genital ulcers and urethritis

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introducedon :

  • Are all bacterial infections, viral, parasitic or mycotic sexually transmitted

bacteria : Syphilis, chancre mou, Donovanose, Nicolas-Favre disease

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

yeasts : genital candidiasis

  • Microorganisms are responsible cosmopolitans
  • more prevalent in tropical countries and Africa.
  • In these areas, STIs are characterized by a higher incidence of complications

ulcers genital :

Fromfinish :

  • Defect, mucocutaneous, single or multiple, infectious
  • Eliminate :

➢ ulceration of caustic origin, traumatic (mechanical or physical) by questioning

➢ genital aphthosis who sits mostly on the scrotum and makes a burrowing ulceration, with clear limits, recurrent painful and, associated with episodes of oral aphthous

➢ ulceration primary / secondary neoplastic

Syphilis primary :

  • Chancre syphilitic d’inoculation : Treponema pallidum, exulcération (superficial ulceration) or erosion 5-15 mm, unique, clean background, rosé, indurated or card to palpation, painless +++, 3-6 weeks

genital ulcers and urethritis 1Seat : usually the genitals :

  • In l’man : sillon balano-préputial, more rarely on the glans or the sheath of the penis
  • In the women : at the outer portion of the vulva, l’ulceration can also occur vaginally or extra-vaginally : buccal, oropharyngé ou anorectal

lymphadenopathy : it is non-inflammatory (painless, non-ulcerated), he s’actually acts d’a package of’lymphadenopathies in which there is a large lymph node, usually unilateral the same side as the chancre, she n’never progresses to fistulization

Evolution  :  primary syphilis evolves spontaneously to regression without sequelae in a few weeks, scar regular and smooth

Diagnostic paraclinique :

  • setting in evidence of Treponema pale : by direct examination in dark field microscope : scraping the serosa at the bottom of the chancre,  pale treponemes are observed as spiral bacteria, brilliant and mobile
  • serology : there are 2 types :

serology specific (treponemal serology) : mainly used TPHA

serology not specific (réagénique serology) : c’is the VDRL

✓ In practice, always ask a TPHA and VDRL

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

Treatment :

  • Benzathine Benzyl Penicillin (Extencilline®) : IM injection of 2,4 million’single dose units, sometimes repeated after 1 week

✓ In case of’allergy to Penicillin : Doxycycline treatment will 100 mg 2x / d for 15 days

Surveillance after treatment : it is quantitatively VDRL to 3 month, 6 month, 1 year 2 years. The antibody levels should gradually decrease and negate after a year

Herpes genital :

  • viral disease due to’Herpes simplex, high frequency, significant risk during pregnancy (neonatal herpes)
  • Diagnostic clinique :

First-infection herpes : young adult, women and men are affected, incubation ranges from 2 at 60 days with an average of 6 days

  • genital ulcers and urethritis 2In the women :

Vulvite acute erosive : a systemic inflammatory and edematous background develop multiple vesicles, which will break giving way to erosion

Seat  :  big lips,  inside the labia minora

signs   functional :   intense,   pain, burns and gene urination

Adénopathies :      inguinales,       bilateral, complete the picture

Evolution :  is towards the disappearance of lesions 3 at 4 weeks

  • In l’man : the clinical picture is that of’an acute vesicular then erosive balanitis, less painful and less sensitive than women. Scarring is more quickly achieved

Herpes genital recurrent : after primary infection, the virus migrates to’to the corresponding node, there remains latent but capable of re

  • Postman triggering : he can s’act d’intercourse, menstruation, d’stress…
  • Prodromes : he can s’act d’a burning sensation, burning sensation or itching
  • Then appears a rash made of’an erythema quickly covered with several vesicles grouped in bouquets. These vesicles will rupture, giving way to erosions that’dry up and disappear without leaving scars
  • Diagnostic paraclinique : necessary in atypical forms or complicated, pregnant women, the newborn and the’immunodéprimé. We can highlight the’herpes simplex virus after cell culture (c’is the reference method currently), PCR (HSV1, HSV2), cytodiagnostic (highlights of ballonisée cell, confirms the diagnosis of’HSV group virus infection)
  • Treatment :

Treatment symptomatic : prevent infection, dry lesions, you never give alcohol products on the mucous membranes and erosions, never ointment because it macerate, of ever dermocorticoïde

  • Through way General : analgesics can be used in case of pain
  • Locally : antiseptics may be used in aqueous solution

Treatment antiviral : Acyclovir (tablets 200 mg, 1 compressed 5 x/j, pendant 10 days), new antiviral (Valcyclovir, Fanacyclovir)

Chancre mou :

  • tropical contamination, endemic in black Africa, Latin America
  • C’is a sexually transmitted genital ulcer due to bacillus Ducrey, Gram bacilli (-), It is highly contagious and self-inoculable
  • It is more common in’man than woman
  • Diagnostic clinique : l’incubation is short (3-7 days), then occurs canker (deep ulceration

> 1 cm, Dirty background, hemorrhagic, non-indurated, irregular edges, shredded)

Palpation protected : found a soft base and highlights the painful nature of this ulceration, in multiple 50% cases

Adénopathie : is unique, unilateral, bulky and inflammatory (rouge, hot and painful)

Evolution : it evolves into the fistula in a single orifice

  • Diagnostic paraclinique : although the diagnosis of chancroid or clinic, Haemophilus ducreyi can be highlighted : Direct examination after staining with toluidine blue, culture, PCR
  • Treatment : we can use :

erythromycin : 2 g per day, per the, pendant 10 days

Ciprofloxacin : 500 mg, 2x/j, pendant 3 days

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genital ulcers and urethritis 3 genital ulcers and urethritis 4

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Other IS :

  • Vegetation venereal : these are lesions due to HPV some of which are oncogenic d’where the need to destroy this type of lesion
  • IS without reached genital : Hepatitis B, C that put the patient the risk of cirrhosis which is the bed of liver cancer
  • PAGE

recommendations therapeutic :

  • Any genital ulcer should be considered a priori as syphilis and treated as follows :

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

➢ + erythromycin (2 g per os, in 4 daily catch) Azithromycin or (1 g per os, single dose) pending the results of the assessment, for treating urethritis Chlamydia trachomatis associated, chancre mou, Nicolas-Favre disease, streptococcal superinfection associated

➢ ± Valaciclovir (500 mg, 2x/j, pendant 10 days) in case of strong suspicion of Herpes

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Therétrites :

Fromfinish :

  • These inflammations, infectious and sexual origin that require prompt attention because of their contagiousness and adnexal complications that accompany the, in particular sterility
  • They are characterized by a urethral discharge, several pathogens are involved in urethritis ; however, Neisseria gonorrhoeae (OF) in the Third World and Chlamydia trachomatis (CT) and M. genitalium in developed countries share most cases.
  • Their association is proven in nearly 10% cases, incubation is 2-5 NG days and 1-5 weeks for CT

classifiedion :

On a 3 groups of’urethritis :

  • urethritis gonococciques : l’responsible agent is the Neisseria Gonorrhoeae
  • urethritis non-gonococciques   :   Chlamydia   trachomatis   (50%   +++,   sterility),   mycoplasmas, Trichomonas vaginalis
  • urethritis mixed : gonococciques + non-gonococciques

Diagnostic clinique :

  • genital ulcers and urethritis 7Obviously when there is a spontaneous discharge from the meatus, very painful and outside of urination.

➢ abundant Flow, yellow, thick, that stains -> evocative NG

➢ translucent Flow, Low intensity, bit painful -> evocative CT or Mycoplasma

  • The diagnosis is more difficult when the symptomatology is poor to such isolated morning flow, meatus glued, of burning on urination, ductal pruritus or dysuria
  • In these conditions, Both exams are important for efficient :

Smear urethral : is positive 75% December NG et 25% TC

Exam of base from centrifugation of premier jet urinary : that define organic urethritis by the existence of 5 cells / field, is positive 95% December NG et 75% TC

  • Before any urethritis, it is necessary to look for complications or disease associations : epididymitis, orchite, orc-Epididymite, prostitis, conjunctivitis, cutaneous signs- articular, female genital damage

Traitement :

urethritis
Cervicites
Neisseria gonorrhoeae Penicillin, Spectinomycine, cephalosporin, Thiamphénicol
Chlamydia trachomatis tetracyclines, erythromycin
urethritis Immunofluorescence Ureaplasma urealyticum tetracyclines
Mycoplasma genitalium azithromycin : J1 : 500 mg, J2-J5 : 250 mg / j
  • processing 2 same time partners
  • recommendations therapeutic :

Infection  not complicated Chlamydia trachomatis :

azithromycin (1 g, per the, single dose) or Doxycycline (per the, 100 mg 2x / j, pendant 7 days)

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