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Genital ulcers and uretrits

(Last Updated On: 8 March 2020)

Introduction:

Bacteria: Syphilis, soft canker, Donovanose, Nicolas-Favre's disease

Virus: genital herpes, venereal vegetation (HPV), HIV

Yeasts: Genital Candidiasis

 

Genital ulcers

Definition

Causal, traumatic (mechanical or physical) ulceration by interrogation

Genital aphtosis that most often sits on the scrotum and performs a widening ulceration,

clear, recurrent and painful limits associated with episodes of oral aphtosis

Primitive/secondary neoplastic ulceration

 

Primary Syphilis

erosion of 5-15 mm in diameter, unique, clean-bottomed, rosé, undured or cardboard to palpation,

painless, 3-6 weeks

Seat: most often at the genital level:

In humans: balano-preputial furrow, more rarely on the

acorn or sheath of the penis

In women: at the outer part of the vulva, ulceration can also sit at the vaginal or extra-vaginal level: oral, oropharyngeal or anorectal

Adenopathy: it is non-inflammatory (painless, non-ulcerated), it is in fact a packet of adenopathies in which we find a large ganglion, usually unilateral on the same side as the canker, it never evolves towards fistulization

Evolution: Primary syphilis spontaneously progresses to regression without sequelae within a few weeks, regular and smooth scar

Paraclinical diagnosis:

Highlighting pale treponeme: by a direct examination under a black-bottomed microscope: scraping the serouss at the bottom of the canker, pale treponemes are observed as spiral, shiny and mobile bacteria

Serology: there are two types:

Specific serology (treponemic serology): TPHA is mainly used

Non-specific serology (reagenic serology): it is VDRL

In practice, you should always ask for a TPHA and a VDRL

 

 

 

 

 

 

 

Serology is positive a few days after the onset of canker: TPHA is positive between the 7th and 10th day, the VDRL is positive between the 10th and 15th day of the canker

Treatment:

Benzathine Benzyl Penicillin (Extencillin®): 2.4 million units im injection

single dose, sometimes repeated after 1 week

In case of penicillin allergy: the treatment will be Doxycycline 100 mg 2x/d

15 days

Surveillance after treatment: it is done on quantitative VDRL at 3 months, 6 months, 1 year and 2 years. Antibody levels should gradually decrease and negative after one year

 

Herpes

(neonatal herpes)

First-year herpetic infection: young adult, woman and man are affected, incubation varies

2 to 60 days with an average of 6 days

In Women:

Erosive acute vulvitis: Erythematous edemamatosus edemaous and inflammatory background develop multiple vesicles, which will rupture giving way to erosions

Seat: large lips, inner face of the

small lips

Functional signs: intense, pain,

burns and urination gene

Adenopathies: inguinal, bilateral,

complete this picture

Evolution: is moving towards the disappearance of

lesions in 3 to 4 weeks

In men: the clinical picture is that of an acute bladder and then erosive balanite, less painful and less sensitive than in women.  Healing is faster

Recurrent genital herpes: after the first infection, the virus migrates to the corresponding lymph node, it remains latent but likely to reactivate

Triggering factor: it may be sex, menstruation,

Stress…

Prodromes: it may be a burning sensation, a cooking sensation or a

Pruritus

▪ Then appears a rash made of a rash quickly covered with several vesicles grouped in bouquets. These vesicles will rupture giving way to erosions that dry out and disappear without leaving scars

pregnant, newborn and immunosuppressed. One can highlight herpes simplex virus after culture on cell media (this is the current reference method), PCR (HSV1, HSV2), cytodiagnosis (evidence of ballooned cell, confirms the diagnosis of an infection with a HSV group)

 

 

 

 

 

 

 

Symptomatic treatment: avoid overinfection, dry lesions, never give alcoholic products on mucous membranes and erosions, never ointment as it macerates, never dermocorticoid

By general means: painkillers can be used for pain

Locally: antiseptics can be used as a watery solution

Antiviral treatment: Acyclovir (tablets at 200 mg, 1 tablet 5 x/d, for 10 days), new antivirals (Valcyclovir, Fanacyclovir)

 

Soft chancre

is highly contagious and self-inoculable

1 cm, dirty bottom, hemorrhagic, undurable, irregular edges, shredded)

Protected palpation: regains a soft base and highlights the painful nature of

this ulceration, multiple in 50% of cases

Adenopathy: is unique, one-sided, voluminous and inflammatory (red, hot and

painful)

Evolution: it evolves towards fistulization by a single orifice

can be highlighted: direct examination after toluidine blue coloring, culture, PCR

Erythromycin: 2 g per day, per bone, for 10 days

Ciprofloxacin: 500 mg, 2x/d, for 3 days

 

 

Syphilis

Primary

 

Soft chancre

Lymphogranuloma

venerated

 

Donovanose

Herpes

Genital

 

Etiology

Treponema

Pallidum

Haemophilus

ducreyi

Chlamydia

Trachomatis

Calymmatobacterium

granulomatosis

Herpes virus

Hominis

 

Incubation

 

21 d

 

4-5 d

 

7-12 d

 

8-80 d

First: 2-12 d

Recurring…

 

Ulceration

Clean, undulatly, painless

Dirty

Multiple

Painful

 

Minimal, unnoticed

 

Granulomatous, clean, painless

Superficial, polycyclic, painful

Duration

evolution

 

3-6 weeks.

Indefinite

(months)

 

2-6 d

Indefinite

(years)

 

7-10 d

 

Lymphadenopathy

Regional

Painless, non-painless

ulcerated

 

Painful, ulcerated

 

Painful, ulcerated

 

Absent

 

Inconsistent

 

Diagnosis

Review

Direct

Serology

 

Culture

 

Culture on

cells, serology

 

Direct review, histology

 

Culture on

Cells

 

 

 

 

 

 

 

Other STIs

to destroy this type of lesion

liver cancer

 

Therapeutic recommendations

Benzathine Penicillin G (1 IM injection of 2.4 MUI systemically)

Erythromycin (2 g per bone, in 4 daily intakes) or Azithromycin (1 g per bone, single intake) while waiting for the results of the check-up, to treat an associated Chlamydia trachomatis urethritis, soft canker, Nicolas-Favre disease, overinfection streptococcal associated

Valaciclovir (500 mg, 2x/d, for 10 days) in case of high suspicion of Herpes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Urtrians

Definition

because of their contagiousness and the accompanying complications,

especially infertility

weeks for CT

 

classification

We have three groups of uretrites:

Trichomonas vaginalis



 

 

 

 

Clinical diagnosis

painful and out of urination.

Plenty of flow, yellow, thick, staining the washing line

de NG

Translucent, low-intensity, low-painful flow

evocative CT or Mycoplasma

isolated morning flow, glued meat, urination burns,

canal or dysury pruritus

Uretral rubs: is positive in 75% of NG and 25% of CTs

Examination of the centrifugation of the first urinary jet: which allow to define biological urethritis by the existence of 5 leukocytes/field, is positive in 95% of NG and 75% of CT

 

Treatment

 

 

Urtrians

Cervicites

 

Neisseria gonorrhoeae

Penicillin, Spectinomycin,

Cephalosporin, Thiamphhenecol

Chlamydia trachomatis

Tetracyclines, Erythromycin

 

Urtrians

Mycoplasma hominis

Ureaplasma urealyticum

 

Tetracyclines

Mycoplasmaium genital

Azithromycin: J1: 500 mg, J2-J5: 250 mg/d

 

Uncomplicated infection

 

Chlamydia trachomatis:

 

Azithromycin (1 g, per bone,

single dose) or Doxycycline

(per bone, 100 mg 2x/d, during

7 days)

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