Soft chancre

Venereologists often have to deal with such a disease as soft chancre, which is a sexually transmitted genital ulcer disease. The bacterium - the causative agent of the pathology - when it gets into the soft tissue causes the formation of an open wound, which is called a soft chancre.

Epidemiology

Soft chancre is endemic in many African, Asian, and Latin American countries. In Europe and the United States, the disease is much less common. For example, about ten years ago, American diagnosticians recorded almost 30 cases of soft chancre in patients. Five years ago, there were only fifteen cases.

Annually, the rate of genital-ulcer infections in the world is about twenty million cases. The first place in this list is occupied by syphilis, followed by herpesvirus. Soft chancre is registered in six million patients a year. The lion's share is attributed to the population of developing countries. In about 10% of patients, soft chancre is found in combination with herpes simplex virus, syphilis and HIV infection.

The male population is more often faced with the problem of soft chancre: according to statistics, there is one infected woman for every three men who fall ill. The average age of patients with soft chancre is thirty years old.

Causes of the soft chancre

Soft chancre (also called chancroid) is caused by Haemofilus ducreyi. This pathogen was first reported in 1887 and was actively studied for the next five years. The names of the scientists who investigated the infection were subsequently fixed in its name - otherwise the bacillus is called Streptobacillus Ducrey-Unna-Petersen. [1]

Soft chancre pathogens have a characteristic position in the affected area, arranged in rows parallel to each other. Specialists talk about the similarity of such rows to "chains" or "fish packs". On the sticks themselves there are rounded tips, in the middle part there is an overstretch. The average length of the bacillus is about 1.8 µm, with a thickness of 0.5 µm.

Soft chancre is infected most often through sexual intercourse with a sick person: the pathogen enters the tissue through microdamage, or settles on the mucous membranes of the genitals.

The bacillus, the causative agent of soft chancre, survives well at low temperatures and is resistant to chemicals. But at temperatures above +40°C, the bacillus dies.

A person is infected with soft chancre mainly through sexual contact. In rare cases, there are other ways of infection, for example, from health care workers treating sick patients or during childbirth (the infection is transmitted from the mother to the baby). [2]

Risk factors

Additional risk factors are:

• immoral lifestyle, frequent promiscuous sexual intercourse;
• alcohol and drug addiction;
• homosexual life;
• lack of education, lack of knowledge about hygiene and adequate sexuality.

Another factor that may contribute to the development of soft chancre is male circumcision in underdeveloped countries, although no clear substantiated information is provided.

Pathogenesis

The main route of transmission of the soft chancre pathogen is considered to be sexual. It is possible to become infected regardless of the type of sexual intercourse: the bacillus can spread from person to person during genital, anal and oral contact.

Other routes of transmission are less common, e.g. During medical manipulation, etc.

The soft chancre pathogen enters the subcutaneous space through epithelial openings - e.g. Through minor scratches, microdamage, skin trauma that may occur during the same sexual contact. After crossing the skin barrier, the soft chancre bacillus forms a large number of inflammatory structures in the inoculated area: macrophages, dendritic cells and polymorphic neutrophils are also formed. At the same time, the production of interleukins 6 and 8 from epidermal and dermal cells is stimulated. As a consequence of such active processes, a focal abscess - a kind of intradermal pustule - is formed. The inflammatory reaction causes the formation of a fluid discharge inside the ulcer cavity. In this fluid in large quantities are present pathogens of soft chancre, so it is particularly dangerous for a healthy person, as it can cause disease not only during sexual intercourse, but also in contact "skin to skin".

The formation of ulcerative defects typical of soft chancre is caused by the transmural toxin, which provokes apoptosis and necrosis of myeloid cells, epithelial cells, primary fibroblasts and keratinocytes. The symptomatology of soft chancre increases due to the specific properties of the bacillus: it can avoid phagocytosis, which entails slow healing of ulcerative defects. [3]

• Incubation period of soft chancre

Most of the known sexually transmitted pathologies have their own incubation period, and soft chancre is no exception. For Streptobacillus to manifest itself, it needs from three to ten days (as a rule, in men there is an earlier symptomatology, and in women - late). In very rare situations, this period lengthens to one month, but can also be shortened to 1-2 days.

• Risk of infection through sexual contact with soft chancres

The risk of infection after sexual intercourse with a sick partner is estimated to be about 50%, which depends on the stage of the disease, immune status, and many other reasons.

Symptoms of the soft chancre

It is possible to easily and affordably describe what a soft chancre looks like. The first signs begin to appear almost immediately after the incubation period, when the infectious agent begins to multiply intensively. In the affected area, a small bloody bubble appears, clearly delineated, dense. After a few days, the bubble opens, an ulcer is formed, from which a small amount of purulent discharge may ooze. The ulcer is usually characterized by an irregular configuration, has a diameter of about 10-30 mm. Gradually, as the painful process worsens, these dimensions increase, not only in width, but also in depth.

There are some differences in the symptomatology of the disease, depending on the sex of the patient. Soft chancre in men is formed in the form of a small reddish bump in the genital area. After a while, a wound surface opens on the site of the bump - this process occurs quite quickly, over several days. Ulcerous defect can appear on any part of the genitals and even in the scrotum.

Soft chancre in women more often has multiple manifestations: several reddish bumps appear in the area of the labia or in the space between them, near the anus or on the upper thigh. As the bumps transform into ulcers, there is an unpleasant burning sensation when excreting urine or feces.

Symptoms characteristic of both female and male patients:

• The ulcerative defect has an average size of 10-30 mm, but in neglected situations can reach 50 mm;
• The ulcer is soft when palpated, the borders are yellowish-grayish;
• when lightly pressed, small drops of blood are visible;
• pain during sexual intercourse;
• In every second case of soft chancre, swelling of the groin area is noted;
• there is a visible increase in lymph nodes, which is especially noticeable in advanced cases of the disease.

During diagnosis, it should be taken into account that several sexually transmitted infections can coexist at once. For example, soft chancre is often enough detected in syphilis, HIV infection. In these situations, the symptomatology is always more extensive and requires mandatory laboratory differential diagnosis.

Soft chancre is most commonly seen in these locations on the body:

• foreskin;
• coronary groove;
• penile frenulum;
• of the urethral sponges;
• navicular fossa;
• labia.

Other types of location, which can be called atypical, are not excluded. It all depends on where the infection has penetrated. So, sometimes there are ulcers and fissures in the area of the anus. Some patients are diagnosed with soft chancre on the lip, in the oral cavity (for example, if the infection occurred after oral sexual intercourse).In medical workers who performed procedures on patients with soft chancre, ulcerative defects appeared in the area of hands and fingers of the upper extremities. [4]

Stages

Through clinical observations, experts have identified several stages of soft chancre development:

1. Incubation stage (on average lasts 3-10 days, but there may be exceptions).
2. The erythematous-papular stage is the initial stage of soft chancre, which is manifested by the formation of erythema - a spot that turns into a nodular formation in about a day.
3. The pustule stage is the period during which the nodule turns into a blister that opens over 1-2 days.
4. Ulcer stage - after opening the blister, an ulcerative defect is formed that exists for several weeks.
5. Healing and scar formation stage - lasts several weeks until a scar forms at the site of the damaged tissue.

Forms

According to etiological, localization and other signs, soft chancre is divided into several varieties: [5]

• Diphtheroid type is characterized by the presence of a grayish-green plaque at the ulcerous base, which is explained by the mixing of infectious agents. This type of soft chancre is characterized by a prolonged course.
• The gangrenous type is due to the presence of anaerobic flora, with the disease process spreading to deep tissues, which often causes septic complications.
• The funnel-shaped type has the appearance of a formation with the presence of a purulent wound rod. Most often this variant is localized in the area of the sulcus of the head of the penis. In appearance, it has much in common with syphilitic hard chancre, so it is necessary to conduct a careful differential diagnosis.
• Follicular type develops when infection enters the sebaceous gland system. Multiple small ulcers up to 2-3 mm in diameter are formed. Pathology is more often found on the labia minora and the penile head furrow.
• The mixed type is the result of a mixture of syphilitic infection and the causative agent of soft chancre. The clinical picture of the disease is characteristic of two pathologies at once: first the signs of soft chancre are formed, and then - hard. A thickening is formed at the base of the ulcerative defect, affecting nearby lymphatic vessels.
• The serpinginosis type is particularly long-lasting and difficult to treat.
• The phagedenic type is characterized by deep penetration of the infection, which may be due to the use of cautery or other problems in the body - in particular, tuberculosis or alcohol addiction.

Complications and consequences

Specialists identify a number of complications that can develop in patients with a soft chancre:

• Lymphangiitis - lymphovascular inflammation provoked by soft chancre as the pathology penetrates the tissues;
• Lymphadenitis is an inflammatory process in the lymph nodes;
• phimosis is a "male" complication characterized by deformation and narrowing of the foreskin, which creates problems in exposing the head of the penis;
• Paraphimosis - in turn, a complication of phimosis, in which the head of the penis is pinched by the ring of the foreskin;
• Soft chancre gangrene - a process of necrosis and rejection of soft tissue, which may additionally be complicated by sepsis and thrombosis;
• Serpingiosis chancroid - a gradual increase in the size of the soft chancre with the formation of scar tissue in its central part;
• Phagedenic chancroid is a complication of gangrenous soft chancre, in which a scab forms and purulent inflammation develops in the underlying tissues.

It is important to realize that independent attempts to diagnose and treat soft chancre, chancroid are extremely undesirable and can lead to serious and even acute negative consequences. Therefore, you should not take risks, and it is better to immediately - and as early as possible - to seek medical help from a professional.

Diagnostics of the soft chancre

Diagnostic procedures for soft chancre are performed in stages:

• Collection of anamnestic data (speed of disease development, first signs, peculiarities of sexual life, etc.).
• Examination of the skin, genitalia of the patient.
• Laboratory tests: OAC (in soft chancre is found an increased level of immunocytes, accelerated COE), biochemistry (inflammatory protein), smear for microflora, performing seeding and serologic reactions.

Swab for flora is taken directly from the affected area, which can be an ulcerous or erosive defect, papule, etc. The material is applied to a glass panel and subjected to examination with a microscope. In some cases, preliminary staining of the preparation is required to improve the identification of the infection.

Seeding is necessary for the final diagnosis, especially if there is doubt about it, as well as for determining sensitivity to antibiotic therapy. Part of the pathological discharge from the infectious focus is taken, applied to a nutrient medium placed in a special laboratory plate. Such a medium provides the most optimal conditions for the development of the pathogen, so bacterial colonies begin to grow on it. In the same container, antibacterial drugs to determine the identity of the infection and clarify the diagnosis. Medications that will have the maximum destructive effect on the pathogen will be recommended as the main drugs.

Serologic reaction is a technique for determining infectious disease that can exist in two variants:

• Determination of antibodies in the patient's blood. When an infectious agent enters the body, the immune defense is triggered, thanks to which antibodies are produced, aimed at destroying the foreign agent. If there are antibodies in the blood - then there is an infection.
• Antigen detection. The essence of the reaction is that part of the biopreparation is placed in antibody-enriched serum. A positive result is indicated by adhesion of antigens and antibodies and their precipitation.

Instrumental diagnostics is not determinative, but is used only as an auxiliary method. Cystoscopy, colposcopy, ultrasound examination are possible. [6]

Differential diagnosis

Differential diagnosis is carried out with other pathologies that are accompanied by the formation of ulcerative defects on the skin and/or mucous membranes.

• Soft and hard chancres are caused by different pathogens: Haemophilus ducreyi in soft chancres and pale treponema in syphilitic hard chancres. There are also external differences: the ulcerative defect of the hard chancre has a rounded shape, a glossy bottom and a dense base. There is no red inflammatory border, pain or swelling.
• Groin lymphogranulomatosis is characterized by the spread of infection to the inguinal, femoral, iliac and deep pelvic lymph nodes. The causative agent is most often the causative agent of chlamydia. Diagnosis is made on the basis of not only clinical signs, but also the results of laboratory diagnosis.
• Gonorrhea is caused by gonococci and affects the urethral canal, vagina, cervix, rectum, oropharynx and ocular conjunctiva. There is pain, burning and discomfort in the genital area and urethra, urethral purulent or mucous discharge appears. The formation of abscesses is not characteristic.
• Mycoplasmosis and ureaplasmosis are caused by opportunistic flora, genital mycoplasmas, so treatment for their detection is not always prescribed, but only in the presence of complaints (discharge from the genital tract, urinary disorders, etc.). Ulcerative lesions are not characteristic of the diseases.
• Groin granuloma (venereal granuloma, ulcerative granuloma, donovanosis) is caused by the bacillus Calymmatobacterium granulomatis. The first clinical signs of pathology are the formation of subcutaneous painful nodules 30-40 mm in diameter, with a gradual further increase in their size. The disease is prone to autoinfection - infection of any zone on the body from the primary focus. The determining value in the diagnosis is given to laboratory methods.
• Chlamydia is caused by the bacterium Chlamydia trachomatis. Patients with chlamydia usually complain of lower abdominal pain, dysuria, bloody and purulent discharge from the cervical canal, vagina or urethra. There may also be hyperemia of the skin near the anus, redness of the conjunctiva and pharyngeal mucosa. Chlamydia can be diagnosed as an independent disease, but it can also be combined with, for example, soft chancres.
• Trichomoniasis is caused by Trichomonas vaginalis: inflammation of the mucous membrane and skin, as well as the subepithelium of the affected organ develops. Itching, burning, swelling, erosions and ulcers on the external genitalia and inner thigh surface are characteristic. Diagnosis is established on the basis of the results of serologic and microbiologic studies.
• Molluscum contagiosum is a parasitic disease characterized by the appearance of multiple papules. Their main localization is the anogenital area. Papules have a characteristic depression in the center, and when pressing, there is a discharge like a curd mass. Pain is not characteristic, sometimes patients complain of itching.

Treatment of the soft chancre

How is soft chancre treated? Doctors consider the most effective use of antibiotics and sulfonamides. Thus, antibiotics with a broad spectrum of activity are used, capable of affecting both bacillary flora and spirochetes - in particular, the pale treponema, which causes the development of syphilis.

Depending on the severity of the disease, complete cure is noted only after several weeks of active treatment. This is not the end of the medication: the patient is prescribed a preventive course of medication. [7]

Among the medications of local action, preference is given to such means:

• sulfonamide ointments;
• lotions and baths with a solution of potassium manganese acid;
• treatment with antiseptics (Furacilin, etc.).

Physiotherapy (e.g., ultrasound) is actively used as an adjunctive treatment.

Detoxification treatment is prescribed in severe neglected course of the disease. With a clear suppression of immune defense is appropriate use of immunomodulators.

Medications

Among the medications of the sulfonamide group for mild chancre, Sulfadimethoxine or Biseptol are most often chosen.

Tetracycline, Azithromycin, Gentamicin, Ciprofloxacin, Ceftriaxone are suitable for antibiotic therapy.

IUSTI, the International Organization for the Control of STDs, in conjunction with the Center for Disease Control, has established the following recommended regimens for the treatment of patients with soft chancres:

• First-line therapeutic:
  • Ceftriaxone as a single intramuscular injection of 250 mg;
  • or Azithromycin as a single oral administration of 1 g.
• Second therapeutic line:
  • Ciprofloxacin as an oral dosage of 500 mg twice daily for three days;
  • or Erythromycin as oral 500 mg four times a day for one week.

If abscesses develop in the lymph nodes, needle aspiration with further drainage is performed.

Ceftriaxone is allowed to be used for therapy of soft chancre in childhood and during pregnancy. Possible side effects: allergic rashes, mycosis, digestive and hepatobiliary disorders.

Ciprofloxacin is not prescribed in pregnancy and lactation, as well as in children under 18 years of age. During these periods, preference is given to treatment regimens with Ceftriaxone and Erythromycin.

Locally, warm baths with a solution of potassium permanganate 1:5000, treatment with sulfonamide powders, oil suspensions, antibacterial ointments. In case of complications in the form of phimosis wash the preputial sac with a solution of potassium manganese acid and injected into it 10% oil sulfonamide suspension. In the case of paraphimosis, the head is repositioned, and in special cases - dissect the impingement ring.

Biseptol, Bactrim, Seprin are considered effective among sulfonamides. These drugs are taken orally 2 tablets twice a day for 1-2 weeks. Possible side effects: allergic reactions, nausea, intestinal motility disorders, headache.

Sulfonamide ointments and creams (Levomekol, etc.), or Sulfathiozole, Norsulfazole in the form of an aqueous mushy mass are used externally.

Vitamins

For mild chancre, it is optimal to take a daily multivitamin complex preparation with minerals containing 1-2 daily doses of useful substances recommended for a healthy person. An infectious disease specialist or therapist will recommend the most suitable preparation from those sold in pharmacies.

Most patients suffering from sexually transmitted diseases are deficient in substances such as vitamins A and E, _B6 and _B12, and zinc. At the same time, one should not forget about contraindications to taking multivitamins.

An alternative to taking complex preparations may be to improve nutrition, enriching it with vegetable vitaminized food. In many third world countries, where soft chancre is a particularly frequent disease, such an enhanced diet is considered one of the most important therapeutic measures. It is recommended to expand the diet with whole grains, porridge, vegetable oils, vegetables, berries and fruits, seafood and nuts.

Physiotherapy treatment

When lymph nodes are affected, the doctor may prescribe physiotherapy. Simultaneous application of the impact of physical factors and medications accelerates recovery, stops the development of the inflammatory process, reduces the severity of the clinical picture. As a rule, the doctor prescribes one of the following manipulations:

• UHF therapy - consists of exposure to ultra-high-frequency pulsed or constant electric field, which leads to vasodilation and transportation of leukocytes to the areas affected by infection. As a result, antibacterial local immune defense is strengthened and swelling is eliminated.
• Laser therapy is the effect of light waves that cause improvement of microcirculation and trophism in the inflammatory focus. The procedure has anti-inflammatory and anti-edematous effects, accelerates the recovery of damaged tissue.
• Galvanization consists in simultaneous exposure to low-frequency electric current and low voltage, which allows you to start the necessary biochemical reactions. As a result, pain in lymph nodes disappears, blood circulation in the inflamed area improves, regeneration accelerates, and impulse transmission in damaged nerve fibers stabilizes.

Treatment at home

As a rule, doctors allow the treatment of soft chancres without placing the patient in the hospital. This is due to the fact that the disease is relatively well treated with antibiotics and sulfonamides. In this case, they often use drugs with extensive antimicrobial activity, which can affect both streptobacilli and pale treponemes.

The duration of therapy is usually limited to a few weeks. After that, the patient should come to the doctor for checkups for another six months. This is necessary to prevent recurrence of soft chancre.

In addition to systemic antibiotics for the treatment of soft chancres, local antibacterial agents are also used - in particular, ointments. They allow to cope with the symptoms of the disease faster and accelerate the healing of ulcerative defects.

Some manipulations, such as physiotherapy or opening lymph nodes, require a visit to a hospital or outpatient clinic. However, these procedures can be done at home:

• wash wounds with a solution of boric acid or potassium permanganate;
• dry with a cotton pad, sprinkle with xerophor;
• put on a disinfectant dressing.

Dressing is repeated 1-2 times a day. This procedure will allow not to start the disease, and in conjunction with conservative treatment will help to accelerate wound healing.

Folk treatment

Folk recipes are an excellent auxiliary method for the treatment of many diseases. However, this can not be said about diseases that are sexually transmitted - for example, soft chancre. This pathology is still better treated traditionally - with medications of systemic and local antibacterial action.

In the people, the most popular recipes for various venereal diseases are considered such:

• make baths and washing of the external genitalia and inflamed foci with a solution of manganese, furacilin, as well as strong infusions of chamomile, celandine, calendula;
• apply lotions with mercury, heparin ointment;
• take Eleutherococcus extract orally;
• make a powder of streptocide tablets;
• wipe the external genitalia with a 1:1000 solution of sulfa;
• treat mucous membranes with 2% boric acid solution or 2% gramicidin.

Each patient has the right to decide for himself whether to adhere to folk treatment or traditional treatment. But doctors strongly recommend deciding in favor of antibiotic therapy - the only reliable way to eradicate soft chancre.

Herbal treatment

Self-administration of herbal remedies is allowed only in the pre-hospital period, when immediate medical attention is not possible. However, it is necessary to take all measures to visit a medical institution in the near future. Soft chancre is cured without problems if treatment is started in a timely manner.

Folk healers and herbalists offer such recipes to get rid of soft chancre:

• Brew 40 g of herbs hernia smooth in 1 liter of boiling water. Take 100-150 ml before meals three times a day.
• Prepare fresh juice from the rhizome of a large burdock. Take 25 drops of the juice daily.
• Brew 10 g flowers of cowpea scepter in 200 ml of boiling water. Take 3 tbsp. L. Three times a day.
• Prepare a decoction of 15 g of juniper (you can take any part of the plant) and 200 ml of boiling water. The remedy is taken three times a day, 1 tbsp. L.
• Brew 20 g of dandelion rhizome in 200 ml of boiling water. Drink 100 ml three times a day. Apply ointment made of a mixture of root powder and honey to wounds externally.
• For pain, prepare a decoction of 10 g of meadow prostrate and 200 ml of boiling water. Take 1 tbsp. Three times a day.
• Prepare an infusion of celandine herb, based on the proportion of 1 tbsp. Of raw materials per 200 ml of boiling water. Take 1 tbsp. Of the remedy per day. Infusion can be replaced with fresh juice of the plant: it is taken in the amount of 1 drop per 2 tbsp. Of water, daily.

Homeopathy

Most homeopathic specialists do not take on the treatment of sexually transmitted diseases. Soft chancre in most cases is well enough to be treated with antibiotics, so there is no need to look for alternative ways of treatment. Nevertheless, such methods exist, although few homeopaths actively use them in their practice:

• For initial mild chancre, Mercurium vivus 30 once; Mercurium solubilis 4 or 6 decimal divisions in the morning and evening; ½ gram Mercurium solubilis in the morning and evening; 1 gram Mercurium solubilis every other day.
• In neglected mild chancre Cinnabaris first plant ½ gr. Morning and evening.
• As an adjunct to the above treatment Acidum nitricum (first tenth. Division, first hundredth and three hundredths).
• For gangrenous chancre, Arsenicum.

Traditional medicine practitioners cannot make any recommendations regarding homeopathic therapy for soft chancre. To date, there is no evidence of either benefit or harm from such treatment.

Surgical treatment

When abscesses develop in the lymph nodes, surgical treatment is prescribed. It consists of opening the foci, evacuation of purulent secretion, washing and drainage. This procedure is performed under local or general anesthesia and subsequently significantly accelerates recovery.

The postoperative period involves strict bed rest with special motor restriction in the affected area. Nutrition is adjusted in favor of easily digestible food.

Medication support consists of taking antibacterial and detoxification drugs, non-steroidal anti-inflammatory and desensitizing agents.

Prevention

People who regularly engage in promiscuous sexual relations are more often than not at risk of contracting sexually transmitted diseases. This should be taken into account and a number of preventive measures should be taken to avoid not only soft chancres but also other dangerous diseases.

It is better to avoid casual intimacy altogether. But if it happens, it is important to use a barrier contraceptive method - a condom.

Health care workers who diagnose and examine patients with suspected soft chancre should only work using personal protective equipment.

Soft chancre is a serious and dangerous venereal disease. However, simple preventive measures can avoid the problem. The main thing is to treat your health responsibly. It is also necessary to know that immunity to soft chancre is not produced: doctors do not exclude the possibility of repeated infections if the patient does not observe elementary safety measures.

Forecast

Soft chancre is an insidious disease that mostly affects the genital area and skin. Most often pathology is found on the labia, foreskin, on the frenulum of the penis or at its base. However, there are also atypical localizations - for example, in the anal area, in the oral cavity or on the lip, on the hands and so on.

It should be understood that the presence of a focus of hard chancre is not always the only manifestation of the disease. Often, if the necessary measures are not taken, a secondary soft chancre develops: this often happens when purulent secretions get into the areas of healthy skin. Such a development is especially susceptible to patients who try to peel or scratch pathological foci.

If the therapy is started in a timely and complete manner, it is possible to talk about complete healing in a few weeks - after about 2 months of regular and intensive treatment. At the site of the lesion remains a pigmented spot, which also disappears with time. In the absence of medical care, there is no hope for self-healing: soft chancre spreads to healthy tissues, affects the lymphatic system, which can lead to tragic consequences in the future.