The primary period of syphilis. Primary syphiloma: Medical blog of an emergency physician. Chancre

Externally, syphilis manifests itself as follows: skin symptoms, like chancre, ulcers, small rashes, white spots. The influence of Treponema pallidum also extends to internal organs, which leads to a late visit to the doctor or complete absence treatment to dire consequences. If suspicious rashes occur, you must undergo an examination.

What chancre looks like with syphilis

Syphilitic chancre looks like a red spot, which over time begins to transform into erosion. It can be single or multiple. Erosions form not only on the skin, but also on the mucous membranes. An ulcerative process occurs in them after exposure to Treponema pallidum, the causative agent of syphilis. Often the damage also affects muscle tissue.

Hard chancres do not cause any particular inconvenience to the patient: they are not observed painful sensations There is no itching in the area of ​​the defect. Sometimes patients do not notice such formations at all. When pressed, the syphiloma begins to release liquid that has a transparent yellowish tint. It contains a large number of Treponem.

Chancre with syphilis develops in patients at the first stage of this venereal disease.

There is no incubation period skin manifestations and often goes unnoticed. The initial stage of syphilis rarely causes symptoms. Laboratory blood tests do not always detect infection. If a positive result is obtained using nonspecific tests, confirmation of the diagnosis is required using more expensive treponemal methods.

Stages of chancre in men and women

Syphilis does not always manifest itself as a rash or ulcerative formations on the skin. In some cases, sexually transmitted diseases occur in a latent form, gradually destroying the tissues of internal organs and causing irreversible impairment of their functions. When a person suffering from infection becomes infected chronic pathologies and reduced immunity, the likelihood of developing chancre is extremely high.

Initially, redness appears on the skin, which does not cause discomfort to the patient. After 2-3 days, a bumpy formation forms from the spot and then turns into a papule. When peeling the epithelium from the chancre, a person may feel pain. Next, the syphiloma enlarges, a dense crust forms on its surface, under which an ulcer begins to form. After the hard layer is rejected, the patient develops chancre.

Chancre with syphilis

The chancre has a raised appearance and a rounded shape with a clear border. His top part smooth and red in color. In some cases there is gray plaque. Syphilomas have a certain morphological feature, but can differ in form:

1. Nodules. Such chancres have clear boundaries. They are able to grow into deep layers of tissue and maintain clear boundaries. The area of ​​localization of hard chancre is the penis, its foreskin.
2. Round formations resembling coins. They are located on the surface of the skin. Scrotum, labia, shaft of the penis - these areas are susceptible to the appearance of chancre.
3. Leaf-shaped sores. They are characterized by clear boundaries and are localized on the head of the penis.

The formation of hard chancre begins after contact with the skin or mucous membranes of the causative agent of syphilis.

Treponema pallidum can occur not only through unprotected sexual intercourse, but also through kissing or using someone else's thing.

In rare cases, infection occurs when unsterile instruments are used in medical clinics and beauty salons. Treponema pallidum can enter the organ during blood transfusions and surgical procedures.

Dimensions

Syphilomas can have different sizes:

• small, sometimes called “dwarf” (less than 1 cm in diameter);
• medium - from 2 to 5 cm;
• large - from 5 cm or more.

Chancroid

The appearance of chancre is associated with the penetration of pathogenic pathogens into the body - streptobacilli. The formation itself does not contain spirochetes. Chancroid differs from a syphilitic ulcer by its soft edges and the absence of a dense base. It can hurt, peel, merge with other rashes and form a large inflammatory focus.

Active spread of infection across circulatory system contributes to the development of intoxication symptoms in the patient: vomiting, headaches, dizziness, muscle weakness. During the inflammatory process, body hyperthermia occurs.

Chancroid is transmitted only through sexual intercourse. As it heals, scar tissue appears in its place. It arises due to severe inflammation superficial lymph nodes and the development of bubonic ulcers. Syphilomas caused by Treponema pallidum do not leave marks on the skin after healing.

Without treatment, ulcers caused by streptobacilli last for 3-4 weeks. Complications manifest themselves in the form of phimosis, paraphimosis. IN severe cases the genitals undergo necrotic processes, and gangrene of the penis develops.

With timely examination and treatment, chancroids disappear within a week. The patient is prescribed a set of drugs for internal and external use. Upon completion of therapy, the patient should be observed by a venereologist for another 6 months.

Condoms help prevent infection with streptobacilli. When having sexual intercourse with an infected partner without barrier protection, sulfonamides must be taken in the first hours after contact.

Localization of ulcers

Primary chancre in 95% of patients is localized in the genital area (pubis, testicle, upper inner part hips, abdominal area).

This arrangement is due to the fact that most cases of infection occur through sexual contact. Ulcers can also form near anus. They look like gathers, folds and cracks. Patients feel pain during defecation. Thick, colorless mucus may be discharged.

Often in representatives of the stronger sex, chancre appears on the fingers and has the appearance of a panaritium. Syphilitic formation can be distinguished by tissue compaction, swelling of the finger and an increase in its size.

Hard chancre on the genitals

In male patients, ulcers occur predominantly on the head and body of the penis, in female patients - in the area of ​​the posterior commissure of the labia majora and uterine cervix.

On the penis and glans

An ulcerative formation can appear in men on the frenulum of the penis. It has oval shape and is capable of bleeding during erections. If a chancre develops in the urethral canal, it becomes painful and hardened. Despite the frightening photos of syphilitic chancre, some patients simply do not notice them or mistake them for ordinary inflammation of the skin. An ulcer on the head of the penis may look like a small erosion, have a gray coating and often cannot be felt at all.

On the labia, photo

A woman infected with Treponema pallidum may not notice that defects have appeared on the labia. Ulcers with syphilis develop extremely rarely on the vaginal mucosa. Much more often they occur on the cervix and cervical canal. They should be differentiated from ordinary erosions. With syphilitic infection, scleradenitis affects not the external lymph nodes, but the internal ones, located in the pelvis. They are not palpable, but are clearly visible during computed tomography.

Hard chancre on the lip and mouth

Syphilitic ulcers can occur in patients and in the mouth. When located on the lips and mucous membranes oral cavity they are similar to erosions that develop with candidiasis. Chancres can be distinguished from a fungal infection by reddish and dense edges and diffuse perifocal inflammation. When they form in the corner of the mouth or in the area of ​​the red border of the lips, they become covered with yellow crusts. In this case, small cracks appear on the surface of the skin.

If pale treponema gets into the mouth, the tongue is affected. The development of chancre begins with a dense papule (tubercle) with a smooth surface. Later it ulcerates and erosion appears. Much less often, chancre occurs near the cracks of the tongue and takes on a star-shaped or slit-like shape.

The area of ​​the lower lip and tip of the tongue is most often affected by Treponema pallidum. Chancres rarely form on the gums, hard and soft palate, pharynx and tonsils. They have a clearly limited healthy skin shape, sealed edge and bottom. Syphilitic infection is sometimes confused with acute tonsillitis. When the oropharynx is affected by treponema, the patient experiences asymmetry of the tonsils, an unpleasant feeling and pain when swallowing, and a sensation of a lump in the throat. When severe indurated tissue edema occurs, the patient may complain of breathing difficulties that occur when walking and physical activity.

Syphilitic manifestations in the area of ​​the conjunctiva, eyelid and eyelash area are observed infrequently. They usually develop in residents of Arab countries, where it is customary to contact the tongue with these areas during sexual caresses.

Healing and treatment

Uncomplicated chancre heals in 1-2 months, often before it develops secondary syphilis. At this stage of a sexually transmitted disease, their appearance can be paroxysmal: ulcers on the skin and mucous membranes persist for about 45 days, and then disappear on their own, later appearing again.

The main task of doctors is complete cure infections, preventing complications and spread of syphilis.

During diagnosis, it is necessary to differentiate a sexually transmitted infection, manifested by the formation of ulcers and other rashes, from acute tonsillitis, herpes, fungal disease, tuberculosis, traumatic erosions. If syphilis is suspected, the doctor issues a referral for a blood test using nonspecific tests (Wassermann reaction, PRP). If a positive result is obtained, additional specific treponemal diagnostics are carried out, which helps to identify antibodies to microorganisms.

The causative agents of the disease are highly sensitive to antibacterial medicines from the group of penicillins, tetracyclines and macrolides. Patients are often prescribed doxycycline, ceftriaxone, and azithromycin. During therapy with these drugs, the patient must regularly donate blood for control tests. Testing is necessary to assess the effectiveness of prescribed medications.

Therapy is carried out for all persons who have had sexual relations with the patient without using condoms. A man and his partner should not have contact during the treatment period if the location of the chancre is genital. When syphilitic ulcers form in the mouth and on the skin of the fingers, it is necessary to use individual cutlery, dishes, toothbrushes, pastes, towels, and linen.

Therapy for chancre begins with the use of oral antibacterial drugs. Along with medications, agents for external use with antiseptic and anti-inflammatory effects are also prescribed.

Treatment regimen

Treatment of chancre includes the use of the following medications:

1. Extensillin. This is the main medicine used to treat sexually transmitted diseases. It is intended for intramuscular injections and entered twice. Dosage 2.4 million units. mixed with novocaine 0.5% (calculation 100 thousand units per ml). If seronegative syphilis It has primary form, the medicine is administered once. Injections are placed into the gluteal muscle.
2. Bicillin. It is administered to the patient in a dosage of 3 million units. twice: once every 5 days.
3. Erythromycin. It is prescribed at a dosage of 0.5 mg four times a day. The tablets are taken on an empty stomach half an hour before meals, if it is impossible to take the drug on an empty stomach - 1.5 hours after meals.
4. To disinfect syphilitic ulcers, dimexide and benzylpenicillin are used in the form of baths and lotions. Such methods help active substances drugs penetrate deep into damaged tissues. Patients may be prescribed applications using ointments based on mercury or heparin. To speed up the healing of chancre with the presence of discharge, products containing erythromycin are used. Synthomycin and mercury-bismuth ointments are highly effective.
5. It is recommended to rinse the mouth if there are syphilitic ulcers on the mucous membranes with a furacillin solution mixed with gramicidin or boric acid. The proportions for diluting the components will be indicated by a venereologist.
6. When fungal infections occur during antibacterial therapy, the patient is prescribed antiprotozoal drugs (metronidazole, tinidazole).
7. After treatment with erythromycin and bicillin is completed, the patient is prescribed probiotic agents that help restore the microflora digestive tract(Linex, Bifiform).
8. To maintain normal immune system function and improve general condition the doctor prescribes a course with multivitamin complex(vitrum, alphabet, duovit).

All drugs are prescribed to patients individually. The doctor takes into account the presence of co-infections, chronic diseases, and the body’s sensitivity to antibacterial agents. If the patient is prone to allergic reactions, antihistamines are prescribed.

Whenever side effects from taking antibiotics, the patient should contact his doctor, who will select more appropriate dosages or replace the drug with a suitable one.

Complications of syphilitic chancroid

When chancre occurs, a number of dangers arise associated with the penetration of others into it. pathogenic organisms. As a result, the ulcer not only begins to itch, but also causes painful sensations due to development inflammatory process and accumulation of purulent fluid.

There are several reasons that provoke infection to penetrate the chancre:

• accidental injury;
• lack of hygiene measures;
• tuberculosis.

The presence of a syphilitic ulcer in women can lead to the development of infectious vaginitis, inflammatory bartholinitis, and endocervicitis of the uterine cervix. In men, complications of chancre are balanitis, balanoposthitis, phimosis foreskin, necrotic processes glans penis.

The consequences of the presence of pale treponema and chancre in the body for a long period of time can be major changes bone tissue. Such disorders lead to the loss of the patient’s ability to live normal life. At untimely treatment or its absence, the development of neurosyphilis is possible, in which the infection affects the central nervous system, causing meningitis, paralysis, meningomyelitis. Without treatment, death occurs.

Hard chancre appears in the first or second stage of syphilis and often goes unnoticed by the patient himself.

The danger of the presence of such ulcerative formations on the skin and mucous membranes is associated not only with a high risk of contracting other infections, but also with a high probability of transmitting Treponema pallidum to healthy people through sexual and household contacts.

Timely diagnosis of sexually transmitted diseases allows as soon as possible cure the patient and prevent the spread of pathogenic microorganisms.

Chancre is the primary stage of syphilis. Syphilis belongs to a number of infectious diseases and has 3 stages. Its causative agent is Treponema pallidum. Chancroid is also known as primary syphiloma, and it occurs at the site through which the pathogen entered the body.

• What does chancre look like?
• Atypical form of the disease
• Basic aspects of therapy

How chancroid develops

Hard chancre, or primary syphilis, forms 3-4 weeks after penetration of Treponema pallidum. The causes of infection are usually the same - sexual contact with an infected person, use of common hygiene products. Chancroid is the most benign form of syphilitic infection because:

• its localization is limited (most often found on the penis or in the oral cavity);
• the active form is characterized by sparseness and monomorphism;
• the formation does not affect internal organs;
• effective and relatively easy to treat.

Most often, signs of chancroid appear in the genital area. However, in 10% of cases, hard chancre can appear on the mucous membrane of the mouth, on the tongue, on the lip, on the chest in women, on the tonsils.

What does chancre look like?

Hard chancre begins with a red spot with smooth edges (what primary syphilis looks like can be seen in photos 1, 2). The spot diameter is no more than 15 mm. The spot has a regular round or oval shape. It does not cause any discomfort to the patient, does not itch or burn. However, in case of joining bacterial infection complications may arise. The latter is evidenced by uneven edges of the formation and pain when touched.

Photo 1 and photo 2. Localization of chancre in the genital area.

After a few days, the spot becomes a flat papule, and a little later it turns into a state of erosion or ulcer (less often) with a compacted base. The bottom of the ulcer is level with the skin around it or rises slightly above it.

In the vast majority of cases, chancre takes the form of erosion. Ulcer formation occurs due to:

• the patient has other chronic infections;
• intoxication of the body;
• therapy using topical irritants;
• neglect of personal hygiene measures;
• teenage or elderly patient.

There are 3 types of chancre depending on the size of the formation:

1. Dwarf - 1-3 mm.
2. Average - 10-20 mm.
3. Giant - 40-50 mm. Typically appears on the thighs, pubic area, face and forearms.

In addition, chancre is classified according to the number of formations on the patient’s body:

1. Single type.
2. Multiple type. IN in this case chancre is formed simultaneously or sequentially in several locations through which treponema pallidum entered the body.

In addition to the solid form of chancre, there are also chancroid. It differs somewhat in morphology from solid. Hard and soft chancroid are symptoms of a syphilitic infection.

Atypical form of the disease

In rare cases, people who contract syphilis from a sick person may develop atypical chancroid. These include:

• indurative edema;
• amygdalitis;
• chancre-pansirium.

Indurative edema is localized in the area of ​​the foreskin (in men) or the labia (in women). Over time, the affected area increases in size by 2-3 times, becomes dense and cyanotic. In this case, the swelling does not cause pain.

As mentioned above, sometimes symptoms of the disease can appear on the tonsils. However, amygdalitis is different from regular form chancre. There is a sharp increase in size of the tonsil, and on one side. The body of the tonsil becomes dense and inflamed. This phenomenon can be mistakenly taken for one of the symptoms of a sore throat.

The symptoms of chancre-felon are almost identical to those of ordinary felon. This complicates the diagnosis of chancre. Chancre felon appears on the phalanges of the fingers. The lesion is characterized by bluish-red swelling with further formation of an ulcer with the formation of pus. With this type of primary syphilis, the infected person feels throbbing or shooting pain in the affected area.

Basic aspects of therapy

If a person is diagnosed with chancroid, he is prescribed treatment in a hospital or in outpatient setting. Since the main and most common method of transmission of infection is sexual, any sexual contact with the patient should be stopped during treatment. In addition, all previous and current sexual partners of the patient should undergo examination and, if necessary, therapy, even if they do not have any symptoms.

Primary syphilis is treated with antibiotics of the penicillin group, since Treponema pallidum is sensitive to them. Often injections of benzylpenicillin and ampicillin are performed.

Chancre is an early stage of syphilitic infection.

By starting treatment at this stage, the infected person will recover easily and quickly, preventing the infection from progressing and eliminating the possibility of complications.

As soon as formations similar in morphology to chancre are found on the body in characteristic locations, a person should immediately seek advice from a dermatovenerologist.

If a person has had sexual intercourse with a suspected carrier of the causative agent of syphilis, he should also contact a specialist for treatment. preventive measures to avoid infection.

One of the specific manifestations of a venereal disease caused by spirochetes Treponema pallidum, is syphilitic chancre(translated from Old French as “ulcer”). Despite the fact that this painless ulceration has typical symptoms and is not difficult to diagnose, most patients at this stage of the disease do not see a doctor. Meanwhile, timely medical care will prevent the spread of the syphilis pathogen throughout the body and avoid serious complications. In our review we will talk about distinctive features, the nature of the course, as well as about atypical forms of chancre.

Features and classification

Chancroid in medicine is a morphological element on the skin and mucous membranes that has an ulceration in the center. This formation is infectious in nature.

There are several classifications of pathology:

• by degree of invasion: superficial (erosive), deep (ulcerative);
• by the number of skin elements: single, multiple; standard sizes(10-20 mm); giant (up to 40-50 mm);
• depending on diameter: dwarf (less than 10 mm);
• by localization: genital - on the skin or mucous epithelium of the penis, vulva, vagina, cervix; extragenital – on the pubis, in the perineum and anal area, on mammary glands, face, mouth and throat; bipolar.

Note! More than 92% clinical cases the location of syphilis chancre in the organ area is observed reproductive system. The growing “popularity” of extragenital localization of the defect is associated with the spread of non-traditional types of sex.

In addition, given the condition of the bottom of the ulcerative element, the chancre can be hard or soft.

Hard chancre is a defect that develops at the point of entry into the body of the spirochete Tr.pallidum. Because it is the first symptom of a sexually transmitted disease, it is often called primary syphiloma. It appears 3-4 weeks after infection. Hard chancre in syphilis is distinguished by stages of development: it forms in the form of a small red spot, then becomes denser at the base, and its center is eroded.

Chancroid is a consequence of infection of the body with Streptobacillus Ducray. Like syphiloma, this defect also changes several successive stages in its development. The red, swollen spot that appears eventually turns into an ulcer with uneven, raised edges. To the touch its base has a medium density.

Other names for chancroid are venereal ulcer, third venereal disease, chancroid.

Table: Characteristics of primary syphiloma and chancroid

Due to its widespread prevalence, chancre, which develops against the background of syphilis, is of great interest to medical science. What is characterized and what clinical features has a primary skin defect due to this dangerous venereal disease?

Symptoms

The mechanisms of formation of syphiloma (chancre) at the site of introduction of the pathogen into the body are complex and insufficiently studied. It is believed that treponema easily penetrates tissue at the site of the smallest skin defects, but there are often cases when spirochetes “leak” through an intact integumentary membrane.

In the development of infection, an important role is played not only by the number and virulence of pathogens that enter the body, but also by the state of the human immune system. According to Russian syphilidologist M.V. Milich, with a single unprotected sexual contact of the patient and healthy person infection occurs in 43-51% of cases. However, it should be taken into account that with long-term sexual relations this figure reaches almost 100%.

According to ICD 10, depending on the genetic or extragenital location, primary syphilis is divided into the following groups:

• genitals;
• anal-rectal area;
• other localizations.

IN exceptional cases There are no symptoms for primary syphilis. In this case, they speak of a “decapitated” course of the disease.

The classic variant of pathology has a number of characteristic features. It is preceded by an incubation period lasting 3-4 weeks.

Note! Currently, there is a tendency towards shortening (up to 10-14 days) and lengthening (up to 5-6 months) incubation period. The latter is usually associated with taking even moderate doses antimicrobials(penicillins, macrolides, tetracyclines).

A skin defect at the site of spirochete penetration appears immediately after the completion of the incubation period. TO typical signs chancre can be attributed to:

• regular round, ellipsoidal shape;
• slightly raised edges gradually descending to the bottom;
• smooth and clear boundaries;
• the color of weathered meat or spoiled lard;
• often a single quantity;
• the presence of erosion (ulceration) in the center;
• the release of a small amount of serous (transparent) fluid, giving the defect a shiny, even “varnished” appearance;
• sometimes - the presence of a thin whitish film on the erosion surface;
• pronounced dense infiltrate at the base;
• complete absence of pain or other subjective sensations.

1-2 weeks after the formation of the primary defect, the patient experiences specific lymphadenitis (hyperplasia of the inguinal or other lymph nodes). At the same time, you can get positive test results for a sexually transmitted infection. And after 3-6 weeks, the chancre disappears without a trace, even without the necessary treatment.

A healed skin defect is not a sign of recovery, as many patients mistakenly believe. The disappearance of chancre indicates the generalization of the infectious process: 9-10 weeks after infection, secondary syphilis manifests itself, manifested by a profuse skin rash.

Features of the course of the disease in recent years

Venereologists note that today syphilis occurs differently than it did 20-30 years ago. The number of patients with multiple chancre has increased significantly. Deep ulcerative defects that heal with the formation of a scar are more common. In addition, sometimes primary syphiloma is characterized by the absence of pronounced density at the base of the defect.

Variants of the course of the disease that do not follow the classical scenario have also become common. What's happened atypical forms chancre: we will look at it in the section below.

Atypical forms

Felon

A distinctive feature of felon chancre is its localization in the area of ​​the phalanges of the fingers. It can be confused with nonspecific (usually streptococcal) acute purulent inflammation of the soft tissues of the hand, but with syphilis the pathology has a number of characteristic features.

The following signs of chancre felon are distinguished:

• the presence of a high-density solid infiltrate;
• lack of redness around the affected area;
• regional lymphadenitis (inflammation of the elbow lymph nodes).

This atypical variant of syphilis most often develops in health care workers who have frequent contact with contaminated material.

Amygdalite

With the development of chancre amygdalitis, patients complain of discomfort when swallowing. During a clinical examination, the doctor detects unilateral enlargement and unusual density of the tonsil. Against this background, a round, ulcer-like defect with raised edges is visualized.

If a chancre forms on an unchanged tonsil, in this case they speak of classic extragenital primary syphiloma.

Sore throat-like chancre

Another atypical variant of syphilis is called angina-like chancre. With this form of pathology, there is a unilateral increase in palatal growth lymphoid tissue(tonsils), which becomes copper-red in color and high density. Ulcerative defect however, it cannot be detected.

It is possible to differentiate pathology from tonsillitis by the following signs: absence of pain, bright hyperemia and severe symptoms intoxication (dizziness, headaches, weakness).

Indurative edema

Indurative edema develops in areas with a widespread lymphatic network - the scrotum, labia majora. There is swelling and noticeable tissue density. If you press on the affected area, a depression will not form.

Complications

As a rule, primary syphiloma does not cause any subjective sensations and disappears without a trace over time. However, in some cases it can cause the development serious illnesses. Experts highlight the following complications chancre:

• balanitis/balanoposthitis;
• phimosis;
• gangrenization;
• Phagedenism.

Balanitis – common consequence primary syphilitic lesion in men. It develops with the activation of pathogenic and opportunistic flora; its main causative agents are Trichomonas and nonspecific infection. The disease is accompanied by the development of swelling, bright hyperemia around the ulcer-like defect. Before this, the scanty serous discharge is replaced by copious purulent discharge. Such systematics can aggravate the course of syphilis and complicate its diagnosis.

With balanoposthitis, accompanied by more widespread inflammatory lesion, phimosis often develops - a narrowing of the skin cavity covering the head of the penis with the impossibility of exposing it. The pathology is characterized by enlargement, pain and redness of the penis due to swelling. If the swollen and infiltrated skin ring pinches the head, circulatory disorders and severe ischemic processes develop in it.

If you do not provide assistance to the patient, the condition worsens and gangrene (necrosis) of the penis forms.

A rare and very severe complication of chancroid is called phagedenism. It is diagnosed in people with weakened immune systems and is characterized by the addition of a specific fusospirillosis infection. In this case, a black scab consisting of necrotic tissue forms on the surface of the skin defect, which quickly spreads beyond the chancre.

Principles for diagnosing the early stages of syphilis

It is worth noting that not only venereologists have to diagnose the primary form of syphilis, but also specialists of other profiles - gynecologists, dermatologists, urologists, proctologists and dentists. Since most serological tests in the early stages of the disease are negative, the examination is based on:

• detection of characteristic clinical manifestations– classic or atypical chancre, regional lymphadenitis;
• the presence of a mention of “doubtful” unprotected sexual contact in the anamnesis;
• microbiological (microscopy, culture on nutrient media) examination of discharge from the surface of the ulcer;
• examination of punctate of an enlarged regional lymph node for Tr.pallidum;
• PCR diagnostics.

Standard serological tests such as RIBT, RIF, RPR remain negative for 3-4 weeks after the appearance of the primary skin defect. Their use if the patient has chancre is inappropriate.

How is chancre treated?

Treatment of primary syphilis is based on taking antimicrobial agents. The drugs of choice are injectable penicillins (medium and long duration of action), to which Treponema pallidum remains highly sensitive. If the use of Bicillin and BBP is impossible due to individual intolerance (allergy) in the patient, reserve medications are used (Doxycycline, Tetracycline).

Drugs are administered for primary syphilis according to one of the following schemes:

• BBP 2,400,000 units intramuscularly into each buttock (1.2 million units) once;
• Procaine-benzylpenicillin (aqueous solution) 600,000 units IM × 1 time per day – 10 days;
• Tetracycline 500 mg orally × 4 times a day – 14-15 days;
• Erythromycin 500 mg - according to the same regimen.

One of the most important principles of treating chancroid is its timeliness. WHO recommends starting specific antibiotic therapy when clinical symptoms of the disease are detected, without waiting for the results of laboratory tests.

Note! It is equally important to diagnose and treat syphilis in all sexual partners of the patient.

After completing antibiotic therapy, patients remain under D-registration with a venereologist. Even in the case of negative results from serological tests, the duration of mandatory D-registration and observation is 12 months. If the pathology was seropositive, the patient must visit a doctor within 36 months.

Among the main criteria for successful treatment are:

• complete disappearance of symptoms of pathology;
• improving the patient's well-being;
• negative results of serological tests for 1-3 years after completion of therapy.

Prevention of infection with syphilis and the formation of chancre consists of following simple rules: it is necessary to avoid unprotected sexual contacts with casual partners, always use barrier methods of protection (condoms), use antiseptics(Heksikon, Terzhinan) after “casual” sex.

Also widely used is the method of primary treatment, which is aimed at eliminating Treponema pallidum in the event of possible infection through unprotected sexual intercourse. He lets you win possible illness even before the development of its clinical manifestations and consists of a single or double injection of a penicillin antibiotic.

The appearance of chancre on the skin and mucous membranes of the genital or extragenital organs is one of the first signs of syphilis infection. If the patient notices this symptom and seeks medical care, treatment of the disease is usually not difficult. A short course of antibiotic therapy will completely remove pathogens from the body before irreversible changes occur.

Chancre is a morphological formation located in top layer epidermis or mucous membrane, having an external resemblance to an ulcer. The main cause is infection infectious disease sexually transmitted. There are two types of chancre - hard and soft. Most often, the formation is painless and indicates infection with syphilis or another sexually transmitted disease.

Show all

Chancre

A chancre is an ulcerative formation characterized by a dark red color, round shape and raised edges. Its base resembles hard cartilage in structure. Another name for it is primary syphiloma, or syphilitic chancre, since it is not a separate disease, but occurs on initial stage syphilis.

The base of the formation is bright red in color; a transparent film with a characteristic shine covers it on top. If it is located on an open area of ​​the skin, the film acquires a dirty tint. The shape of this type of chancre is regular, with smooth edges. It has a clear boundary with surrounding tissues.

Chancre

This symptom does not cause significant discomfort to the infected person. After treatment, the ulcer disappears, leaving a pigment spot, which also disappears over time. Effective therapy This disease is possible if you consult a doctor in a timely manner. Therefore, if signs of the disease are detected, it is necessary to visit a specialist.



Chancroid

The cause of chancroid is Streptobacillus Ducray. This type is also called venereal ulcer, chancroid or venereal disease III.

Initially, a small reddish swelling forms, the edges of which are raised and uneven. The base of the ulcer is characterized by an irregular shape, a bright red hue and copious discharge of pus. One of the pronounced signs of chancroid is an increase in local lymph nodes.

Chancroid

It received the name “venereal ulcer” due to the characteristic places of formation, which most often are the genitals. The appearance of chancre is accompanied by severe pain.

The causative agent of the infection is Ducrey's bacillus (haemophilus ducreyi) - a microorganism that develops in conditions of heat and humidity. Therefore, this disease is most common in Africa, Asia and South America, from where it has spread throughout the world.

The only wayinfection– sexual intercourse with a sick partner. The probability of infection in this case is 50%. Other routes of transmission have not been confirmed to date and are isolated in nature. Moreover, representatives of both sexes can become infected with equal probability. However, most often women are carriers of the infection. The best method prevention is the use of barrier contraceptives.



Localization

Experts call chancroid a syphilitic “marker”, since the primary location of the ulcer on the skin indicates the site of infection in the body. The most common method of infection is sexual intercourse; in most cases, a formation of this type is located in the area of ​​the external organs of the reproductive system.

The locations of hard and soft chancre are identical in representatives of both sexes, which is explained by the method of infection. In women, ulcerative compaction most often appears on the labia and clitoris. In men soft chancre is localized on the pubis, glans, frenulum, foreskin, inner or outer surface of the penis.



Localization

In cases of infection during non-standard sexual intercourse, the lesions are located in the head area - in the mouth, on the tongue, in the pharynx and tonsils, on the lips, mammary glands, near the anus or other parts of the body. In some situations, the placement site is the urethra in men, the vaginal walls and cervix in women.



Development of the disease

Typically, it takes several weeks from infection with the Treponema pallidum bacterium (spirochete) to the formation of a chancre as the initial sign of syphilis.

Initially, a reddish spot forms. Gradually destruction occurs epithelial tissue, erosion occurs. An ulcer appears when the spirochete reaches the subcutaneous tissue layer, submucosal layer or muscle layer.

It is round in shape and can increase in size up to 1.5 cm. The base of the ulcer is brown-red in color, with a purulent coating. The shape remains unchanged, the surrounding tissues are not affected. There is no pain or itching.

After 4–13 weeks, the chancre disappears on its own. The characteristic features of a syphilitic ulcer are its limited location and a favorable prognosis for curing the disease. It does not affect internal organs and does not penetrate deep into the body. However, its disappearance does not indicate a cure, but indicates the transition of the disease to the next phase - secondary syphilis (latent clinical form).

The nature of the development of soft chancre is standard. The incubation period for men is from 3 to 5, for women – from 7 to 11 days after the infection enters the body. The immune system cannot cope with the influence of the pathogen, so cases of re-infection are possible. This pathology external signs has similarities with hard chancroid, but differs from it in the presence of severe pain.

The development of the disease begins with redness of the infected area and the formation of a small purulent capsule. In a short time, the capsule bursts, and in its place a weeping ulcerative seal forms. This type of ulcer is characterized by irregular shape, intensive increase. The size of the formation is from 10 to 20 mm. In the internal part, blood and pus accumulate.

Spilling out, the exudate leads to the formation of new smaller ulcers on nearby tissues surrounding the primary focus of inflammation. As the infection progresses, it merges into a single focus. Ulcers form over 20-40 days, after which self-cleansing from pus and the scarring process. In the absence of timely medical intervention, the infection affects the lymph nodes, which leads to an increase in their size and increased pain.

Symptoms

The main symptom of the development of chancre at the initial stage is the appearance of an ulcer - chancroid, which is characterized by:

• softness of the base;
• the presence of pus at the bottom;
• connection of the inflammatory process;
• the appearance of bleeding;
• sharp pain (in men the syndrome is less pronounced than in women).

The first stage of syphilis is accompanied by the following symptoms:

• the appearance of a reddish spot;
• localization site - upper layers of the epidermis or mucous membranes;
• gradual destruction of the epidermis, accompanied by an erosion process.

As the disease progresses, a hard ulcer forms, characterized by the following symptoms:

• rounded shape of ulcerative formation;
• size – from 0.1 to 5 cm;
• brown-red base color;
• the presence of yellowish pus at the bottom;
• maintaining the original shape throughout the entire period of ulcer development;
• absence of itching and pain symptoms;
• when pressed, it is released from the chancre clear liquid, having a slightly yellowish tint;
• spontaneous disappearance of the ulcer after 3-12 weeks.

If medical assistance was not provided on time, hard or soft chancroid passes into a more advanced stage of the disease, which is fraught with serious consequences for life and health. One of the most common complications is damage to the lymph nodes, leading to inflammation of the tonsils (amygdalitis).

Complications

After the incubation period, the disease enters a more advanced stage - aggravated chancroid, the main symptom of which is damage to the lymph nodes:

• Lymphadenitis - the size of the nodes increases, they unite, and the skin above them turns blue. Pus forms inside, which leads to the development of sepsis if it enters the circulatory system.
• Lymphangitis - the lymph node becomes denser, the skin over it turns red and swells, which is accompanied by intense pain.

An advanced disease over time leads to other complications in any person, regardless of gender. Men often develop phimosis - the foreskin swells and pus discharges from the head of the penis. Another complication often occurs - paraphimosis - the foreskin becomes inflamed, which is accompanied by exposure of the head and leads to necrosis.

Treatment

If the first signs of the disease are detected, you should immediately seek advice from a venereologist, who will correctly diagnose based on the studies performed and prescribe complex therapy.

A scraping is taken from the periphery of the formation, and a tissue sample is analyzed for the presence of the pathogen. To clarify the diagnosis and exclude syphilis, bacteriological culture and PCR are used.

Standard therapy includes the use of antibiotics, specialized topical ointments local action and antiseptic compounds. The most commonly prescribed penicillins, which have highest efficiency against treponema pallidum (Bicillin, Ampicillin). Antibiotic therapy is complemented by agents that stimulate the functions of the immune system and normalize the intestinal microflora. Physiotherapeutic procedures are prescribed. Application of modern therapeutic techniques allows you to completely eliminate the infection at the primary stage of development.

The main goals of therapy in this situation are to eliminate the pathogen, block the spread of the disease, strengthen immune functions body, to exclude possible complications.

In this case, they get rid of primary syphilis, and chancroid is eliminated as its main symptom. Systemic medications can destroy Treponema pallidum, and local therapy can eliminate signs of the disease. When developing a treatment regimen, the specialist takes into account the characteristics of each specific situation – allergic reactions for certain medications, severity of the disease, localization of ulcers, etc.

Chancre is a symptom of primary syphilis, which is the most common manifestation of this disease. The disease has been known since the 15th century and in some periods of history caused serious epidemics in European countries. After the discovery of penicillin and the active introduction of antibiotic therapy, the prevalence of chancroid decreased significantly in all developed countries. Today, syphilis occurs in only 50 cases per 100,000 population, but 100 years ago this figure was 20–50 times higher.

Forms of chancre

There are several ways to separate chancre. IN international classification diseases of the 10th revision (ICD 10) it is proposed to distinguish it by location on the patient’s body:

• chancre of the genital organs;
• chancre of the anal area;
• chancre of other localizations.

A separate form of primary syphilis is distinguished, in which chancroid does not develop and the patient has no clinical symptoms of the disease.

There is also an older morphological classification of this pathology. It is based on the appearance of education. According to it, they distinguish:

• typical chancre;
• chancre felon; it develops on the fingertips (it is often confused with staphylococcal infection nail plastic);
• sore throat-like chancre; it occurs when the mucous membrane of the tonsil is damaged, manifested by its enlargement without the formation of ulcers or erosion.

Indurative edema often accompanies chancroid in women.

Causes of chancroid

Infection with Treponema pallidum (one of the types of gram-negative spirochetes) leads to the development of chancre. Most often it occurs during sexual intercourse, which is why syphilis is classified as a sexually transmitted disease.

The pathogen can also be transmitted through blood. In this regard, patients who require blood transfusions are at risk. Thanks to modern methods for diagnosing primary syphilis, the likelihood of infection by this method is minimal today. More high risk injection drug addicts who use one syringe are susceptible. It is also possible to transmit Treponema pallidum from mother to child during pregnancy.

In domestic conditions, infection is possible through close contact with a patient, using his linen, hygiene products, and utensils. Treponema pallidum in saliva can cause the development of the disease in the presence of hard chancre in the oral cavity (for example, when kissing).

Hard chancre can be localized on the fingertips (due to hand touching the elements of primary syphilis).

Medical workers are also at risk, especially if antiseptic rules are insufficiently observed.

Treponema pallidum easily passes through mucous membranes (even intact ones). The frequency of infections during sexual intercourse is due not only to the localization of chancre, but also to the high probability of injury skin. Reacts immediately to pathogen penetration the immune system human, the purpose of which is to localize Treponema pallidum in the area of ​​primary infection. Cellular mechanisms are activated, which provokes the development of local specific inflammation. Treponema pallidum has developed defense mechanisms that do not allow it to be destroyed by phagocytes. This is a factor contributing to the chronicity of the disease.

Signs of chancroid

A chancre is a dense formation on the skin with erosion on the surface. Its edge is usually smooth, and the surface is covered with secretions that give a shiny hue. Elements appear on the skin or mucous membranes of the genitals, groin area, anus and inner surface hips Due to trauma during infection, several hard chancre may develop at once. All formations remain painless. Enlarged local lymph nodes can often be palpated around them.

Typically, chancre protrudes several millimeters above the surface of the skin. The development of the tumor is quite slow. In the absence of adequate treatment, it can remain for about 1–2 months in a practically unchanged state, after which it is destroyed.

Symptoms of chancroid can go unnoticed for a long time. The patient's general well-being remains virtually unchanged. Quite often, hard chancroid in women is diagnosed accidentally during an external examination during a visit to the doctor regarding another pathology. Mild discomfort in the area of ​​development of chancre is possible, which is caused by local inflammation of the lymphatic vessels and nodes (lymphadenitis and lymphangiitis).

Chancroid felon is characterized by the appearance of a club-like deformity distal phalanx fingers, their soreness and severe swelling. Enlarged regional lymph nodes in the elbow area often help identify this form of chancre.

A chancre is a dense formation on the skin with erosion on the surface.

When localizing primary lesion in the oral cavity or oropharynx, symptoms of chancroid are often observed, which are similar to acute tonsillitis:

• asymmetric enlargement of the tonsil;
• painful sensations when swallowing;
• feeling of a lump in the throat.

If this is accompanied by pronounced indurative swelling of the tissues, then the patient will also complain of difficulty breathing, especially during physical exertion.

Diagnostics

Diagnosis of chancroid begins with a history. Based on the results of examining formations on the skin or mucous membranes, a preliminary diagnosis of primary syphilis can be made. To confirm it, a number of specific laboratory tests are carried out.

With chancroid there are usually no deviations from the norm in general and biochemical analysis blood (except in cases of secondary bacterial infection). Instrumental studies ( ultrasound diagnostics, computed tomography or magnetic resonance imaging) can only show signs of regional inflammation of the lymph nodes.

Specific laboratory tests for diagnosing chancroid are divided into treponemal and non-treponemal. The latter are most often used for primary diagnosis diseases. These include:

• The Wasserman reaction is the historical first test for syphilis, which is now practically not used (it often gave a positive result in other pathologies).
• RPR test (Rapid Plasma Reagins) – anticardiolipin test. The test is used to screen for pathology in the general population in most Western countries.
• VDRL test (Venereal Disease Research Laboratory) - used to diagnose chancroid in Asian countries. Quite often gives false positive results.

Treponemal laboratory tests are used to make a definitive diagnosis of chancroid. They are highly specific, but they are also more expensive. These include:

• FTA-ABS test (immunofluorescence assay) - uses specific antibodies to Treponema pallidum, which practically eliminates the possibility false positive result. This study is the gold standard for diagnosing primary syphilis in many European and American clinics. It is based on its results that the effectiveness of therapy is monitored.
• Immunoblotting is based on the detection of specific antibodies in the blood using electrophoresis and an enzyme-linked immunosorbent reaction.
• Polymerase chain reaction (PCR) – it requires a sample of the affected tissue or blood. Used in complex diagnostic cases. The result of the test is the form of the gene type of the causative agent of the disease.

Treatment

Infection with Treponema pallidum (one of the types of gram-negative spirochetes) leads to the development of chancre.

Treatment of chancre necessarily includes antibacterial agents. Just like 50 years ago, penicillin and its synthetic analogues. The standard treatment regimen includes a twenty-day course of intramuscular administration of benzylpenicillin or its longer-acting analogue, bicillin-5.

If there are contraindications to prescribing drugs penicillin series(for example, in case of hypersensitivity), as well as resistance to them, treatment of chancroid is carried out with antibiotics of other groups - macrolides, cephalosporins or tetracyclines.

The effectiveness of the treatment can be monitored by the dynamics of regression clinical symptoms diseases. With effective antibiotic therapy, chancre in men and women quickly heals, and only a small scar remains in its place. Cure from syphilis must be confirmed by specific laboratory research(FTA-ABS test) at the end of the course of therapy.

Possible complications

The following possible complications of chancroid are identified:

• Development of secondary and tertiary syphilis (in the absence of adequate treatment).
• Attachment of a secondary bacterial or fungal infection; in such cases, the symptoms of complications come to the fore.
• Development of phagedenism; This complication of chancroid is manifested by the development of gangrene.
• Development of paraphimosis; it occurs when the head of the penis is pinched by the skin of the foreskin and is accompanied by severe pain and difficulty urinating.
• Development of phimosis; chancre in men can lead to cicatricial narrowing of the foreskin.

Features of chancre in pregnant women

The clinical picture of chancroid in pregnant women is almost identical to that in other groups of patients. However, in this case, syphilis is dangerous due to its complications for the fetus - the development congenital form disease that has more severe course than in adults.

Treponema pallidum can pass through the placental barrier, which is the cause of congenital syphilis. It is characterized by damage to most systems and organs, tissue degeneration and developmental defects. In the absence of adequate therapy, pregnancy may be terminated prematurely.

Prevention measures

There is no specific prevention in the form of a vaccine against primary chancre. Most effective method avoid infection - no casual sex and use barrier methods contraception. It has been proven that using a condom during traditional sexual intercourse, while maintaining its integrity, greatly reduces the risk of contracting syphilis.

People at risk (especially medical workers who come into contact with patients) must practice good hygiene. When diagnosing primary chancre in a patient, a circle of people with whom he had sexual relations is established for prophylactic antibiotic therapy.

In order to detect the disease, all hospitals screen incoming patients. A test for syphilis is included in the mandatory list of tests during pregnancy in most countries of the world.

Video from YouTube on the topic of the article: