Soft chancre (chancroid)

A soft chancre (chancroid) is a sexually transmitted infection, manifested by a painful ulcer at the site of the pathogen and a purulent lesion of the peripheral lymph nodes.

The causative agent of soft chancre is Petersen-Ducray streptobacillus.

Infection occurs sexually.

Soft chancre is widespread in states with a tropical and subtropical climate.

The latent period of soft chancre is 4-7 days from the moment of infection.

There are the following forms of soft chancre:

  • funnel-shaped soft chancre, in which a deep ulcer is located in the neck of the glans penis;
  • gangrenous – characterized by gangrenous fusion of tissues on the head of the penis due to the addition of fusospirillosis or anaerobic infection;
  • diphtheroid – in which the ulcers are covered with a greenish-gray fibrinous coating, due to the attached infection with a false diphtheria bacillus;
  • impetigenous – clinically similar to impetigo;
  • serpinginous – an atypical form of a soft chancre, in which the ulcer heals with a scar from one side and increases from the other;
  • follicular – an atypical form in which multiple small ulcers appear with slightly raised edges and a deep compacted bottom, which is due to the penetration of the pathogen into the ducts of the sebaceous glands or into the hair follicles;
  • mixed – observed with simultaneous infection with syphilis and soft chancre, when an ulcer characteristic of a soft chancre then acquires the features of a hard chancre.

Ulcers of soft chancre have jagged edges, a deep pitted bottom with a yellowish coating, purulent discharge. Surrounded by an acute inflammatory corolla, but there is no infiltration, so the ulcer appears soft to the touch. The size of ulcers – from the size of a pinhead to the palm of your hand and more. They are characterized by significant pain and bleeding. Ulcers are traditionally multiple, merge with each other. Possible autoinfection. As a rule, soft chancre ulcers are localized on the genitals – the inner sheet of the foreskin, in the coronal groove, on the frenulum of the penis, the sponges of the urethra, in the scaphoid fossa, on the large and small labia. Sometimes there are primary extra-sexual manifestations of a soft chancre, for example, in connection with the professional activities of medical workers. They can be located on the hands or fingers.

Secondary extra-sexual chancres are often observed. We are talking about chancres that appear as a result of pus flowing from ulcers located on the genitals, to nearby areas of the skin of the inner plane of the thighs or to parts of the body remote from the genitals. This phenomenon is observed in the case when the infection in these areas is transferred by the hands of the diseased themselves. Lesions of the lymphatic system can join, phimosis and paraphimosis also develop. Lymphangitis and lymphadenitis are classified as specific complications, since they are caused by the penetration of chancre pathogens into the lymphatic pathways.

Sometimes there is erysipelas. In rare cases, genital warts appear.

Lymphangitis in the bulk of cases is observed on the back of the penis and on the outer plane of the labia. It manifests itself in the form of a compacted painful cord. The skin over the thickened surface is hyperemic and edematous, palpation is painful. In rare cases, inflammatory nodes are formed along the course of the painful cord, which can suppurate, and then turn into bubobules (Nisbet’s chancres).

The most typical sign of a soft chancre is regional lymphadenitis (bubo), which occurs 2-3 weeks after infection. It usually develops due to the late start of treatment of the chancre, irritating local therapy, the development of phimosis or paraphimosis, physical overload, etc. Lymphadenitis begins with soreness and enlargement of the lymph node, which merges with surrounding tissues.

With the localization of a soft chancre on the genitals, the inguinal, sometimes femoral, lymph nodes increase. They are painful due to periadenitis, soldered to each other, to nearby tissues and skin. A local reaction is also expressed by reddening of the skin over them. Patients often complain of chills, fever, general weakness. In the future, suppuration of the node may occur with subsequent opening of it, the release of a large amount of pus and scarring of the resulting ulcer. The scar is formed after 3-4 weeks. In rare cases, the bubo is characterized by more pronounced and rapidly growing inflammation, the development of a phagedenic ulcer (the rate of necrosis prevails over the rate of regeneration), and slow healing. However, in some patients, the bubo opens even after 2–3 weeks. turns into a typical soft chancre ulcer, in its liquid purulent discharge sticks of a soft chancre are found. Healing with scar formation lasts more than a month.

In cases where swelling of the foreskin occurs, phimosis may develop. At the same time, the head of the penis cannot be exposed, and the pus accumulating under the foreskin is released through a narrow preputial opening. In the purulent discharge, causative agents of the soft chancre are found. Due to autoinfection, chancre ulcers appear around the circumference of the prepuce. With swelling of the foreskin behind the naked head of the penis, paraphimosis is possible. Its outcome may be gangrene of the glans penis due to tissue compression by the ring of edematous foreskin.

With proper treatment, the condition improves after three days.

Reasons for treatment failure : incorrect diagnosis, a combination of soft chancre with another sexually transmitted disease, HIV infection, non-compliance with medical prescriptions by patients.

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