A chancre is an inflammatory dense accumulation of cell mass, blood and lymph; an ulcer or erosion occurs on the surface of the chancre. Chancre does not cause acute pain. The manifestation of chancre occurs after the third week from the moment the pathogen of syphilis (treponema pallidum) enters the human body. If primary syphilis occurs on the genitals, then there is a high probability of developing phimosis, balanoposthitis, gangrenization and similar complications.
Also with primary syphilis, regional scleradenitis, specific polyadenitis and specific bubo often occur. The disease of primary syphilis is diagnosed on the basis of anamnesis, when chancroid is clearly pronounced and treponema pallidum is found in its secretions. Standard serological test reactions are usually negative for the disease. Only starting from the third week, when syphilides appear on the skin, can there be a positive result of serological reactions. Treatment of primary syphilis is carried out using drugs that contain penicillin.
Classification of primary syphilis
Medical experts divide primary syphilis into three forms.
These forms differ in the reaction of serological studies.
- Form 1 - seropositive primary syphilis, in which serological reactions to syphilis are positive;
- Form 2 - seronegative primary syphilis, in which serological reactions to syphilis are negative;
- Form 3 is latent primary syphilis, in which serological reactions can be both positive and negative. The disease occurs without any significant symptoms. This type of syphilis often occurs in people who, after the introduction of Treponema pallidum into the body, initially began treatment, but did not complete it.
Medical specialists also classify primary syphilis depending on the location:
- primary syphilis affecting the genitals;
- primary syphilis affecting the anal areas;
- primary syphilis affecting other organs.
Soft chancre - symptoms and treatment
The disease is more common in men than in women. In some countries, the female to male ratio ranges from 3:1 to 25:1.[3] Most women are asymptomatic and serve as reservoirs for infection.[15]
Chancroid
The main symptom is chancre [16] - single or multiple ulcers of round or irregular shape with a diameter of 2-3 cm with a narrow erythematous rim along the periphery. The edges of the ulcer are undermined, soft, overhanging. The bottom of the ulcer is often uneven and covered with necrotic, unpleasant-smelling gray or yellow exudate. On palpation, the base of the ulcer is soft and there is sharp pain.
Localization in men:
- foreskin;
- glans penis;
- bridle;
- coronal sulcus;
- shaft of the penis and scrotum.
Localization in women:
- labia majora and minora;
- vestibule of the vagina;
- clitoris.
A case of chancre localization in the vagina and cervix has been described.[17]
Dropouts appear as a result of autoinoculation (random transfer of microbes) or simultaneous infection of several areas of the skin. They are multiple ulcers, usually of small diameter, often located on contacting surfaces or at a distance from the main lesion (in the pubic area, thighs, perineum). They are a specific symptom of infection.[16]
Extragenital chancre
Chancres have been reported on the hands, eyelids, lips, breasts, oral mucosa, perianal area and anus.[16] But with the exception of localization in the oral mucosa, vermilion border of the lips and anus, these cases were most likely the result of autoinoculation.
Chancre, which occurs during anal intercourse, is a sharply painful small ulcer, often linear in shape.
Atypical chancre[18]
A dwarf chancre is a small, superficial, relatively painless ulcer.
Giant chancre is a large granulomatous ulcer at the site of the opened inguinal bubo, extending beyond its limits.
Follicular chancroid is associated with hair follicles of the labia majora and pubis in women. At first it looks like a follicular pustule, which later transforms into a classic ulcer.
Transitional chancre is presented in the form of superficial herpetiform quickly healing ulcers, but with typical inguinal lymphadenitis.
A sickle-shaped chancre is multiple ulcers fused together, forming a continuous arc-shaped lesion.
Phagedenitis chancre occurs due to secondary infection with fusospirochetes. Ulceration causes extensive destruction of penile tissue, including self-amputation.
Papular (raising) chancroid presents as a granulomatous ulcerated papule, resembling donovanosis or condyloma lata.
Mixed chancroid occurs when there is a joint infection with treponema pallidum (the causative agent of syphilis) and streptobacilli, in which a classic chancroid ulcer first appears, and after 3-4 weeks, its base thickens with the formation of a hard chancroid.
Inguinal lymphadenitis (bubo)
Develops within 1-2 weeks after the appearance of the primary ulcer in approximately 30-60% of patients, more often in men.
The inguinal lymph nodes are enlarged on one side and painful on palpation. In a quarter of patients, the process progresses with the formation of a purulent abscess, followed by its opening, as well as with the formation of fistulas.[8]
Cutaneous (extragenital) chancroid
Recent studies have identified H. ducreyi as a previously unrecognized cause of nongenital skin ulcers in children and adults in tropical areas.[19] Infection occurs through household contact. The lesions often present as a single ulcer in the area of the legs and thighs, which is clinically no different in appearance and course of the process from a classic genital ulcer.
Other lesions
Several anecdotal (rare) cases of diseases caused by Haemophilus ducreyi have been reported - conjunctivitis[20] and esophageal lesions in an HIV-infected patient[21].
Complications of primary syphilis
Patients with primary syphilis may experience complications that can provoke the development of syphilis and its transition to the secondary stage. And secondary syphilis already affects all human vital systems and organs. Skin rashes increase and cover a larger area. Complications of primary syphilis in 20% are characterized by syphilitic alopecia. A person infected with syphilis quickly loses hair over fairly large areas of hair. Hair loss can be either small-focal or widespread. A sick person develops severe headaches, a sharp increase in temperature, general weakness and body aches.
The symptoms are very similar to those of the flu. Complications of chancroid usually threaten with phimosis, paraphimosis, balanitis, balanoposthitis, phagedenism and gangrenization. If complications occur, you must immediately contact medical specialists for surgical treatment.
Diagnostics
Syphilis is diagnosed by examination, characteristic signs and laboratory tests:
- Examination by a dermatovenerologist. He asks the patient in detail about the course of the disease, examines the skin, genitals, and lymph nodes.
- Detection of treponema or its DNA in the contents of gummas, chancre, syphilides using dark-field microscopy, direct immunofluorescence reaction, and PCR.
- Instrumental studies: search for gummas using ultrasound, MRI, CT, X-rays, etc.
- Carrying out various serological tests: Non-treponemal - search for antibodies against treponema membrane lipids and phospholipids of tissues destroyed by the pathogen (Wassermann reaction, VDRL, rapid plasma reagin test). The result obtained may be false positive, i.e. show syphilis where there is none. Treponema - search for antibodies to Treponema pallidum (RIF, RPHA, ELISA, immunoblotting, RIBT).
Remember that for such a serious disease you cannot diagnose yourself “on the Internet” by reading about syphilis and its symptoms. The fact is that the rash and other changes can visually copy those of completely different diseases, so that even doctors are periodically misled.
Chancroid: features
development of chancre
Primary chancre first looks like a red spot on the skin or mucous membrane, then the spot turns into erosion - superficial damage to the epithelium. A typical syphilitic ulcer is formed after treponemas penetrate into the subcutaneous tissue or submucosal layers, and can go deeper into the muscle tissue.
Signs of chancre:
- The sizes range from 1-2 mm to 4-5 cm, chancre with a diameter of 1-2 cm is more common.
- The shape is oval or round, the edges are dense and smooth.
- The bottom is brown-red and hard, resembling cartilage in density.
- Sometimes there is a yellowish purulent coating on the surface, but the skin (or mucous membrane) around the chancre always retains its normal color and does not thicken or become inflamed.
A typical chancre never hurts or itches ; some patients may simply not notice it. If you press on the syphiloma from the sides, a clear yellowish liquid containing treponema will appear on the surface. The symptom, called “crying chancre,” is used for differential. diagnosis of various ulcers and chancre with syphilis.
The main symptoms of chancre are: characterized by small erosions or ulcers, dense edges and bottom, painlessness and absence of inflammation.
The erosive chancre heals within 3-4 weeks, leaving no trace. A syphilitic ulcer can last up to 2 months and is detected at the beginning of the secondary period of syphilis; it always heals with the formation of a scar. The disappearance of chancre is a signal about the transition of syphilis to a clinically latent form. It is characterized by complaints of deterioration in general health, pain in muscles and joints, and generalized scleradenitis. The symptoms are caused by the rapid proliferation of treponemes and their spread throughout the body.
What should I do if I'm pregnant?
If you think you are or may become pregnant, it is important to get tested for syphilis. If the mother has syphilis, the baby may be born with congenital syphilis. It can cause stillbirth and birth defects, but you can avoid this by getting tested for syphilis during the first and third trimester of pregnancy.
Is there a cure for syphilis?
Yes, syphilis is highly treatable, especially in the initial stages. As a rule, syphilis is treated with penicillin, but if you are allergic, a similar medicine will be found for you.
How do I know if I have syphilis?
Syphilis is diagnosed only through a blood test; according to the law on medical care for the population of Russia, you can take a syphilis test for free, anonymously at any speed center.
Treatment of syphiloma
The main goals are to cure the infection, avoid complications and block the spread of syphilis.
Treponemas are sensitive to antibiotics - penicillins, tetracyclines (doxycycline) and macrolides (azithromycin), cephalosporins (ceftriaxone). During antibiotic therapy, control tests are done to confirm the effectiveness of the drugs. Both partners are always treated; sexual contact is prohibited until complete recovery. When syphiloma is localized in the mouth and on the fingers, it is important to separate personal items - dishes, bed linen, towels, toothbrushes, etc. Treatment of chancre begins with antibiotics, and local remedies are also used.
- Extensillin is the basic drug for the treatment of syphilis. Administer intramuscularly (IM), twice. A dose of 2.4 million units is diluted in 0.5% novocaine at the rate of 100,000 units per 1 ml. For primary seronegative syphilis, a single dose is sufficient. It is preferable to give injections in the buttocks.
- Bicillin-5, intramuscularly, 3 million units once every 5 days, twice.
- Tablets: erythromycin 0.5 x 4 per day, before meals 30 minutes or after, an hour and a half. Doxycycline 0.5 x 4 per day, during or immediately after meals.
- In local treatment, the main thing is hygiene of the chancre area. They also use baths or lotions with benzylpenicillin and dimexide, which help the drugs penetrate deeper. Applications with mercury and heparin ointments are shown. Erythromycin (1-3%), 10% mercury and mercury-bismuth, syntomycin (5-10%) and levorin (5%) ointments accelerate the healing of weeping erosions and ulcers.
- Chancres in the oral cavity: rinsing with solutions of furacillin at a dilution of 1:10,000, boric acid (2%) or gramicidin (2%).
The duration of treatment and dosage are prescribed by the doctor. Antibiotics are selected individually, taking into account co-infection and drug tolerance. Patients prone to allergies are additionally prescribed suprastin or tavegil.
Causes and course of the disease
The development of syphilis of the pharynx is possible at all 3 stages of the disease.
Primary lesions are more often in the nasopharynx than in the oropharynx. Moreover, infection can also occur through the use of infected medical instruments (iatrogenic factor of infection).
When the nasopharynx is affected, the most common manifestations of the disease are:
- Enlargement of the lymph nodes of the neck, which in some cases are very pronounced;
- Severe pain when swallowing, which radiates to the ear and is accompanied by congestion.
