early detection of the virus as its cause, after epidemiology, tissue culture, serology, animal inoculation, immunofluorescence and electron microscopy, etc. have not been further confirmed. The dyeing report suggests that the onset may be related to autoimmune abnormalities caused by lentivirus infection; some reports have found evidence of the relationship between HSV-1 and the disease, such as evidence of the relationship between anti-HSV-1 and the disease in the patient's blood, such as patients. Increased anti-HSV-1 antibody titer in blood HSV-1 affects CD4 lymphocytes and causes immune abnormalities and HSV-1 has DNA homologous to peripheral blood lymphocytes of the disease.

2. Streptococcus: Because some patients often develop diseases such as tonsillitis, pharyngitis and periodontitis, it is believed that the onset is related to bacteria in these lesions. The study found that the anti-streptococcal antibody titer in the patient's serum increased; the strain isolated from the patient's mouth was most closely related to streptococcus, especially S. sanguinis, which was intradermally tested with its bacterial components. Positive results were obtained in the macrophage migration inhibition test; the 65-KDa heat shock protein test of Streptococcus can cause skin hypersensitivity and systemic symptoms. These studies were mainly conducted by Japanese scholars. Although they were considered to have an important role in the pathogenesis, they did not reach a consensus conclusion.

3. Tuberculosis: Since 1964, there have been reports of cases related to tuberculosis infection in China, that is, tuberculosis, such as tuberculosis, lymphatic tuberculosis, etc., have been diagnosed before the initial damage of Behct disease. It can be an old lesion, but it is mostly active. Most of the OT tests are strongly positive; anti-tuberculosis drug treatment not only has a significant effect on the primary lesions, but also is an allergic manifestation of tuberculosis. The 65-KDa heat shock protein of tuberculosis is also associated with the disease.

Second, trace elements:

A few reports found that the levels of various trace elements in the pathological tissues such as vascular endothelial cells, macrophages, sural nerves, and aqueous humor, serum and neutrophils were increased. Organochlorine, organic phosphorus and copper ions were studied. The latter is the highest, which may be caused by occupational or environmental factors.

Third, genetic factors:

The disease has a regional morbidity, such as more common in the Mediterranean coastal countries; there are cases of bloody familial morbidity, which can be seen in 2, 3 or 4 generations, and the incidence is more male. HLA-B5(+) is a marker of immune heredity, and its positive rate can reach 67%-88%, indicating that the incidence is related to HLA-B5, but also related to HLA-D, especially HLA-DR. The Behcet disease susceptibility gene is located on the 6-arm of the chromosome, between the HLA-B and TNF-beta sites, which may provide direction for future research on gene therapy. Behcet's disease has no genetic pattern and may be recessively inherited by the system.

Fourth, immune abnormalities:

There are anti-oral mucosal antibodies and anti-arterial wall antibodies in the serum of the patients; in addition, there are complexes in the serum, which are up to 60% positive and are related to the disease activity; in addition to the slight increase of IgG, IgT and IgM, sometimes IgE Elevated; DIF examination revealed IgG, IgA, CIC, and C3 in the vessel wall, especially in the venous wall. In vitro, the lymphocyte transformation test values of these patients were generally low, the DNCB skin test was mostly negative, and the T-cell and TH cell values were decreased. The cells infiltrated by nodular erythema-like lesions were mainly T cells, and It is a TH and NK cell, and the infiltrating cells in the eye tissue are mainly CD4 lymphocytes and macrophages, and few B cells and NK cells. These CD4 lymphocytes and macrophages are HLA-DR(+). The above facts indicate that the disease has normal humoral and cellular immunity, but it is generally believed that cellular immune abnormalities are more closely related to the disease.

V. Other:

Although the etiology of this disease is not clear, the pathogenesis is related to immune abnormalities. During the process of immune regulation and inflammation, changes in cellular components and various active substances produced, such as plasmin inhibitors, can dissolve plasmin. Fibrin activity is reduced, and fibrinogen content is increased; and neutrophil chemotaxis is enhanced; tumor necrosis factor (TNF-beta), IL-2 and IL-6 are produced, which are in the development of lesions. May also have a role.

6. Sex hormones:

Sex hormones such as testosterone, progesterone, estradiol, luteinizing hormone, follicle stimulating hormone and pituitary prolactin were measured in 21 male and preovulatory females. Statistical analysis of male testosterone and female progesterone values compared with the control group Low, its p value is.

an examination

Related inspection

Waxmann reaction fungal histopathology immunopathological examination serological response

Examination and diagnosis of genital ulcers:

There is no specific serological and pathological diagnosis method, mainly for clinical diagnosis. A diagnosis can be made by having a mouth, eye, genital damage (three-in-one) or skin damage (tetralogy). Positive acupuncture skin allergy test is helpful for diagnosis. For incomplete or atypical, comprehensive analysis should be combined with system performance.

Differential diagnosis

Identification of symptoms that are easily confused with genital ulcers:

Perineal traction pain: Acute prostatitis refers to acute inflammation caused by non-specific bacterial infection of the prostate, mainly manifested as urgency, frequent urination, dysuria, rectal and perineal pain, and many aversion to cold and fever.

Perineal tearing: perineal III degree laceration or complete perineal laceration, including vaginal laceration, perineal laceration and anal sphincter laceration, severe rupture can extend to the rectal wall, causing stool and gas incontinence. The cause of the accident is due to improper handling during the delivery process, and occasional trauma. Due to the vigorous implementation of the new method, the birth attendant properly protects the perineum and greatly reduces the incidence of perineal III degree laceration.

Pussy skin flushing: The perineum is consciously moist, hot, and red. Patients with conscious symptoms and laboratory tests found that the genital herpes simplex virus can be diagnosed.

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