Chancroid: photos, types and symptoms of the disease. The primary period of syphilis. Primary syphiloma

Hard chancre (primary syphiloma, hard ulcer) is a morphological element on the skin or mucous membranes, which is formed at the stage of primary syphilis - a chronic infectious disease, predominantly sexually transmitted, the causative agent of which is treponema pallidum(Treponema pallidum). The localization of hard chancre depends on the place of introduction of the pathogen into the body. Education can be either single or multiple.

A chancre is a dense, painless ulceration that appears between 10 days and 3 months from the time of infection. When taking antibacterial drugs, the incubation period of syphilis may be prolonged. With simultaneous infection from several sources, the incubation period is reduced.

Causes

Infection occurs through contact and household (most often sexual) means. In addition, transmission of the infectious agent can occur during surgery, childbirth, blood transfusions, and breastfeeding. Infection with Treponema pallidum can occur through dental or other medical instruments, bedding, personal hygiene products of a sick person, and dishes. A possible route of transmission of syphilis from mother to fetus is through the placenta (transplacental route of transmission).

Child with congenital syphilis dies shortly after birth or has severe lesions internal organs.

Types of chancre

Chancre is classified according to several criteria.

Depending on the size of the ulceration:

• dwarf chancre (up to 10 mm);
• medium-sized chancre (10–25 mm);
• gigantic (up to 55 mm).

The most contagious is dwarf chancroid. Giant hard chancres are localized mainly on the abdomen, thighs, pubis, forearms, etc. (in places where subcutaneous tissue is abundant).

Based on the number of ulcerations, there are:

• single;
• multiple chancres.

Multiple hard chancres are rare; they occur when repeated infections during the first few weeks and/or with the simultaneous introduction of an infectious agent in several places.

Depending on location:

• genital chancre (on the genitals);
• extragenital (in the mouth, on the face, mammary glands, legs, near the anus, on the scalp, etc.);
• bipolar (located simultaneously on the genitals and other parts of the body).

Considering the fact that infection in most cases occurs during sexual intercourse, the localization of chancre is predominantly genital.

According to the form of education there are:

• typical;
• atypical (atypical) chancroid.

Chancres of atypical shape, in turn, are divided into:

• chancre amygdalitis (anginal) – localized in the tonsil area, most often the lesion is unilateral. The mucous membrane above the tonsil changes color, the tonsil increases in size, is compacted and painless on palpation. Voice changes may be observed (hoarseness, hoarseness);
• chancre felon - formed on the fingers (most often on the terminal phalanges of the index and thumb), characterized severe pain shooting character. Swelling occurs at the site of the lesion. The ulceration has uneven edges with suppuration inside the morphological element from which it comes bad smell. The pathology is typical for surgeons and gynecologists who perform invasive interventions, as well as for other medical workers in the event of injury from contaminated medical instruments;
• indurative edema - localized mainly on the genitals. Requires differential diagnosis with pathological conditions with similar clinical manifestations. It differs from edema of other origins in that when pressed it does not leave dents.

Atypical hard chancre is characteristic of cases of combination of syphilis with other infectious diseases.

In addition, among hard chancres there are:

• slit-shaped - localized in the interdigital spaces, corners of the mouth and folds of the skin;
• diphtheria - ulceration covered with a necrotic gray crust;
• herpetiformis - clinical manifestations are similar to genital herpes;
• Folman's balanitis - characterized by multiple small erosions and a clearly defined edge.

Symptoms of chancroid

Hard chancre occurs at the site of introduction of the pathogen at the end of the incubation period of syphilis, which is often accompanied by an increase in body temperature, muscle and joint pain, and an increase in regional lymph nodes and other symptoms.

Ulceration in primary syphilis usually takes the form of a round or oval erosion with clear boundaries and a saucer-like shape. The exudate gives the morphological element a varnished appearance. At the base of the ulceration there is a hard infiltrate; with deep damage, the infiltrate has a cartilaginous structure.

Against the background of weakened immunity and alcohol addiction, complications of chancroid such as gangrenization and phagedenism can occur.

Chancre is painless, heals even without treatment after 1.5-2 months, and ulcerative chancre scars, and erosive chancre heals without leaving any traces. The spontaneous disappearance of chancre does not mean a cure for the infection, but indicates the transition of syphilis to the secondary stage, which is more severe and dangerous. The healing time of chancre is determined by the nature of the infiltrate and its severity at the base. Giant hard chancres with a powerful infiltrate at the base can persist even at the stage secondary syphilis.

In women, hard chancre of genital localization can form on the labia majora and minora, the clitoris, in the vestibule of the vagina, in the vagina, etc. In addition, hard chancre in women is often located on the internal organs of the genitourinary tract (for example, on the cervix). In this case, the symptoms of chancroid may go unnoticed, and this may cause further infection of sexual partners and other contacts. Typical chancre is not characterized by inflammation. With indurative edema, the labia majora and minora become enlarged, sometimes acquiring a cyanotic tint.

Hard chancre in men is often localized on the body and head of the penis, the surface foreskin, urethra. When located on the urethra, the chancre is painful on palpation, interferes with urination, and bleeds. In some cases, cicatricial narrowing of the urethra is observed. If the outflow of lymph is impaired (if there is damage to lymphatic vessels) indurative swelling forms on the penis or scrotum.

With the extragenital location of chancroid, it is most often localized in the mouth. The edges of the chancre are dense and red. On the lips, including in the corners of the mouth, chancre becomes crusty yellowish color. Hard chancre in the pharynx, tonsils, hard and soft palate, and gums develops less frequently.

When you press on the chancre from the sides, a yellowish liquid appears on its surface. This symptom has the name “crying chancre” and serves for the differential diagnosis of syphilis from other pathologies.

The clinical picture of chancre may change when a secondary infection is added.

Diagnostics

Diagnosis of syphilis is based on the detection of pale treponema in the discharge of chancre, the results serological analysis blood and, if necessary, additional research data.

Infection with Treponema pallidum can occur through dental or other medical instruments, bedding, personal hygiene products of a sick person, and dishes.

Required differential diagnosis with soft chancre. Hard and soft chancre (chancroid) have a number of similar symptoms, but soft chancre is painful, has soft edges, and also forms purulent-hemorrhagic exudate.

Treatment of chancroid

The purpose of the therapy is to eliminate the infectious agent (treponema pallidum), restore affected tissues, increase immunity, and prevent relapses and/or complications. Treatment can be carried out both on an outpatient basis and in a hospital setting. When syphilis is determined in one of the sexual partners, diagnosis and preventive treatment are indicated for the second (other) sexual partner and contact persons. You should avoid sexual contact with an infected person until he or she has completely recovered.

Treatment regimens for chancroid (i.e. primary syphilis) vary depending on the severity of the course, the location of the ulceration and a number of other reasons. Main drugs drug therapy are antibacterial agents. They are selected individually, taking into account the probable co-infection, sensitivity of microorganisms and drug tolerance. Therapy is carried out under the control of tests. Sulfonamides have proven themselves to be effective in the treatment of syphilis. Antibacterial drugs are supplemented restoratives, as well as immunomodulators. In the presence of allergic reaction antihistamines are indicated.

Besides general treatment, carry out treatment of chancre medicines for external use, with anti-inflammatory and disinfectant effects. If chancre is located in the mouth, rinsing the mouth with solutions of antibacterial drugs is prescribed. local action. Maintaining hygiene in the chancre area is of no small importance.

Therapy for syphilis at the primary stage of the disease (chancroid stage) ends complete cure. Advanced disease requires long-term therapy (up to several years), and dispensary observation behind the dynamics of convalescence.

Prevention

Measures to prevent syphilis include:

• protected sexual intercourse;
• refusal of casual sexual relationships;
• avoiding the use of other people's personal hygiene products, dishes, etc.;
• regular examination of persons belonging to risk groups (persons leading an antisocial lifestyle, suffering from alcoholism, drug addiction, medical workers, etc.);
• drug prevention for casual unprotected sexual intercourse.

Consequences and complications of chancroid

When the disease progresses and there is no necessary treatment infectious process spreads to other organs and tissues of the body.

When a secondary infection occurs, men develop inflammation of the glans penis (balanitis) and the inner surface of the foreskin (posthitis), which in some cases becomes the cause of a complication of chancre such as narrowing of the foreskin, or phimosis. The latter is often complicated by pinching of the glans penis by the foreskin (paraphimosis).

The addition of a bacterial or trichomonas infection to chancroid in men leads to acute inflammation around the ulcerations and narrowing of the foreskin.

In addition, against the background of weakened immunity and alcohol addiction, complications of chancroid such as gangrenization and phagedenism may occur.

In pregnant women, syphilis can cause transplacental infection of the fetus with subsequent death during the period of prenatal development. A child with congenital syphilis dies soon after birth or has severe damage to internal organs.

Video from YouTube on the topic of the article:

Initially, it is worth saying that solid or syphilitic chancre in women it is not the only ulcerative formation associated with a sexually transmitted disease. There is also such a thing as chancroid. Despite the large number of differences between these two types of formations, venereologists cannot always determine with accuracy what type of sexually transmitted infection we are talking about. To accurately diagnose and draw up a program, you need to undergo a full examination of the body and determine at the microbiological level the causative agent of the disease and its source.

In this section of the article it is worth talking about chancre in women as direct sign the occurrence of the primary stage of syphilis. Chancroid is the most common type of chancroid, appears in both women and men, and has three stages of growth. The first stage is considered to be the most dangerous, since the manifestation of the disease is not always easy to identify and consult a doctor in time. The causative agent of ulcerative formations on the body of an infected person is the bacterium that carries syphilis, spirochete or.

Chancre occurs due to the entry of the syphilis bacteria into the blood, which is transmitted through unprotected sexual contact through the mucous membrane. Due to active sex life modern man Today, cases of hard chancre on the mucous membrane of the mouth and anus have become more frequent. Medicine is also aware of cases of doctors becoming infected with the spirochete bacterium when examining or operating on an infected person. The pathological form of chancre on the hands is characterized by pain and fever, which is not observed in other forms of this formation.

The incubation period of chancre in women takes no more than 4 weeks. During this time, the treponema bacterium attaches to the mucous membrane and begins to produce toxins and also divide. In the place where the spirochete multiplies, a slight redness occurs, which later turns into an ulcerative wound - this is a chancre.

Many of our readers are interested in what chancre looks like in women. There are a number of features due to which chancroid can be distinguished from other similar types of manifestations of sexually transmitted infection on the body:

• A chancre is called hard because it has a cartilaginous base that can be felt if you press lightly on the edges of the ulcer.
• The edges of the chancre are clearly defined and slightly raised above the base of the wound.
• In a normal state of infection, the skin adjacent to the chancre is not inflamed or damaged.
• The inside of the chancre is painted bright scarlet or Brown color, depending on its location.
• The top of the ulcerative wound is covered with a smooth film, which, when pressed, oozes a small amount of brown liquid.
• Chancre does not cause pain, does not itch or burn, and does not provoke attacks of fever or dizziness.

Remember that self-diagnosis of the disease can lead to severe consequences and significant worsening of the disease. At the slightest sign of the appearance of hard chancres on the body, you should immediately contact a specialized clinic and conduct a full examination of the body, instead of looking in search engines answers to queries: “chancre on the labia”, “syphilitic chancre in women”, “chancre in the vagina”, “chancre symptoms in women”, “what does chancre look like on the labia”, “chancre pictures in women”, “what is chancre this is what it is like in women”, “syphilis chancre in women”, “treatment of chancre in women”, “chancre on a woman’s labia”, “what initial stage chancre looks like in women”. Remember that a timely visit to the doctor is the key not only Get well soon, but also wellness your partner.

On what parts of the body does chancroid develop in women?

It is worth saying that the localization of hard chancre in women is much more complex than in men. Often chancre in women can occur on the cervix or labia minora, making it almost impossible to notice them in time and provide first aid for the disease. The painlessness of hard chancres often becomes the cause of advanced forms of syphilis, which also could not be detected in time.

The localization of hard chancre in women in the mouth is marked by the formation of large ulcerative cracks. On the mucous membrane oral cavity primary signs of syphilis may appear on the tongue, inside cheeks, lips or palate. In women, chancre also takes the form of cracks on the anus.

IT IS IMPORTANT TO KNOW!

It is important to know that chancroid of the syphilitic type is predominantly a one-time ulcerative formation that does not spread throughout the body and does not cause accompanying swelling of the skin. However, in special cases, for example, when an ulcer ruptures or the surface of the wound is damaged, spirochete bacteria can spread to healthy areas of the skin and cause pathological multiple ulcerative lesions. If not treated promptly, chancroid in women can develop to gigantic proportions and cause swelling of the lymph nodes, fever and bouts of vomiting.

How to diagnose chancroid in women?

Self-diagnosis in case of infection with syphilis is absolutely not applicable, since at the moment there are a large number of various types chancre and their combinations, which are simply impossible to determine at home and make a correct diagnosis. To diagnose chancroid of an infected person, a number of microbiological tests are used:

The first method involves taking a swab from an infected person's ulcer. This method is used at the primary stage of syphilis, when the development of chancre reaches its peak and a large number of spirochetes accumulate in it. However, it is worth remembering that a few days before taking a smear, the affected area should be treated by special means, killing natural microflora and other bacteria so that the research results are as reliable and clear as possible.

Complicated forms of chancroid may be a reason for repeat treponemal type or analysis based on antibody counting. Both methods help with more likely determine the type of sexually transmitted disease that caused ulcers on the body and prescribe the most effective method of treatment.

Chancroid in women and the reasons for its appearance

The similarity of the name of chancre does not indicate their similar characteristics and methods of manifestation. Chancroid in women is a bleeding ulcerative formation on the body, which occurs due to the entry into the blood of a bacterium called Ducray's bacillus. A large percentage of those infected with this type of chancre live in countries with a hot tropical climate.

Chancroid is very rarely diagnosed in women. This is due to the fact that in female body Ducray's bacterium is in a latent form and very rarely manifests itself pathologically. Medicine knows of cases where the bacterium was in a woman’s body for many years and was not diagnosed. However, during sexual contact with an infected woman, a man runs the risk of becoming a carrier of this bacterium and subsequently experiencing the appearance of multiple soft chancres on the body.

Distinctive characteristics of chancre are:

• Rough edges that can increase over time and cause multiple inflammations in the adjacent areas of the skin.
• Increased pain in ulcerative wounds, burning sensation.
• Bleeding ulcers.
• Discharge of large amounts of purulent and bloody fluid when pressed.
• The ability to increase in size and provoke the emergence of other foci of inflammation, which ultimately form a large ulcerative lesion skin.

Soft chancre can cause attacks of fever, nausea, dizziness, headaches, multiple inflammations of the lymph nodes, and digestive system disorders.

After healing, chancroid leaves behind a large scar that does not disappear over time.

How to identify and treat chancroid in women

Diagnosis of soft chancre, like hard chancre, most often occurs by taking a smear from the affected area of ​​the skin. Treatment of this type of sexually transmitted infection is carried out by taking and thoroughly externally treating the affected areas of the skin in order to eliminate the likelihood of developing pathological forms of the disease and protect the infected person from recurrent forms of infection. It is important to note the fact that exposing Ducray’s bacteria to general-spectrum antibiotics does not have any effect, since this type microorganisms is insensitive to their composition. If chancroid occurs, the doctor prescribes narrowly targeted antibiotics, which not only help destroy the bacteria that cause the infection, but also help prevent the risk of relapse of the disease.

At the end of the incubation period, at the site outside the drainage of pallid treponema, the first sign and main manifestation of the primary period of syphilis develops - primary syphiloma (synonyms: chancroid, primary sclerosis, primary erosion, ulcus durum, sclerosis primaria, sifiloma primaria, erosia indurativa). Sometimes there are cases when manifestations of syphilis begin after 3–3.5 months immediately with rashes of the secondary period. This is the so-called “decapitated syphilis”.

Hard chancre (ulcus durum) is an erosion or ulcer that forms at the site of penetration of pale treponema into the skin or mucous membranes. Erosive chancroid is observed in 80–90% of patients; the occurrence of ulcers is facilitated by a violation of the general condition of the patient due to chronic diseases; intoxication; elderly or early childhood, as well as non-compliance with personal hygiene rules or self-treatment of chancroid with external irritants.

Hard chancre is not a true primary morphological element of syphilis, since its appearance is preceded by the development of the so-called “primary sclerosis”, which is asymptomatic and, as a rule, is not noticed by either the patient or the doctor. These changes begin with the appearance of a small red spot, which after 2–3 days turns into a hemispherical, painless, slightly scaly papule slightly raised above the skin level. After a few days, this papula becomes denser and enlarges through peripheral growth. A crust appears on its surface, upon rejection of which an erosion or superficial ulcer (“hard chancre”) is formed. The chancre has an oval or round shape, often geometrically regular, its boundaries are smooth, clear, the bottom lies flush with the surrounding skin or slopes upward (saucer-shaped erosion). Uncomplicated chancroid never has undermined or steep edges, which has important diagnostic significance.

The surface of primary syphiloma is flat, smooth, and has a bright red color (color “ raw meat") or covered with a dense coating of dull grayish yellow color. Sometimes this plaque is located only in the central part of the chancre. A red rim remains between it and healthy skin. In some cases, small pinpoint hemorrhages (“petechial” chancre) are visible on the red or grayish-yellow background of erosion, especially in its central part. On the surface of the chancre there is a transparent or opalescent discharge, giving it a kind of mirror or varnish shine. When the bottom of the chancre is irritated, the serous discharge becomes abundant and contains a large number of pale treponema, which is used for diagnosis. When localized on open areas of the skin, chancre is usually covered with a dense brownish crust.

At the base of primary syphiloma there is always a compaction of the underlying tissues, which was the basis for calling primary syphiloma chancroid. This compaction is clearly limited from the surrounding tissue and extends several millimeters beyond the boundaries of the erosion or ulcer. The consistency of the compaction is densely elastic; upon palpation, it resembles the cartilage of the auricle. In shape it can be nodular, lamellar or leaf-shaped.

The nodular seal has a hemispherical shape, clear boundaries, and penetrates deeply into the surrounding tissue. It is most often observed when hard chancre is localized on the inner surface of the foreskin and the coronary groove. In this case, the compaction can be seen with the eye (symptom of the “visor” and “tarsal cartilage”). When located in the area of ​​the foreskin, the tissues that are subject to chancroid can become so strongly sclerotic that their mobility is impaired up to the development of phimosis.

The lamellar seal resembles a coin placed under the base of the chancre. It is most often observed when the chancre is localized on the outer surface of the preputial sac, in the shaft of the penis, the labia minora and majora. A leaf-shaped seal appears in the form of a sheet of thick paper; most often it can be observed when a hard chancre is localized on the head of the penis.

Subjective sensations in the area of ​​primary syphiloma, as a rule, are absent, although sometimes it can be quite painful.

The size of chancre is usually small, with an average diameter of 10–20 mm. There are also very small (dwarf) chancre, 1–3 mm in diameter, or large (giant) chancre (up to 40–50 mm). Dwarf chancre usually occurs on areas of the skin with a well-developed follicular apparatus when the infection spreads deep into the follicle. Dwarf chancre is especially dangerous from an epidemiological point of view, as it is difficult to detect and can be a source of infection. Giant chancres are most often observed on the skin of the pubis, lower abdomen, inner thighs, forearms, and face. Having reached a certain size, chancre does not tend to grow peripherally.

Hard chancre can be single or multiple. Multiple chancre occur simultaneously or sequentially. For the simultaneous development of multiple hard chancre, the patient must have several defects of the skin or mucous membrane that facilitate the penetration of Treponema pallidum (for the presence of concomitant diseases with itching and scratching, maceration, skin trauma, etc.). Multiple hard chancre occurs sequentially with multiple non-simultaneous sexual intercourse with a patient with an infectious form of syphilis. These chancre vary in size and degree of compaction.

Primary syphilomas that occur in a patient simultaneously on two parts of the body that are far apart from each other (for example, on the genitals and mammary gland, red border of the lips, etc.) are called bipolar chancre. When bipolar chancre occurs, the normal course of syphilis changes; The incubation and primary periods are shortened, and serological reactions in the blood become positive earlier.

Primary syphiloma can be localized on any area of ​​the skin and mucous membranes, where conditions for infection are created. There are genital, perigenital and extragenital localization of chancre. In more than 90% of patients, chancre is localized on the genitals. In men, hard chancre is most often observed in the coronary sulcus, on the inner and outer layers of the foreskin, the glans, and less often on the shaft or base of the penis, especially when using condoms. Possible intraurethral location of hard chancre, which is localized in the area of ​​the scaphoid fossa or near the external opening urethra, passing to the mucous membrane of the urethra. It is characterized by limited compaction in the distal part of the urethra, scanty serous bloody discharge, pain when urinating and specific enlargement of regional lymph nodes. Healing of the chancre can lead to a narrowing of the urethra. Intraurethral chancre must be differentiated from urethritis of various etiologies, with which (especially with chronic gonorrhea) it is often combined.

In women, primary syphiloma is localized on the labia majora and minora, in the area of ​​the posterior commissure, clitoris, on the cervix, and very rarely on the walls of the vagina. It is believed that chancroid of the cervix is ​​observed in 8–12% of cases, however, apparently, it occurs much more often than is diagnosed.

Chancre in the area of ​​the vaginal part of the cervix is ​​usually localized on upper lip and around the outer hole cervical canal; It is a sharply limited rounded erosion with a smooth, shiny, bright red or covered with a grayish coating surface separating serous or serous-purulent exudate. There are no inflammatory phenomena around the erosion. In the area of ​​the external opening of the cervical canal, the chancre has a ring-shaped or semi-lunar shape and significant compaction.

Cases of indurated edema and the location of hard chancre on the mucous membrane of the cervix are described.

Chancre can be observed in the anus in both women and men, especially homosexuals. These chancre are located in the area of ​​the anal folds, external sphincter, anal canal and rarely on the rectal mucosa. They may look like typical syphilitic erosion or take on an atypical form. In the depths of the folds of the anus, primary syphiloma has a rocket-shaped or slit-like shape, in the area of ​​the internal sphincter - oval. A slit-like chancre in the depths of the anal folds is very similar to a banal fissure, from which it differs in a compacted base and incomplete closure of the edges. Primary syphiloma in the anus is painful regardless of the act of defecation, but during the latter it can bleed. It can occur with symptoms of proctitis and sometimes requires differential diagnosis with an ulcerated hemorrhoid, polyp, and even rectal cancer. Regional lymphadenitis with chancre of the anal area is not observed in all patients. Hard chancre in the rectal area is detected only with the help of a rectal speculum or rectoscope.

Extragenital chancre can occur on any part of the skin and mucous membranes and occurs in 1.5–10% or more of patients with syphilis. They can be single or multiple, unlike genital chancre, they quickly take the form of an infiltrated ulcer, are marked by greater pain, duration of the course and are accompanied by a significant increase in regional lymph nodes. Extragenital primary syphiloma is most often localized on the red border of the lips, mammary gland, fingers, armpits, navel, eyelid.

A chancre of the mammary gland is an erosion or ulcer of a regular or fissure-like shape, located in the area of ​​the nipple or areola. It has a lamellar compaction at the base, is often covered with a crust, can be single or multiple, and localized on one or both mammary glands.

The localization of hard chancre on the fingers is noteworthy, most often observed during occupational infection of medical workers (surgeons, obstetricians, gynecologists, dentists, pathologists), as well as during manual contact (petting). Sometimes there is a combination of this chancre with primary syphiloma of the genital organs (bipolar chancre). Hard chancre is most often located on the distal phalanges of the fingers, especially II; it can be typical or in the form of chancre felon.

Chancroid panaritium is usually considered an atypical form of primary syphiloma, since its clinical picture is extremely similar to ordinary panaritium. Chancroid felon begins with the formation of erosion or ulcer on the dorsum of the finger and simultaneous compaction of the underlying tissues of the phalanx. The ulcer is deep, its edges are sinuous, sometimes overhanging. The bottom is covered with purulent necrotic masses; areas of dead tissue are often visible. Soft fabrics they become not only dense, but as if welded into one whole (from the skin to the periosteum). The infiltration does not have clear boundaries and extends to the entire phalanx, which is typical of other dactylitis. The affected phalanx becomes swollen, club-shaped, swollen, and the skin over it acquires a dark or purplish red color. The similarity to panaritium is increased by spontaneous, shooting or throbbing pains that increase with the slightest movement. Soon the ulnar and axillary lymph nodes enlarge, the palpation of which is painful. The course of chancre felon is long (weeks, months). The cause of the atypical course of primary syphiloma on the fingers appears to be the combination of a secondary infection.

Diagnosis of chancre felon is very difficult and the diagnosis is often made when secondary syphilides appear. In the presence of chancre felon, patients may develop malaise, fever, and symptoms of general intoxication.

There are two more forms of primary syphilitic lesions of the fingers and hands - dactylitis luetica and paronychia luteca. They are characterized by slight pain with severe inflammatory phenomena. There may be no suppuration. The course is chronic. Enlarged regional lymph nodes in both of these forms, unlike chancre of felon, are painless.

Special varieties of chancre also include:

1) burn (combustiform) chancre, is an erosive primary syphiloma, prone to pronounced peripheral growth with weak (leaf-shaped) compaction at the base; as erosion grows, its boundaries lose their correct outlines, the bottom becomes red and granular;

2) Vollmann's balanitis - a rare clinical variant of chancre; multiple small erosions appear on the head of the penis in men or on the external genitalia in women without noticeable compaction at the base; in a woman, this is facilitated by treatment with antibiotics during the incubation period or their local application to the chancre in the first days of its appearance;

3) chancre herpetiformis appears in the form of small erosions located in groups over a small area; compaction at the base of the erosion is weakly expressed; the clinical picture is very similar to genital herpes.

There are some variants of the course of a typical chancroid depending on the localization of the process and the anatomical features of the affected areas. On the head of the penis, the chancre is usually erosive, has a round shape with slight lamellar compaction; in the coronary sulcus - ulcerative, large in size with nodular compaction; on the frenulum of the penis - in the form of a cord with a compaction at the base, bleeds during erection. Chancres, localized in the area on the outer border of the foreskin, are usually multiple and often have a linear shape. When primary syphiloma is located on the inner layer of the foreskin, it becomes difficult to remove the head from under it, radial tears appear and the infiltrate at the base of the chancre rolls out in the form of a plate (hinged chancre).

Chancroid is primary stage 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. Chancre 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, if a bacterial infection occurs, complications may occur. The latter is evidenced by the uneven edges of the formation, painful sensations 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 hard form of chancre, soft chancre is also isolated. 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 (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 - early stage 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 to take preventive measures to avoid infection.

Chancre is a symptom of primary syphilis. It is also called primary syphiloma or erosion. Hard chancre appears in men and women approximately three weeks after the introduction of the causative agent of the disease, Treponema pallidum, into the body. Its symptoms are erosive or ulcerative formations on the skin or mucous membranes.

Chancre has the following features:

• characterized by limited localization;
• does not affect internal organs and body systems;
• responds well to treatment.

Hard chancre gets its name from the type of base of the ulcer or erosion formed. The duration of primary syphiloma is six to eight weeks.

Localization

The localization of primary syphiloma can be absolutely any. Hard chancre in humans appears directly at the site of introduction of Treponema pallidum into the human body a certain time after infection. Its most common location is the external genitalia - in women the labia, clitoris, in men the head, base and shaft of the penis, the outer or inner layers of the foreskin. In some cases, chancre forms on the internal mucous membranes: in the urethra in men, on the walls of the vagina or cervix in women.

In ten percent of all cases, an extragenital location of the chancre is observed. Chancre in women and men can be localized:

• in the oral cavity;
• on the tongue;
• on the edge of the lips;
• on the tonsils in the throat;
• on the mammary glands of women.

Symptoms

Externally, chancre looks like a reddish spot with clearly defined, smooth edges, up to 1.5 centimeters in size. It has the shape of a geometrically regular circle or oval. Sheer or undermined edges indicate a bacterial complication.

Symptoms of chancroid are only external. It does not bother the patient in any way, does not cause any painful sensations. Complications develop only if a bacterial infection is added to the lesion.

After a few days, the redness turns into a flat papule, and after some time into an erosion or ulcer with a compacted base. A hard chancre has a bottom that is located at the same level with the skin or slightly raised above.

In almost 90% of cases in women and men, chancre looks like erosion. An ulcer is formed:

• when the body is weakened as a result of concomitant chronic diseases;
• as a result of intoxication;
• when self-medicating with local irritants;
• failure to comply with basic personal hygiene rules;
• in young or elderly patients.

When formed on the penis in men, the hard chancre is covered on top with a transparent, dense detachable film. It is in it that pale treponema is found, which is then used to determine syphilis. If a chancre is located on an open area of ​​the body, then on top it is covered with a dense brownish film.

The size of chancre can be:

• from 1 to 3 mm – dwarf, it is considered the most dangerous from an epidemiological point of view;
• from 1 to 2 cm – average;
• up to 4–5 cm – gigantic, localized on the skin of the thighs, pubis, forearms or face.

Hard chancre in humans can vary in the number of morphological units, that is, it can be single or multiple. If multiple chancres are present, they can appear all at once or sequentially, one after another, after some time. If there are multiple lesions on the skin, then chancre appears in several places at once, that is, where Treponema pallidum penetrates the body. Multiple chancre most often occurs during repeated sexual intercourse with a partner with syphilis.

Atypical chancroid

Rarely, men and women infected with syphilis have chancre in atypical form. These include:

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

Amygdalitis chancre is very different from the usual hard chancre on the tonsils. It has other external symptoms. In most cases, amygdalitis looks like a unilateral enlargement of the tonsil, which occurs very suddenly. It becomes dense to the touch and hyperemic. This symptom is sometimes confused with manifestations of tonsillitis.

Indurative edema occurs in the labia in women or the foreskin in men. The affected area, unlike a typical chancre, after some time increases in size two to three times, becomes dense to the touch and acquires a bluish tint. The swelling is not painful and is not accompanied by acute inflammatory symptoms.

Chancroid felon is the most atypical manifestation; its danger lies in the fact that the symptoms completely coincide with ordinary felon, and it looks exactly the same. This may lead to an incorrect diagnosis. Chancre-felon is characterized by localization on distal phalanx thumb or index finger. A bluish-red swelling appears on the affected area, which turns into an ulcer with a purulent coating at the bottom and uneven deep edges. Chancre-felon is characterized by symptoms such as throbbing or shooting pains. Most often, it occurs in gynecologists and operating surgeons who are in direct contact with the body of a person infected with syphilis, thus chancre-felon in most cases is the result of occupational infection.

Syphilis in the form of chancre-felon is very rarely detected on time, and therefore the diagnosis becomes known already in the second stage of the disease. Timely detection of atypical chancre is very important, since the primary stage of syphilis is treated most effectively.

Treatment

Chancre in a person infected with syphilis is treated in an inpatient or outpatient setting. Throughout the course of therapy, cessation of any sexual contact is required. It is necessary to treat all sexual partners of a person with syphilis, regardless of how many there were. The fact is that the probability of their infection with Treponema pallidum is extremely high.

Treatment of chancre is carried out with antibacterial drugs of the penicillin group, since the causative agent of syphilis has not lost sensitivity to them. Most often this injection forms ampicillin and benzylpenicillin.

You need to know that chancre in itself is not dangerous. It allows you to detect syphilis at its earliest stage. And therefore timely treatment makes it possible to prevent further development of the disease and the occurrence of complications. If you find a formation on the skin that resembles the description of a chancre, you should immediately consult a doctor for examination.

After suspicious unprotected sexual intercourse, prophylactic treatment may be prescribed to prevent the syphilis pathogen from entering the body. To do this, you should immediately contact a dermatovenerologist.

Primary syphilis manifests itself in enlarged lymph nodes and chancre. What is chancre? This symptoms of syphilis, which are round sores with a diameter of about one centimeter on the patient’s body.

They are red and blue in color, sometimes they are painful, but generally the patient does not perceive pain at the site of erosion. The first signs of syphilis in men: formation of chancre on the head of the penis, and in womensymptoms of syphilisappear on the walls of the uterus and on the external genitalia. These sores also occur on the pubis, near the anus, on the tongue and lips.

Syphilis develops quickly, and the lymph nodes become inflamed and enlarged first, and then the formation of hard chancre.

It may resolve on its own, even without drug treatment, after one to two months. It goes away almost without a trace, although if the ulcers are large, dark spots may remain.

Chancre with syphilis - this is the focus of syphiloma, which is formed at the site of treponema in the body.

Chancre gets its name from French word, which translated means ulcer, erosion. In some infectious diseases there is chancre, but in the case of syphilis, this erosion is the first sign of syphilis in the first stage. Educationchancre,on the body after a little more than 4 weeks from the moment of infection with this disease. During this period, the spirochete infection manages to get into many organs and lymph, and begins to multiply, which causes an inflammatory process and can temperature appears.

Types of chancre

They are classified according to the type, size, number of ulcers on the body, and their location.

The chancre is divided by type:

• erosive - this is erosion that affects the layers of the mucous system;
• Ulcerative chancre is an ulcer that penetrates into the deep layers of tissue.

According to the quantitative classification, chancre is divided into:

• single is a chancre, which consists of one ulcer;
• multiple is an erosion that consists of many ulcers and creates a single wound.

Syphilomas of chancre The sizes are:

• small (dwarf) - diameter less than 10 mm;
• medium - diameter from 20 mm;
• large (giant) - diameter 50 mm and above.

Place of appearance of hard chancre on the body:

• extragenital - the tongue, anus, chest, throat, legs, gums are affected by ulcers;
• genital - these are erosions, emerging on the genitals of a sick person;
• bipolar are chancres that simultaneously appear on the genitals and other parts of the body.

By the end of the primary period of syphilis, chancre becomes a form of the disease that:

• has localization in specific places, in the oral cavity and on the genitals;
• does not have a numerous form;
• does not affect internal organs;
• It is quite easy to treat and leaves no consequences.

Features of the development of chancre

In people who have become infected with syphilis infections and at the same time have reduced immunity, ulcerative lesions appears Necessarily. Also, the formation of ulcers on the body occurs due to chronic infections, toxicity of the body and age reasons. Due to self-medication syphilis Pustular erosions form, which, after fading, leave pigment spots and scars.

It begins to develop with redness, which does not cause itching or pain. After 48 to 72 hours, this redness begins to form a bump and form a papule. At this point, the epithelium from the chancre may peel off, and the infected person begins to feel pain for the first time.

In the following hours and days, the syphiloma becomes larger, spreading around the circumference. A hard crust begins to form on the papule, under which an ulcer forms. Over time, the crust is rejected and a sign of syphilis appears - chancre.

The shape of the chancre is slightly raised, with clear round edges. Sometimes these edges are oval in shape. The surface of the chancre is smooth, sometimes has a grayish coating, but the main color of the chancre is red.

The shape of chancre varies:

• nodule shape - this ulcer has clear boundaries. This ulcer grows into the deep layers of tissue and retains its clear boundaries. This chancre is localized on the foreskin of the penis;
• the shape of a plate or coin - the chancre is localized on the upper layers of tissue and is located on the labia, shaft of the penis, and on the scrotum;
• leaf-shaped - erosion has clear boundary lines and is located mainly on the head of the phallus.

Atypical chancroid

Except hard chancre, there is also atypical chancre and many of its types:

• indurative edema is a large lump that forms on the foreskin of the penis, genitals in women and in the lip area on a person’s face;
• Panaritium is a chancre that develops on the nails and does not heal for several months. There may even be nail rejection;
• lymph nodes - increase in this period. Depending on which part of the body the chancre formed, the lymph nodes closest to the chancre become inflamed;
• A bubo is a lymph node that has a mobile shape and has no painful signs and is located closest to the chancre: on the patient’s neck if the chancre is in the tonsils, and in the groin part of the body if chancre on penis , in the genital area;
• polyadenitis is inflammation and hardening of all lymph nodes, from this moment we can assume that symptoms of secondary syphilis began to appear.

Complications of syphilis in the first period are very serious both for women and also have serious consequences for the male part of the population.

Chancre in the female body

In the female body occurs:

• on the labia majora and minora;
• on the clitoris;
• on the walls of the cervix;
• in the area between the anus and vagina.

On the walls of the vagina, chancre with syphilisoccurs very rarely, since the acidity of the vagina has a detrimental effect on treponema.

Very often, syphilis chancre forms on the cervix. This chancre is invisible and is diagnosed mainly at the second stage of the disease.

Over 10 percent of women with syphilis in the first stage have a hard chancre on the walls of the cervix. Syphilis chancre is detected only at the time of examination of the uterus using medical equipment. This examination is carried out by a gynecologist or venereologist.

In the oral cavity, chancre forms on the tongue, lips, soft palate and tonsils. There are frequent cases of ulcers on the gums, cheeks, fingers and chest.

Diagnosis of syphiloma

Diagnosis of syphilis consists of several types of examinations and tests:

• serological diagnosis is the detection of Treponema bacteria from scraping of chancre. Based on the results of this examination, the doctor makes a diagnosis;
• Treponema immobilization reaction;
• immunofluorescence reaction;
• Wasserman reaction;
• microreaction on glass;
• linked immunosorbent assay;
• microprecipitation reaction;
• passive hemagglutination reaction.

Relationship between chancre and primary syphilis

Syphilis is venereal disease, which proceeds in a classical form. Syphilis chancroid, the main symptom of this disease. Chancroid is a symptom of primary syphilis only.

Syphilis in the first stage of its development manifests itself in enlarged lymph nodes and chancre. Towards the end of this period the following symptoms appear:

• state of general malaise;
• constant headache;
• elevated temperature;
• pain in muscle tissue;
• aches and pain in the bones;
• decreased hemoglobin;
• significant increase in leukocytes.

Syphilic chancre has the ability to pass on its own and leave no traces, so people who self-medicate can assume that syphilis has been cured.

This is a misconception, because the disappearance of chancre is preceded by secondary syphilis, which is much more dangerous than syphilis in the first stage of development and treatment of this type is much more complex and lengthy.

Complications of syphilitic chancroid

As complications of syphilitic chancre, other infections can penetrate the chancre, which leads to painful symptoms and the accumulation of pus in this place.

There are several reasons for infection:

• chancre injury;
• lack of hygiene;
• diabetes mellitus;
• HIV infection;
• development of tuberculosis bacillus in the body.

The female body develops:

• syphilitic gangrene;
• infectious vaginitis;
• inflammatory bartholinitis;
• endocervicitis of the cervix.

Complications in the male body lead to:

• balanitis;
• balanoposthitis of the head of the penis;
• phimosis of the foreskin;
• paraphimosis of the foreskin;
• gangrenization of the head of the penis;
• phagedenism of the penis.

Treatment of syphiloma

At the primary stage, the task is to cure the infection and prevent syphilis from moving into the second stage. Chancre, treatmentmust be carried out as early as possible.

The main drugs used in treatment are antibiotics different groups and directions:

• penicillins;
• macrolites;
• tetracyclines;
• fluoroquinolones.

Together with antibiotics, the following are involved in the treatment process:

• antifungal drugs;
• immunomodulators;
• multivitamins;
• probiotics.

The treatment regimen for syphiloma is prescribed by the attending physician, based on the diagnosis and test results.

During the course of treatment, tetracyclines and drugs based on bismuth and iodine are added to penicillins. This complex of drugs can increase the effect of the antibiotic in the body.

If syphilis is diagnosed, both sexual partners are treated.

At the time of therapy, the patient is prescribed a diet in which protein foods predominate and the consumption of fats and carbohydrates is limited.

During this period, smoking and drinking alcohol are contraindicated, and it is also necessary to reduce physical stress on the body.

Main condition quality treatment, this means observing the rules of personal hygiene and not having sex during the treatment period.

It is necessary to treat chancroid with antibiotics:

• Extensillin - intramuscular injections, it is enough to carry out the procedure twice;
• Bicillin - injections, twice, every 5 calendar days;
• Erythromycin - 0.5 mg taken 4 times a day;
• Doxycycline - 0.5 mg taken 4 times a day.

For local treatment of chancre, lotions on the chancre with benzylpenicillin and dimexide are needed.

It is necessary to lubricate the syphilitic chancre with heparin ointment, erythromycin ointment, ointment based on mercury and bismuth. Syntomycin ointment and levorin ointment help remove pus from the ulcer.

Chancres that are in the mouth must be rinsed with solutions:

• furacillin;
• boric acid;
• gramicidin.

Chancre is a very important sign in recognizing syphilis in the body. The earlier an infection is detected in the body, the faster treatment of the disease will begin, and the duration of the course of drug treatment may be minimal. In this case, treatment with folk remedies and self-medication are contraindicated.

Only a competent doctor can make a diagnosis and prescribe the necessary treatment. Compliance with all doctor's instructions, a healthy lifestyle, hygiene will give positive result in curing syphilis at the first stage of the disease.

Clinical picture. Primary syphilis is characterized by the development at the site of penetration of pale treponema chancroid (ulcus durum, primary syphiloma) and regional lymphangitis and lymphadenitis. Sometimes, between the chancre and enlarged regional lymph nodes, a strand of regional lymphangitis can be seen and palpated.

Thus, the clinical manifestations of the primary period of syphilis are represented by three elements:hard chancre, regional lymphadenitis and regional lymphangitis.

At the end of the primary period, general flu-like disorders are sometimes observed: headache, osteoarticular and muscle pain, general weakness, insomnia, increased body temperature.

Chancre

Hard chancre most often persists until the onset of the secondary period and heals soon; it rarely exists for up to several weeks and after the appearance of a generalized rash, and even less often it heals before the onset of secondary manifestations. This depends mainly on its size. Concomitant regional lymphadenitis usually occurs 7–10 days after the appearance of chancre. A chancre is a very characteristic erosion or ulcer, but it does not immediately take on these features. After the incubation period, a red spot first appears at the site of treponeme penetration, which then turns into a dense nodule with sharply defined boundaries. Within 7–10 days, the nodule increases significantly in size, and the infiltration of its base takes on the character of a specific compaction. Due to malnutrition of the epidermis caused by vascular damage characteristic of syphilis, necrotization occurs in the center of the infiltrate and erosion or ulceration forms.

The main clinical signs of a typical chancre are: erosion (ulcer) with the absence of acute inflammatory phenomena; loneliness or singularity; regular (round or oval) outlines; clear boundaries; size - about a small coin; elevation of the element above the surrounding healthy skin (mucosa); smooth, shiny (“varnished”) bottom; flat (saucer-shaped) edges; bluish-red color of the bottom; scanty serous discharge; dense elastic (“cartilaginous”) infiltrate at the base (nodular, lamellar, leaf-shaped); painlessness; resistance to local disinfectant and anti-inflammatory therapy.

Along with the described classic form of chancroid, there are various deviations in one or more of its listed characteristics, which creates quite numerous varieties of primary syphiloma. Multiple chancre is rare (in about 1/5 of patients). Their number rarely exceeds 10. The multiplicity of chancre is explained by the presence in the patient at the time of infection of numerous minor violations of the integrity of the skin or mucous membrane. Concomitant skin diseases, such as eczema or scabies, can play a decisive role, especially when localized on the genitals. It is characteristic that no matter how numerous the hard chancre may be, they are all at the same stage of development if they are the result of the simultaneous penetration of infection through several entrance gates. These are the so-called twin chancres. If infection occurred in different time(for example, as a result of repeated sexual intercourse with an interval of several days), then chancre will appear at different times and differ from each other in the degree of maturity. These are the so-called sequential chancre. Giant hard chancres are usually located in places with abundant subcutaneous fatty tissue: in the pubic area, abdomen. Their size can reach a child's palm. Dwarf chancre is extremely small in size - down to the size of a poppy seed, but under a magnifying glass all the characteristic signs of primary syphiloma are revealed. Diphtheritic hard chancres, covered with a grayish necrotic film, are very common. Cortical chancre is observed in places where the discharge easily dries out: on the face (nose, chin), on the skin of the lips, sometimes on the stomach, the shaft of the penis. It may be very similar to pyodermic elements: impetigo, ecthyma. Slit-like chancres, shaped like a crack or the pages of a book, are usually localized in small folds of the skin: in the corners of the mouth, in the interdigital folds, in the anus. Folman's erosive chancre does not have a clear compaction at the base and is usually localized on the head of the penis. Hard chancre located at the external opening of the urethra, in the folds of the anus and on the tonsils can be accompanied by significant pain. The localization of chancre depends on the route of infection of a given patient with syphilis. In case of sexual infection, chancre usually appears on the genitals or adjacent areas (pubis, abdomen, inner thighs, perineum, anus). Chancres on the cervix occur in 12% of sick women. In this regard, examining women with suspected syphilis using a vaginal speculum is of great importance. In some cases, during sexual infection, chancre is located extragenitally (for example, on the lips, tongue, mammary glands, fingers). Extragenital chancre can be located anywhere skin and mucous membranes. The second place after the genital organs in terms of the frequency of localization of primary syphiloma is occupied by the oral mucosa (lips, gums, tongue, soft palate, tonsils). Other localizations of chancroid are rare.

Atypical hard chancres includeindurative edema, chancre-amygdalitis and chancre-felon .

Indurative edema usually occurs on the labia or foreskin. The affected area enlarges 2–4 times, becomes dense, the skin acquires a stagnant bluish color or retains its normal color. The lesion is characterized by painlessness and the absence of acute inflammatory phenomena, which distinguishes indurative edema from processes such as bartholinitis or inflammatory phimosis (such diagnoses are most often given to patients).

Chancroid-amygdalitis should be distinguished from erosive (ulcerative) chancre on the tonsils. Chancre-amygdalitis is characterized only by a sharp, usually unilateral enlargement of the tonsils. The tonsil is dense, there are no acute inflammatory phenomena. Chancroid-amygdalitis is very similar to indurative edema. This atypical chancre is often mistaken for a common sore throat. L1ankr-felon is the most atypical of all chancre. It is indeed very similar to a banal panaritium: on the distal phalanx, usually the index or thumb, against the background of bluish-red swollen skin there is a deep ulcer with uneven, overhanging, as if gnawed edges and a purulent-necrotic coating. Chancroid felon is accompanied by sharp, “shooting” pains. Most often it occurs in surgeons, gynecologists, pathologists and is the result of occupational infection; it is rarely diagnosed in a timely manner. Typically, the diagnosis of syphilis is made after the appearance of secondary period rashes.

Chancre felon should not be confused with typical chancre on the finger. Histologically, a typical chancre is an infiltrative-erosive or infiltrative-ulcerative formation with characteristic changes in the vessels of the dermis. It has a number of pathohistological signs: the absence of the epidermis (and part of the dermis) in the central zone of the preparation due to the formation of foci and zones of necrosis; in the dermis there is a dense infiltrate of lymphocytes and plasma cells, along the periphery the infiltrate has a perivascular location; changes in the blood and lymphatic vessels of the dermis in the form of proliferation and infiltration of all membranes (panvasculitis) with obliteration and thrombosis of some vessels; many pale treponema in all areas (especially in the walls of blood vessels and in their circumference).

When spirochetes have penetrated, for which an insignificant, completely imperceptible violation of the integrity of the skin is enough. After the first incubation period, most often at the end of the second week, a small nodule appears. It very often, but not always, ulcerates. Gradually it turns into an extremely dense, cartilaginous hard infiltrate, forming the base and edge of the developing ulcer. This phenomenon is called chancroid in men and women. Photo, initial stage We will consider how the primary signs are in the article.

Symptoms of chancre, initial stage

Specific signs of chancre with syphilis are the following changes in the skin. The rash, also known as infiltration, is mostly flat and sharply demarcated. It feels as if there is a hard plaque in the skin. But depending on where it is located, the nature of the rash can be very different.

There is usually only one primary rash. But it is relatively common to encounter several hard chancre. Moreover, they are all at the same stage of development, since they all appear simultaneously depending on the same infection. Further transfers in the same patient from one chancre are not observed, since after infection, immunity to a new infection soon occurs. Moving to another area of ​​the skin as opposed to chancroid for a given primary sign syphilis is not observed.

Dimensions of chancre photo

The size of chancre varies within very wide limits. Its surface can be covered with a thin, moist sheen, as if eroded epithelium, which is especially characteristic. When palpated, a cartilaginous infiltrate is felt. With a more pronounced erosion surface, the skin appears dark red, as if granular. When ulcerated, the ulcer is always smaller than a hard cushion and has a dense base. When ulceration occurs, depending on the method of formation:

1. With ulcerated sclerosis.
2. With sclerotic ulceration.

IN the latter case the situation may vary. Firstly, a very small nodule formed at the site of infection can turn into a vesicle and an ulcer before the actual syphilitic infiltrate is detected.

On the other hand, an existing vesicle, especially a vesicle, can serve as a site of entry for spirochetes, which is relatively common. In this case, an ulcer quickly forms.

How chancroid begins photo

Most important role plays a role in the origin of infiltrating, sclerosing ulcers. It may have existed before syphilis infection or was acquired at the same time as it. With such simultaneous infection: soft and hard chancroid, which is not uncommon, soft chancroid develops first. It has a much shorter incubation period of only a few days. Hardening, as a result of simultaneous infection with syphilis, is detected after 2-3 weeks. The base and circumference of the soft ulcer become denser: a “mixed chancre” (chancre mixte) is obtained.

Not only that, but a chancre ulcer may heal before a lump develops. “Mixed chancre” deserves special attention. Namely, we must remember that if a chancre ulcer is present, the possibility of simultaneous infection with syphilis cannot be excluded before the expiration of several weeks.

Stages of chancre in men and women

Ulcerating sclerosis, i.e., a sequentially decaying syphilitic infiltrate, can lead to the formation of:

• then flat
• either deep or crater-shaped,
• either smooth or having a pitted bottom,
• then a gangrenous or serpiginous ulcer.

It is only important to remember that an ulcer of chancre is never so sharply demarcated and such a regular round shape as an ulcer of soft chancre. And that it always has a hard bottom and a hard cushion. It is also characteristic that on the edge surrounding the ulcer a very narrow strip always appears red, eroded, and devoid of epithelium.

What chancre looks like, photos in women and men with syphilis

Depending on the location, chancre may present some differences. Thus, when localized in the coronary sulcus, sclerosis often appears in the form of a dense ridge, sometimes running parallel to the entire length of the sulcus. Often this results in phimosis or paraphimosis. Sclerosis, hidden by phimosis, is felt when palpated, mostly in the form of limited hardening.

Of the mucous membranes, the sites of sclerosis are mainly:

All sclerosis of the mucous membranes soon disintegrates into deep, crater-shaped ulcers with a dense bottom and ridge. Every place on the skin and visible mucous membranes can be a site of primary sclerosis.

Hard chancre on the penis and glans photo

If sclerosis sits on the edge of the foreskin, then perpendicular to the opening of the preputial sac an ulceration forms in the form of a crack in a dense ring.

A particularly peculiar picture is obtained when a significant, diffuse inflammatory swelling appears on the genital organ, as a sequential condition.

Then the penis takes on a completely shapeless appearance and appears doughy and swollen to the touch (indurative edema).

A similar condition occurs on the vulva.

Hard chancre on the labia photo:

Chancroid photo on the hand

If sclerosis is on the finger, then primary lesion often has the appearance of paronychia or panaritium; recognition can be extremely difficult.

Syphilis chancroid on the lip photo

Often primary sclerosis occurs on the lip and on the breast nipple, where it forms a dense, limited, eroded and ulcerated tumor.

The most important feature of every syphilitic primary manifestation is, without a doubt, the presence of spirochetes.

Chancre is the first manifestation of the introduction of Treponema pallidum into the skin.

Asymptomatic period Syphilis infection usually lasts 3-4 weeks when infected.

In the place where the treponema has penetrated the skin or mucous membranes, a small nodule appears, shaped like a circle or oval, colored reddish, initially vaguely demarcated from healthy skin. Soon the nodule gradually changes its consistency; it becomes dense and sharply demarcated from the surrounding parts. Then, upon palpation, a sharply demarcated hardening is felt, in typically pronounced cases of cartilaginous, densely elastic consistency.

Signs of chancroid

That's what it is syphilitic sclerosis – .

Subsequently, sclerosis, having existed for several days, becomes covered with whitish scales, which, peeling off, disappear. Gradually, sclerosis resolves, leaving at first age spot, which then disappears. In other cases, sclerosis erodes, forming an erosive chancre. Sometimes sclerosis, gradually developing, begins to disintegrate from the surface, followed by the formation of ulcerative chancre. Thus, the primary syphilitic lesion can be in the form of a single round or oval surface erosion, non-painful, with sharply defined, smooth edges, or in the form of an ulcer, and the bottom of the ulcer is saucer-shaped, even, smooth, shiny, the color of living meat. It is located at the level or slightly higher than the surrounding parts, due to the deposition of a specific infiltrate in the bottom and edges. The discharge from the ulcer is mostly not purulent, but serous-sucrose, not profuse.

When you squeeze the bottom of the ulcer between your thumb and index finger, you get a feeling of density and hardening. Where did the name of this lesion come from - chancroid or primary sclerosis.

Typically, erosions or ulcers of primary syphilis are single. However, in cases where the infection occurs simultaneously through several lesions, multiple erosions or ulcers are formed. They are at approximately the same stage of development, which is very typical for such lesions.

The size of erosions or ulcers of chancre varies. On average, it ranges from a few millimeters in diameter (dwarf chancre) to a centimeter in diameter or more (giant chancre).

Most often, their size reaches an average of ½ cm - 1 cm. If erosions or ulcers are located in skin folds, they lose their characteristic round or oval shape and become oblong, in the form of cracks.

The average duration of existence of hard chancre is from 3 to 6 weeks. Then it begins to heal, leaving temporary pigmentation after erosion or a permanent mark in the form of a scar after an ulcer. This is, in general terms, the usual course of chancre.

In typical cases, the appearance and development of hard chancre occurs without noticeable inflammatory phenomena along the periphery. However, sometimes it can be complicated by acute inflammatory phenomena, gangrene, phagedenism and associated chancroid.

Acute inflammatory phenomena can complicate the course of chancroid. Both due to contamination by pyogenic microbes, and from the introduction of chancroid sticks.

Uncleanliness and inappropriate treatment in the form of excessive cauterization irritants, for example, lapis, copper sulfate, etc. also often contribute to the appearance of acute inflammatory phenomena.

The picture of chancre in these cases will differ from the usual one: redness appears around the chancre, the sharpness of the boundaries is lost, and the nature of the erosion may change - it becomes painful and separates a lot of pus. In appearance, it becomes similar to a chancre ulcer. The healing of such an ulcer is delayed.

And only after the source of inflammation has been eliminated, it again takes on the typical picture of chancre. As a result of sometimes developing inflammatory phenomena, men may develop phimosis and paraphimosis. And women have sharp, dense swelling of the lips major and minor. In some cases, with hard chancre, regardless of their size, a special peculiar swelling develops around the chancre, which does not have an acute character inflammatory edema. This is the so-called indurative edema - oedema indurativum, which is extremely characteristic of the primary period of syphilis. With this swelling from pressure, there is no pitting and there is no redness (the color is dark red, with a bluish tint).

The swelling exhibits a special dense elastic consistency. Most often, indurative edema develops in men on the foreskin and scrotum, in women - on the labia majora and minora. When complicated by gangrene, a small area of ​​superficial necrosis forms in the center of the chancre, in the form of a dense grayish-black mass.

If the course is favorable, after a few days the area of ​​necrosis is cleared, the ulceration granulates, scars and heals. In other cases, necrosis quickly spreads, the ulcer is covered with a solid black scab, tightly fused to it. Then the scab becomes mobile, falls off and the ulcer heals with the formation of an irregular, ugly scar. The course of such chancre is long and painful for the patient. When the causes that caused gangrene are eliminated, healing, although it will be slow, does not cause major tissue destruction and ugly scars.

Phagedenism (necrotization) It also begins with gangrenization of the surface of the ulcer, and the ulcer can heal on one edge and spread further on the other.

Once the gangrenous scab falls off, the process does not stop. Gangrenous outbreaks are repeated and, as a result, deep tissue destruction occurs. So, for example, destruction of the entire big lips, entire foreskin, etc.

Phagedenism develops mainly in severely malnourished people, alcoholics, the elderly, and tuberculosis patients. When simultaneous infection with chancroid and syphilitic infection occurs, the so-called mixed chancroid – ulcus mixtum – develops. In this case, on the second or third day, one or more typical deep ulcers of the chancre are formed.

With undermined soft edges, a greasy bottom, with copious purulent discharge, with noticeable inflammation along the periphery, very painful.

After two to three weeks, when the first incubation period expires, phenomena characteristic of syphilis appear, and the edges and bottom of the ulcers acquire a specific cartilaginous density. After the ulcer heals, it leaves scars that are located on the seal. The latter disappears after some time.

In some of these cases, the disease is accompanied by the formation of an inflammatory bubo, characteristic of chancroid. But subsequently the glands acquire changes typical of syphilis.

Atypical chancroid

Hard chancre can be localized anywhere human body, depending on where the infection penetrates. Most often, the primary syphilitic lesion is localized on the genital parts, resulting from infection during sexual intercourse.

Atypical chancre(extragenital sclerosis) can be localized on the lips, mouth, pharynx, and tongue.

On the cheeks, on the gums, on the wings of the nose, on the eyelids, on the breast nipples, on the arms, on the legs and other places.

Histologically, with the primary syphilitic phenomenon - chancre, the most significant changes occur in the vessels - lymphatic, arterial and venous.

The spirochete penetrates through damaged skin or mucous membrane, first into the intercellular spaces and then into the lymphatic crevices and capillaries of the skin itself. It causes inflammatory phenomena of varying degrees, with the release of lymphocytes from the vessels, changes in the walls of blood vessels and the formation of a special cellular infiltrate around them.

The latter consists of lymphocytes, plasma cells, proliferating connective tissue cells, as well as a few epithelioid and giant cells.

The vascular endothelium multiplies, desquamates, blood clots appear, blockage of the lumens of blood vessels, and tissue breakdown.

The density of chancre depends on the sharply developed limited cellular infiltration of blood vessels, and also, apparently, on their hyaline degeneration. Some also associate this density with the development of a finely looped network of lattice fibers in the infiltrate.

The pale spirochete is found between epithelial cells. And also in the lumen of blood vessels, especially lymphatic ones, in their walls and along the periphery.

The rapid spread of the spirochete depends on its early penetration into the lumens of blood vessels and intercellular spaces, on its rapid entry into the lymphatic system, glands and epidermis, from where it can also serve as an easy source of infection.

The presence of the spirochete causes significant changes in the skin itself, as well as in the epidermis. Where vacuolar degeneration develops, the death of a number of layers, rejection of the horny, granular, spiny, erosive chancre occurs. If there are changes in the blood vessels, endo-meso-peri-vasculitis leads to blockage of blood vessels, causing disorders in tissue nutrition and tissue breakdown, destruction of the skin itself, and ulcerative chancroid occurs.

With erosive chancre, the death of the skin itself and underlying tissues does not occur. Therefore, the process ends without a lasting trace; the epidermis from the periphery of the erosion, growing, compensates for the former defect.

With ulcerative chancre, not only the papillary layer is destroyed. But often also the deeper parts of the skin and subcutaneous fat. Therefore, after an ulcerative chancre there is always a permanent mark, a scar.

A constant companion of chancroid is the so-called primary lymphadenitis. It develops 1-2 weeks after the appearance of chancre.

Depending on the location of the chancre, the corresponding lymph glands thicken and swell. So, for example, when sclerosis is localized on the genitals, the inguinal glands are affected earlier than other glands.

When sclerosis is localized on the chest or arm, it is affected axillary glands or elbows.

If sclerosis is located on the tonsil, then the submandibular or anterior ear gland is affected.

If on the lips, then the submandibular glands, etc., swell; with syphilitic primary adenitis, one gland swells. Later, other glands of this group enlarge.

The glands gradually acquire a special density, different sizes, and are not fused to each other, neither to the skin, nor to the underlying tissues. The glands are painful, round or oval in shape, often arranged in a row in a distinct manner.

Swelling lymph glands with syphilis it is not limited to the location of the primary sclerosis. 3-4 weeks after the appearance of the latter or 7-8 weeks after infection, all other lymph glands swell and enlarge. General polyadenitis develops. This is a progressive enlargement of the lymph glands. It, like a number of other characteristic painful symptoms, precedes the appearance of secondary syphilis - general polyadenitis develops at the end of the primary period.

Diagnosis of chancre

Hard chancroid is diagnosed based on the clinical manifestations described above and the presence of a pale spirochete in the discharge of erosions or ulcers. Some blood reactions are not important in the diagnosis of primary sclerosis, because they become positive only 4-6 weeks after infection.

At differential diagnosis You should first of all keep in mind chancroid.

The clinical picture of a typical hard chancre differs sharply from that of a soft chancre.

A developed soft chancre is an ulcer; a hard chancre can be in the form of erosion, disappearing without a lasting trace. If you are dealing with ulcerative chancroid, it usually does not have inflammatory phenomena along the periphery, but soft chancroid does.

The edges of an ulcer of a soft chancre are undermined, while with a hard chancre they are dense, not undermined, and go directly into the bottom, which is usually smooth, shiny, and the discharge of the ulcer is scanty. In addition, with a soft one, the bottom of the ulcer is uneven, has separate depressions, and abundant purulent discharge.

An ulcer of a soft chancre is painful, a hard one is usually painless.

The number of ulcers with syphilis is always less.

Soft chancre is usually multiple - new ulcers gradually form, since their secretion is easily released. With syphilis, new ulcers do not appear - their secretion does not appear in the patient, or more precisely, it appears only during the first 10-12 days of the existence of the primary phenomenon.

Objective data are supplemented with chancroid by the presence of characteristic painless primary lymphadenitis or polyadenitis.

In mild cases, the glands are painful, welded together, with subcutaneous tissue, skin, and have a tendency to produce buboes.

When examining the discharge of ulcers or punctate lymph glands in syphilis, a pale spirochete is detected, with chancre streptobacillus.

The anamnesis complements the clinic - with chancre the incubation period is short - 2-3 days, with syphilis - 2-3 weeks.

Primary lymphadenitis is always observed with hard chancre; with soft chancre, adenitis may be absent. Lymphangitis does not always occur with syphilis, for example, along the back of the penis.

If it is present, unlike soft-chancroid lymphangitis, there is no inflammatory swelling of the skin - it is not fused either to the skin or to the underlying parts.

With chancre, there are usually severe inflammatory phenomena. And sometimes the transition of lymphangitis to suppuration, then the so-called bubonulus is formed - a small bubo. In many cases, it is practically important to promptly distinguish erosive chancroid from erosions of herpes, which often recurs on the genitals. However, a careful examination usually reveals that erosion after herpes resulted from the merger of a group of erosions after former blisters. Since about the periphery there are scalloped outlines of the lesion and the inflamed background on which they arose. When palpating the erosion of herpes, they do not detect compactions or infiltrates, which are so characteristic of chancroid.

Concomitant lymphadenitis, if it occurs with herpes, is usually of an acute inflammatory nature. Bacterioscopic examination facilitates diagnosis.

If you suspect syphilis, contact the author of this article, a venereologist in Moscow with 15 years of experience.