genital ulcers and urethritis


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 the 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 & rsquo; ulceration may also sit in the vagina or extra-vaginal : buccal, oropharyngé ou anorectal

lymphadenopathy : it is non-inflammatory (painless, non-ulcerated), it s & rsquo; is made of & rsquo; d & rsquo a package; lymphadenopathy in which we find a large ganglion, usually unilateral the same side as the chancre, it n & rsquo; never evolves into fistulisation

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 & rsquo; 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 & rsquo; single dose units, sometimes repeated after 1 week

✓ If & rsquo; 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 the man : the clinical picture is that of & rsquo; vesicular acute balanitis and erosive, less painful and less sensitive than women. Scarring is more quickly achieved

Herpes genital recurrent : after primary infection, the virus migrates up & rsquo; the corresponding node, there remains latent but capable of re

  • Postman triggering : s can & rsquo; d & rsquo act; sexual intercourse, menstruation, d & rsquo; a stress ...
  • Prodromes : s can & rsquo; d & rsquo act; a burning sensation, burning sensation or itching
  • Then appears a rash made d & rsquo; a rash quickly covered several vesicles grouped in clusters. These blisters will break giving way to erosion that s & rsquo; dry up and disappear without scarring
  • Diagnostic paraclinique : necessary in atypical forms or complicated, pregnant women, newborn and rsquo &; immunocompromised. We can highlight the & rsquo; herpes simplex virus after culture on cell medium (c & rsquo; is currently the reference method), PCR (HSV1, HSV2), cytodiagnostic (highlights of ballonisée cell, confirms the diagnosis of & rsquo; an infection by a group of viruses HSV)
  • 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 & rsquo; is a sexually transmitted genital ulcer caused by the bacillus of Ducrey, Gram bacilli (-), It is highly contagious and self-inoculable
  • It is more common in the & rsquo; men than in women
  • Diagnostic clinique : l & rsquo; short incubation (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

genital ulcers and urethritis 5

Other IS :

  • Vegetation venereal : They are lesions due to HPV oncogene some of which are d & rsquo; hence the need to destroy this type of injury
  • 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

genital ulcers and urethritis 6

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 d & rsquo groups urethritis :

  • urethritis gonococciques : l & rsquo; is the causative agent 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 :

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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