Shankroid

Description:

Shankroid (venereal ulcer, the third venereal disease) is an acute venereal infection which is shown by erethistic multiple ulcers of generative organs and an inflammation of lymph nodes.

Shankroid is an endemic disease for the countries of Africa, Southeast Asia, Central and South America, and in some regions the disease prevails over syphilis. Shankroid is registered in Great Britain, Portugal, Italy, the USA and other countries. In the USA it is annually reported not less than about 1000 cases. In many large cities of the United States шанкроид became an endemic disease; at the same time incomplete registration of this infection is eurysynusic. In the countries of the former Soviet Union шанкроид meets seldom, generally infection occurs during trips abroad.

According to messages of the American physicians, шанкроид it is closely connected with HIV infection. About 10% of patients with shankroidy are at the same time infected with causative agents of syphilis and genital herpes.

Shankroid's symptoms:

The incubation interval of a shankroid lasts, as a rule, not for long: 3-5 days at men and up to 10 days at women. Sometimes it can longer last, up to several weeks, but it is a rarity. Sometimes the incubation interval of a venereal ulcer, on the contrary, is shortened to 2 or even 1 day.

After the termination of an incubation interval on site of implementation of the activator - a streptobacillus the small edematous spot of bright red color appears, in its center the small knot, on site which soon there is a bubble with purulent contents is soon formed. In several days the bubble is opened, and on its place the chancre - an erethistic ulcer with a diameter from several millimeters to several centimeters and irregular shape is formed.

The ulceration formed on site implementations of the activator quickly expands, increasing also in the diameter (to 1-1,5 cm), and in depth. The ulcer at a venereal ulcer of a krovotochiv is also sharply painful that distinguishes it from the hard ulcer arising at syphilis. The basis of an ulcer and she soft to the touch (from here and the name of a disease "venereal ulcer"), uneven edges of an ulcer are surrounded with an edematous inflammatory nimbus, the bottom is covered is purulent - a bloody plaque. Getting on surrounding fabrics, this purulent discharge provokes formation of new multiple ulcerations, the smaller size so single ulcers at a venereal ulcer meet seldom. New small ulcers usually are located on the periphery around a big ulcer. Merging, they form the new big, as if "creeping" ulcer. Most often at a shankroida at the same time there are many ulcers which are in different stages of development.

Most often primary chancres (ulcers) at a venereal ulcer are formed in the field of generative organs:
- on an internal leaf of a prepuce
- in a coronal furrow
- on a penis bridle
- urethra sponges
- in a navicula
- on big and small vulvar lips

But also other options of their localization - so-called, primary extra sexual manifestations of a venereal ulcer are possible (that is the manifestations arising out of generative organs).

Their arrangement depends, first of all, on under what circumstances there was infection with a venereal ulcer. Sometimes it is, however, quite rare, the ulcer is formed in the field of an anus (here it represents a deep painful crack), is even more rare - on mucous than a mouth if infection occurred at proctal or oral sexual contact. Besides, cases of emergence of primary extra sexual displays of a venereal ulcer in connection with professional activity at health workers were described. In a similar case of an ulceration, caused by a venereal ulcer, can be located on brushes or fingers of hands.

Except primary extra sexual manifestations formation of secondary extra sexual manifestations of a venereal ulcer is possible. Such chancres arise at flowing purulent separated primary ulcer on nearby sites of skin of an internal surface of hips or on body parts, remote from generative organs. Patients who literally own hands move an infection from the struck generative organs to other areas of a body "are most often guilty" of emergence of secondary chancres.

Process of formation of chancres (ulcers) continues, as a rule, 2-4 weeks then the bottom of an ulcer is cleared, and still after a while there is a healing to formation of a small hem. In uncomplicated cases healing occurs in 1-2 months after infection if the current of a venereal ulcer was complicated, then it is required to time for healing of ulcers more. In the absence of full treatment of a venereal ulcer damage of lymph nodes and vessels which leads to numerous complications becomes the following step of a venereal ulcer.

Sometimes ability of a shankroid to peripheral growth gains the expressed character, at the same time there is a so-called serpiginozny venereal ulcer. Its feature is that the ulcer, cicatrizing in the center, extends from generative organs to a pubis, hips, promezhnost area of an anus.

The ulcer at a shankroida can extend not only on the periphery, but also deep into. At such growth of an ulcer there can be a gangrenous kind of a venereal ulcer which is considered the heaviest and fraught with especially dangerous complications.

At a gangrenous kind of a shankroid the ulcer gets into depth, baring cavernous bodies. The patient has a fever, body temperature increases, the septic phenomena develop; sometimes there is a destruction of cavernous bodies which is followed by severe bleeding. In certain cases the sphacelism gets the long progressing current, striking extensive sites of skin. In this case it is about a phagedenic venereal ulcer.

At the initial stage of development of a shankroid full treatment of sick difficulty does not represent. Certainly, only the venereologist has to carry out treatment. In the absence of serious complications and the started disease treatment comes within 7-10 days. However the human body does not develop immunity to a venereal ulcer therefore repeated infection remains possible.

Complications of a shankroid
Most often meet: limfangiit (an inflammation of lymphatic channels), lymphadenitis (an inflammation of lymph nodes), a phymosis (narrowing of an opening of a prepuce), a paraphimosis (infringement of a balanus the narrowed prepuce).

Limfangiit it is observed on a dorsum penis and on an outside surface of vulvar lips. It is shown in the form of the condensed painful tyazh. Skin over a reinforced surface is hyperemic and edematous, the palpation is painful. In rare instances on the course of a painful tyazh there are inflammatory nodes which can suppurate, and then turn into bubonul (Nisbet's chancres).

The most typical sign of a shankroid is regional lymphadenitis (bubo) arising in 2-3 weeks after infection. Lymphadenitis is characterized by sharply arising unilateral increase in one or several lymph nodes soldered among themselves and to skin. Over the affected lymph nodes skin gains bright red color. The inflammation of lymph nodes can independently pass after a while, the formed bubo at the same time resolves. Suppuration is possible: in the center of a bubo fluctuation appears, and it is opened with release of dense pus with blood impurity. The ulcer which is formed at the same time cicatrizes afterwards.

When there is prepuce hypostasis, the phymosis can develop. At the same time the balanus does not manage to be bared, and the pus accumulating under a prepuce is emitted through a narrow preputial opening. In purulent separated find activators of a shankroid.

At hypostasis of the prepuce which is behind a naked balanus the paraphimosis is possible. Gangrene of a balanus owing to squeezing of fabrics a ring of an edematous prepuce can be its outcome.

Shankroid's reasons:

The activator of a shankroid is the stick of a venereal ulcer of Haemophilus ducreyi. For the first time the stick of a venereal ulcer was described in 1887 by the Russian scientist O. W. Petersen. In 1889-1892 it was in detail studied by the Italian dermatologist A. Dyukryoy and the German dermatologist P. G. Unna. By name these three scientists-researchers the stick of a venereal ulcer received the second name - a streptobacillus of Dyukreya-Unny-Petersena.

Sticks of a shankroid are located in the defeat center with quite characteristic image: parallel ranks. Researchers compare an arrangement of sticks of a venereal ulcer in a pus smear to "chains" or "flocks of fishes". A streptobacillus has the rounded-off ends and a banner in the middle, their length makes 1,5-2 microns, and thickness of 0,4-0,5 microns. Infection with a venereal ulcer occurs, as a rule, during sexual contact when a streptobacillus gets or on the injured skin, or on a mucous membrane of generative organs.
Sticks of a shankroid well transfer low temperatures, they are rather steady against various chemicals too. However at a temperature above 40 °C the streptobacillus perishes.

Infection occurs sexually, and the persons rendering sex services play here not the last role. In seamen and the military personnel of the USA having sexual contacts preferential with prostitutes шанкроид it is found more often than syphilis. Promote infection of injury of skin or mucous membranes. Very seldom, but extra sexual transmission is possible. There are messages on infection of children and health workers.

Shankroid's treatment:

As a rule, шанкроид rather easily and completely recovers by means of antibiotics or sulfanamide drugs. Antibiotics which action is directed to destruction not only a streptobacillus, but also pale treponemas - causative agents of syphilis are most often used.

The course of treatment of a venereal ulcer usually makes 1-2 weeks then the patient within half a year has to visit preventively the doctor to avoid a recurrence and development of other infections, the most dangerous of which is syphilis.

Except antibiotics of a systemic effect at treatment of a shankroid local antibiotics, as a rule, in the form of ointments which help to eliminate the clinical symptoms of a venereal ulcer causing to the patient pain and inconveniences are used.
Besides, in treatment of a venereal ulcer as the means supplementing the main treatment fortifying and immunomodulatory drugs are used.
If the patient addresses the venereologist with the started form of a venereal ulcer which managed to give complications, then sometimes the doctor should resort to surgical intervention. Therefore treatment of a venereal ulcer needs to be begun at earlier stage of a disease.