What is a chancre when infected with syphilis. Syphilitic chancre: what it is, what it looks like in men, treatment

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

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Chancre

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

The base of the formation is distinguished by a bright red color; a transparent film with a characteristic sheen covers it on top. If it is located on an open area of \u200b\u200bthe skin, the film acquires a dirty shade. The shape of this variety of chancre is correct, with smooth edges. It has a clear border with surrounding tissues.

Chancre

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

Chancroid

Streptobacillus Ducrey is the cause of soft chancre. This species is also called venereal ulcer, chancaroid or venereal disease III.

Initially, a reddish edema of a small size is formed, the edges of which rise and are uneven. The base of the ulcer is irregular in shape, bright red in color and profusely purulent. One of the pronounced signs of a soft chancre is an increase in local lymph nodes.

Chancroid

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

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

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

Localization

Experts call hard chancre a syphilitic "marker", since the primary location of the ulcer on the skin indicates the site of infection in the body. The most common way of infection is a sexual act, in most cases the formation of this type is located in the area of the external organs of the reproductive system.

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

Localization

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

Development of the disease

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

Initially, a reddish spot is formed. Gradually, the epithelial tissue is destroyed, erosion is formed. An ulcer appears when the spirochete reaches the subcutaneous tissue layer, submucosal layer, or muscle layer.

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

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

The nature of the development of the soft chancre is standard. The incubation period for men is from 3 to 5, for women - from 7 to 11 days after the infection enters the body. The immune system does not cope with the influence of the pathogen, so cases of re-infection are possible. This pathology is similar in appearance to solid chancroid, but differs from it in the presence of pronounced pain.

The development of the disease begins with reddening of the infected area and the formation of a small purulent capsule. In a short time, the capsule bursts, in its place a weeping ulcerative seal is formed. An ulcer of this type is characterized by an irregular shape, an intense increase. The size of the formation is from 10 to 20 mm. In the inner part there is an accumulation of blood and pus.

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

Symptoms

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

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

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

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

With the development of the disease, a hard ulcer is formed, characterized by the following symptoms:

rounded form of ulcer formation;
size - from 0.1 to 5 cm;
brown-red color of the base;
the presence of yellowish pus at the bottom;
preservation of the original form throughout the entire period of development of the ulcer;
absence of itching and pain symptoms;
when pressed, a clear liquid is released from the hard chancre, which has a slightly yellowish tint;
independent disappearance of the ulcer after 3-12 weeks.

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

Complications

After the incubation period, the disease passes into a more advanced stage - an aggravated chancre, the main symptom of which is the defeat of the lymph nodes:

Lymphadenitis - the size of the nodes increases, they unite, and the skin above them turns blue. Inside, pus is formed, which leads to the development of sepsis if it enters the circulatory system.
Lymphangitis - the lymph node thickens, the skin over it turns red and swells, which is accompanied by intense pain.

A neglected disease over time leads to the appearance of other complications in any person, regardless of gender. Men often develop phimosis - the foreskin swells, pus is released from the glans penis. Often there is another complication - paraphimosis - the foreskin becomes inflamed, which is accompanied by exposure of the head and leads to necrosis.

Treatment

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

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

Standard therapy includes the use of antibiotics, specialized topical ointments and antiseptic formulations. Most often, penicillins are prescribed, which have the highest effectiveness against pale treponema (Bicillin, Ampicillin). Antibiotic therapy is supplemented with agents that stimulate the functions of the immune system and normalize the intestinal microflora. Physiotherapy procedures are prescribed. The use of modern therapeutic techniques allows you to completely eliminate the infection at the primary stage of development.

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

At the same time, they get rid of primary syphilis, and the hard chancre is eliminated as its main symptom. Systemic medications can destroy pale treponema, and local therapies are signs of the disease. When developing a treatment regimen, a specialist takes into account the characteristics of each specific situation - allergic reactions to certain drugs, the severity of the course of the disease, the localization of ulcers, etc.

Unfortunately, not everyone tries to protect themselves from various diseases. It is for this reason that some people become victims of the most dangerous diseases. Some of these diseases can even lead to death. One such dangerous disease is syphilis. On the initial development of syphilis on the body of a sick person appear chancre.

What is primary syphilis?

Primary syphilis called the initial stage of syphilis, which develops after infection with pale treponema. Primary syphilis begins with formations on the skin, as well as with penetration inside. With primary syphilis, a hard chancre appears on the body. These formations can form both on the skin and on the mucous membranes.

Currently, modern medicine has identified some differences regarding the clinical picture of primary syphilis, compared with those manifestations that were noticed before.

For example, earlier at the initial stage of development of syphilis, the chancre was formed in a single amount in almost 90% of patients. Currently, chancres began to appear on the skin in the amount of two formations. In addition, the chancres began to increase in size.

In another article on our site, we discussed.

Solid syphilitic chancre - the initial stage of syphilis

Primary chancre at the very beginning, it looks like a red spot, which eventually turns into erosion.

The main signs of a hard syphilitic chancre:

The diameter of the spot on the skin or mucous membrane can reach 5 cm.
The shape of the spot is oval.
Education has clear boundaries.
The color of the spot is red or burgundy.
The presence of yellow purulent plaque.

Hard syphilitic chancre is never accompanied by pain or itching. Many people simply do not notice it because of this on their body. If you press lightly on the stain from the side, then a yellow liquid may stand out from it.

Healing of a hard chancre occurs within a month. After that, this formation on the body does not leave any visible marks. But, despite this, it is worth noting that the disappearance of a hard chancre indicates that the disease can take a latent form.

Among women

Syphilitic hard chancre in women is a very dangerous venereal disease. Even at the initial stages of its development, syphilis is a serious infection for sexual partners, and at an advanced stage, the disease can cause death.

In order for the treatment to give some positive result, the chancre in a woman must be identified at the initial stages of its formation.

The period of manifestation of chancre after infection usually takes about 3 weeks. In women, a hard chancre may form on the labia or clitoris. However, it is much more difficult to detect a formation if it is localized inside the vagina. Such a chancre can be noticed only by chance during a gynecological examination. It is for this reason that you should not neglect regular visits to a female doctor.

In men

Solid syphilitic chancre in men, as a rule, manifests itself in the area of \u200b\u200bthe genital organ. To be more specific, it affects the head of the penis, the coronal sulcus and the scrotum.

If a man is a supporter of non-traditional sexual orientation, then formations may appear in the anus and in the mouth. In size, chancre in men can be both miniature and giant. Moreover, it is worth noting that the most contagious are miniature chancres, which are only a few millimeters in diameter.

The first symptoms of a hard syphilitic chancre may appear both 2 weeks after infection and 3 months later. A hard chancre is formed, usually in the place that was subject to the introduction of pale treponema, the main provocateur of the disease.

The most common sites of infection are the genital organs of a person. However, at present, more and more cases have begun to occur when the chancre appears on the abdomen, thighs, face and fingers.

External distinguishing features of a solid syphilitic chancre:

Formation of fleshy erosion.
The diameter of the formation can reach several cm.
Erosion has raised edges.
The stain has a burgundy or red tint.
A liquid is released from erosion, which externally makes it lacquered.
The base of the formation is a dense infiltrate.

A photo

IT'S IMPORTANT TO KNOW!

As a rule, syphilitic chancre is divided into the following types, which differ in symptoms:

Giant hard chancre most often formed at the site, which is characterized by abundant fatty tissue under the skin. The size of such a chancre can reach the size of a child's palm.
Dwarf hard chancre differs in its size, which can reach the size of a poppy seed.
Diphtheritic chancre differs in that its surface is covered with a gray film, like diphtheria. This species is very common.
Cortical hard chancre It is formed on those parts of the body where the discharge easily dries out (nose, lips, face).
The slit-like chancre looks like a crack. Most often, this type is formed in the corners of the mouth, between the fingers and in the anus.

Symptoms of a syphilitic chancre

As mentioned earlier, at the first stage of the development of syphilis, a hard chancre forms on the body.

The main symptoms of the initial stage of syphilitic chancre:

The formation of a spot of red-brown spots (most often on the genitals).
No inflammation.
The ulcer can be up to 5 cm in diameter.
The presence of yellow plaque in the center of the ulcer.

After a few weeks, all these symptoms may disappear, but this only indicates that the second stage of the disease will soon come.

Atypical form

Primary syphilis is characterized by the appearance of an atypical form of hard chancre.

Atypical hard chancres have a number of some features:

The formation of syphiloma, which differ in their compaction. It differs from ordinary edema in that after pressing on the formation, there are no pits on the body.
Amygdalitis- the formation of a chancre, which is painful and located in the throat of a person. Amygdalitis is very easy to confuse with a common sore throat. But it differs from angina in the absence of temperature and an increase in only one tonsil.
Chancre panaritium characterized by a purulent process that manifests itself at the fingertips. This type of chancre is accompanied by the presence of severe pain and even fever.
Syphiloma-herpes. In this form, the head of the penis and the inner leaf of the foreskin become inflamed.

Atypical forms of chancre create serious problems in diagnosis. They are also capable of causing serious complications aimed at blood circulation and tissue trophism.

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Healing of syphilitic chancre

Earlier it was said that the healing of a syphilitic chancre does not mean the disappearance of the disease. Healing of syphilitic chancre most often occurs after 1-2 months after its formation on the body.

The ulcer heals on its own, even if the patient did not seek the help of a specialist and did not use any methods of treatment. After healing, only a pigment spot or a small scar remains at the site of the ulcer.

How long does it take for symptoms of secondary syphilis to appear?

Secondary syphilis is a process that is fully consistent with the development of infection in the body. This type of syphilis follows almost immediately after the manifestation of the primary, that is, 2-3 months after pale treponema enters the body. Secondary syphilis can affect the somatic organs, limbs and nervous system of a person.

Diagnostics

Most often, the diagnosis of the disease at the first symptoms does not cause any special complications. Despite this, it is necessary to conduct a laboratory study. This process is able to detect the presence of pale treponema. For such studies, a smear or scraping is usually taken from the surface of the resulting erosion.

Differential diagnosis is carried out:

In the presence of traumatic erosion, which was formed on the patient's genitals.
In the presence of the usual allergic balanitis, which can occur in a person who does not follow the basic rules of personal hygiene.
In the presence of gangrenous balanoposthitis.
In the presence of a soft chancre.
In the presence of genital lichen.
In the presence of scabies ecthyma.
In the presence of an ulcerative process.
With the formation of ulcers on the labia in girls who are actively sexually active.

Treatment

It should be noted right away that the initial syphilis can be completely cured if treatment begins at the initial stages of the development of the disease. Before and after treatment, special studies should be carried out through a complex of serological reactions. In addition, the microprecipitation reaction is also included in the process.

Most commonly used in the treatment of primary syphilis penicillin and its derivatives. This drug is the only one to which the main causative agent of syphilis has developed resistance more slowly than to other drugs. If the patient does not tolerate penicillin derivatives, then others are selected for him.

Means that are also able to fight syphilis:

If the treatment is outpatient, then the following drugs are used:

Extencillin.
Bicillin 1.
Bicillin 3.
Bicillin 5.

If the treatment is stationary, then drugs are used, which include the sodium salt of penicillin. If the patient has intolerance to penicillin, then the drugs listed above are used.

Chancre is formed in patients after the end of the incubation period and is located at the site of the introduction of pale treponema into the skin or mucous membranes. Hard chancre is most often localized on the skin and mucous membranes of the genital organs (head of the penis, area of the preputial sac, anus in homosexuals, large and small labia, posterior commissure, cervical region), less often on the thighs, pubis, abdomen. Extra-genital chancres, which are much less common, occur on the lips, tongue, tonsils, eyelids, fingers, and any other area of the skin and mucous membranes where pale treponemas have penetrated. In these cases, they talk about the extragenital location of the primary syphiloma. Extragenital hard chancres, as well as when they are localized on the cervix (according to some reports, in 11-12% of cases) are often not detected, and primary syphilis is not diagnosed in a timely manner. The clinical picture of hard chancre, as a rule, is very characteristic. More often it is a single erosion of regular rounded or oval outlines, saucer-shaped with sharp clear boundaries, usually up to the size of the little finger nail, but may be more. The color of erosions is meat-red or similar to the color of spoiled fat, the edges rise slightly and gently sink to the bottom (saucer-shaped). The discharge of erosion is serous, scanty, and gives the chancre a shiny, "varnished" appearance. The most characteristic sign of a hard chancre is an infiltrate of a densely elastic consistency, which is palpated at the base of the erosion (hence the name - ulcus durum). In ulcerative hard chancre, the edges protrude above the bottom, the infiltrate is more pronounced. After healing, the ulcerative hard chancre leaves a scar, and the erosive one heals without a trace. Several chancres are much less common. Primary syphiloma is characterized by slight pain or complete absence of subjective sensations. In the discharge of primary syphiloma, when examining in a dark field, pale treponema is easily found.

In recent years, the number of changes in the clinical picture of hard chancre has increased. If, according to many authors, earlier one of the essential features of primary syphiloma was its loneliness (80-90% of cases), then in recent decades the number of patients with two or more chancres has noticeably increased. Along with this, there is a significant increase in the proportion of ulcerative chancres and their complication with pyogenic infection. The number of patients with chancres in the anogenital region has increased. A certain number of chancres in the oral cavity and in the anus are associated with sexual perversions. Thus, the proportion of chancres of the oral cavity is much higher in women. In men with extragenital localization, chancres are most often located in the anus. One of the features of the current course of primary syphilis is the absence in some cases of a clearly defined compaction at the base of primary syphiloma.

Atypical forms of primary syphiloma are relatively rare, usually they can be of several varieties: chancre-amygdalite, chancre-felon and indurative edema.

On the fingers, a hard chancre can occur, in the usual clinical form, but it can proceed atypically (chancre panaritium). Such localization of the chancre is observed mainly in medical personnel (laboratory assistants, gynecologists, dentists, etc.). Chancre panaritium according to the clinical picture, it resembles a banal panaritium of streptococcal etiology (club-shaped swelling of the terminal phalanx, severe pain), however, recognition is facilitated by the presence of a dense infiltrate, the absence of acute inflammatory erythema, and, most importantly, the presence of a characteristic regional (in the region of the ulnar lymph nodes) lymphadenitis.

Indurated edema as a manifestation of primary syphilis, it is located in the region of the labia majora, scrotum or foreskin, i.e., places with a large number of lymphatic vessels. Swelling of these areas is noted. A pronounced compaction of tissues is characteristic, with pressure on which recesses are not formed. Diagnosis of atypical chancre in the form of indurative edema is also facilitated by the presence of characteristic regional lymphadenitis, history, examination of the sexual partner, and positive results of a serological blood test for syphilis (in the second half of the primary period).

In a number of patients, primary syphiloma is complicated by an attached secondary bacterial infection. In these cases, they speak of complicated hard chancres.

For chankra-amygdalspa characterized by an increase and compaction of one tonsil in the absence of erosion or ulcers on it (if erosion or an ulcer of the primary period of syphilis is located on the tonsil, then they speak of primary syphiloma located on the tonsil).

When localized on the tonsil, a hard chancre can have one of three forms: ulcerative, angina-like (chancre-amygdalitis) and combined s ulcer against a background of angina-like. With an ulcerative form, the tonsil is enlarged, dense, against this background, a meat-red oval ulcer with gentle, even edges is observed. The mucous membrane around the ulcer is hyperemic.

At angina-like chancre there is no erosion or ulcer, there is a unilateral significant enlargement of the tonsil . It acquires a copper-red color, painless dense. The process differs from angina in the one-sidedness of the lesion, the absence of pain and acute inflammatory hyperemia. There are no general manifestations, body temperature is normal.

In the circumference of the tonsil, there are no pronounced inflammatory phenomena, sharp boundaries are noted, there is no temperature reaction and pain when swallowing. On palpation of the tonsil with a spatula, its elasticity is felt. In these cases, on the surface of the tonsil (after light stroking with a platinum loop), a large number of pale treponemas are easily found. Diagnosis is facilitated by the presence of regional scleradenitis characteristic of the primary period of syphilis on the neck at the angle of the lower jaw (lymph nodes ranging in size from large beans to hazelnuts, mobile, densely elastic consistency, not soldered to the surrounding tissue, painless) and the appearance of positive blood serological reactions.

Complications of hard chancre include balanitis, balanoposthitis, phimosis, paraphimosis, gangrenization and phagedenism. Balanitis and balanoposthitis are the most common complications of chancre. They arise as a result of the addition of a bacterial or Trichomonas infection. In these cases, puffiness, bright erythema, maceration of the epithelium appear around the chancre, and the discharge on the surface of the chancre becomes serous-purulent. The latter circumstance greatly complicates the detection of pale treponema and, therefore, diagnosis. To eliminate inflammation, lotions with isotonic sodium chloride solution are prescribed (for 1-2 days), which makes it possible in most cases to establish the correct diagnosis during repeated studies.

Balanoposthitis can lead to a narrowing of the cavity of the foreskin, which does not allow opening the glans penis. This state is called phimosis. With phimosis due to swelling of the foreskin, the penis appears enlarged, reddened, painful. Hard chancre, localized in these cases in the coronary sulcus or on the inner layer of the foreskin, cannot be examined for pale treponema. Diagnosis of syphilis is facilitated by the characteristic appearance of regional lymph nodes, in the punctate of which they are looking for the pathogen. An attempt to forcibly open the glans penis in the presence of phimosis can lead to another complication called paraphimosis ("noose"), in which the edematous and infiltrated preputial ring infringes on the head. As a result of a mechanical disturbance of blood and lymph circulation, edema increases. If measures are not taken in a timely manner, then necrosis of the tissues of the glans penis and the cavity of the foreskin may occur. In the initial stages of paraphimosis, the doctor, having released the serous fluid from the edematous cavity of the foreskin (for which the thinned skin is repeatedly pierced with a sterile needle), makes an attempt to “reset” the head. In the absence of effect, it is necessary to dissect the foreskin.

More severe, but rarer complications of chancre are gangrenization and phagedenism. They are observed in debilitated patients and alcoholics as a result of the addition of fusospirillosis infection. A dirty black or black scab forms on the surface of the chancre (gangrenization), which may extend beyond the primary syphiloma (phagedenism). Under the scab there is an extensive ulcer, and the process itself may be accompanied by fever, chills, headache and other general phenomena. After healing of a gangrenous ulcer, a rough scar remains.

Regional lymphadenitis (scleradenitis) is the second most important symptom of primary syphilis. It appears 7-10 days after the onset of a hard chancre. Since the time of Rikor, regional scleradenitis has been given a meaningful name "associated bubo". Rikor wrote: “He (scleradenite) is a faithful companion of the chancre, he accompanies him invariably, fatally he follows the chancre like a shadow ... There is no hard chancre without a bubo.” Fournier noted the absence of regional scleradenitis in only 0.06% of 5000 patients with primary active syphilis. However, in recent decades, according to a number of authors, regional scleradenitis is absent in 1.3-8% of patients with primary syphilis.

The lymph nodes closest to the chancre (most often inguinal) increase to the size of a bean or hazelnut, become densely elastic, they are not soldered to each other, surrounding tissues and skin, painless; the skin over them is not changed. Regional lymphadenitis continues for a long time and resolves slowly, even despite specific treatment. With the localization of a hard chancre in the cervical region and on the mucous membranes of the rectum, it is not possible to clinically determine regional lymphadenitis, since in these cases the lymph nodes located in the pelvic cavity increase.

With the localization of primary syphiloma on the genitals, inguinal lymphadenitis is most often bilateral (even in cases where the hard chancre is located on one side). This is due to the presence of well-developed anastomoses in the lymphatic system. Unilateral lymphadenitis is less common, it is usually observed on the side of the chancre localization, and only as an exception is of a "cross" character, that is, it is located on the side opposite the chancre. Recently, the number of patients with unilateral lymphadenitis has increased markedly (according to Yu.K. Skripkin, they account for 27% of patients with hard chancre).

Syphilitic lymphangitis (inflammation of the lymphatic vessels) is the third symptom of primary syphilis. It develops as a dense, painless cord the size of a nugged probe. Sometimes, along the cord, small bead-like thickenings are formed. In about 40% of men, lymphangitis is located in the anterior surface of the penis (with genital chancre).

Oral mucosal lesions are the most common. Hard chancre can occur on any part of the red border of the lips or oral mucosa, but is most often localized on the lips, tongue, tonsils.

The development of a hard chancre on the lip or mucous membrane of the mouth, as in other places, begins with the appearance of limited redness, at the base of which a seal occurs within 2-3 days due to an inflammatory infiltrate. This limited compaction gradually increases and usually reaches 1-2 cm in diameter. In the central part of the lesion, necrosis occurs and erosion of a meat-red color is formed, less often an ulcer. Having reached full development within 1-2 weeks, a hard chancre on the mucous membrane is usually a round or oval, painless meat-red erosion or an ulcer with saucer-shaped edges ranging in size from 3 mm (pygmy chancre) to 1.5 cm in diameter with dense elastic infiltrate at the base. In the scraping of the surface of the chancre, pale trenonemas are easily detected. Some erosions are covered with a grayish-white coating. When the chancre is located on the lips, significant swelling is sometimes formed, as a result of which the lip sags, and the chancre lasts longer than in other places. More often, one hard chancre develops, less often - two or more. If a secondary infection joins, then erosion can deepen, and an ulcer with a dirty gray necrotic coating is formed.

With the localization of the chancre on the lips or mucous membrane of the mouth, regional lymphadenitis develops 5-7 days after its appearance. This usually increases the submental and submandibular lymph nodes. They are densely elastic consistency, mobile, not soldered together, painless. However, in the presence of a secondary infection or traumatic moments due to the development of periadenitis, regional lymph nodes can become painful. Simultaneously with the submandibular and chin, superficial cervical and occipital lymph nodes may increase.

Atypical forms of primary syphiloma occur when a hard chancre is localized in the corners of the mouth, on the gums, transitional folds, tongue, tonsils. In the corners of the mouth and in the region of transitional folds, the hard chancre takes the form of a crack, but when the fold in which the hard chancre is located is stretched, its oval outlines are determined. When a hard chancre is located in the corner of the mouth, it can clinically resemble seizures, which are distinguished by the absence of compaction at the base.

On the tongue, a hard chancre is usually solitary, occurs more often in the middle third. In addition to erosive and ulcerative forms, in individuals with a folded tongue, when a hard chancre is localized along the folds, a slit-like form can be observed. When a hard chancre is located on the back of the tongue, due to a significant infiltrate at the base, the chancre sharply protrudes above the surrounding tissue, there is meat-red erosion on its surface. Noteworthy is the absence of inflammation around the chancre and its painlessness. A hard chancre in the gum area has the appearance of a bright red smooth erosion, which surrounds 2 teeth in the form of a crescent. The ulcerative form of the hard chancre of the gums is very similar to the banal ulceration and almost does not have any signs characteristic of primary syphiloma. Diagnosis is facilitated by the presence of a bubo in the submandibular region.

differential diagnosis. In typical cases, the differential diagnosis of chancre is not difficult and is based on very characteristic symptoms. However, with an atypical clinical picture or complicated chancres, it is necessary to carry out differential diagnostics with a number of diseases.

With herpes simplex in the genital area (herpes simplex), a group of vesicles is formed, located against a pink spot. After opening them, small grouped erosions form, which, when merged, form a continuous erosion, which has to be differentiated from erosive primary syphiloma. Herpetic erosion differs from the latter by finely scalloped edges, fragments of the epidermis, the presence of inflammatory hyperemia in the circumference of erosion, the absence of induration or the presence of a slight induration at the base, pain, negative results of studies on pale treponema and the absence of regional lymphadenitis. However, tests for treponema in these cases must be carried out several times (as well as serological blood tests for syphilis) in order not to miss a herpetiform hard chancre, which clinically very much resembles the erosion that forms with herpes simplex. In these cases, the compaction at the base of the erosion, the absence of subjective sensations, the presence of regional lymphadenitis, and, finally, the main thing, the detection of pale treponema, testify in favor of the chancre.

Chancre on the lips should be differentiated from herpes simplex, in which, unlike syphilis, rashes are preceded by burning or itching, erosion is located on a hyperemic, slightly swollen base and has microcyclic outlines. In addition, in herpes, erosive eruptions are preceded by blisters that never occur during the formation of the chancre. Unlike hard chancre, herpetic erosions are almost always characterized by rapid onset and rapid elicitation; in addition, herpes, unlike hard chancre, often has a relapsing course. It should be noted that with the prolonged existence of herpetic erosion on the lip, an infiltrative seal appears at its base, which enhances the similarity of erosion with primary syphiloma.

shancriform pyoderma is rare, but presents the greatest difficulty in differential diagnosis with a hard chancre. The etiology of the disease is streptococcal. A solitary erosion or, more often, an ulcer is formed, which is clinically very similar to primary syphiloma: rounded outlines, dense uncut edges and bottom, scanty serous or serous-purulent discharge and often regional lymphadenitis, which has all the features of syphilitic. The infiltrate always goes beyond the borders of the ulcer. The issue is finally resolved on the basis of multiple negative results of studies on pale treponema, the absence of treponema in the punctate of the lymph nodes and the negative results of repeated blood tests (Wasserman reaction).

Ulcerative chancre on the lip and oral mucosa may resemble a decaying cancerous tumor. It should be taken into account that the formed cancerous ulcer is located deeper than the primary syphiloma, its edges are very dense, uneven, often corroded, the bottom is uneven and bleeds easily. It should be borne in mind that cancer develops relatively slowly, more often in the elderly, and hard chancre in young people. Decisive in the differential diagnosis are the results of laboratory studies - the detection of pale treponema in syphilis and cancer cells in cancer in a scraping from an ulcer. With a gummy ulcer, there is also a dense infiltrate of the edges and bottom, but not so pronounced. Diagnosis is facilitated by the presence of a gummous rod and the nature of serological reactions.

Ulcers in miliary ulcerative tuberculosis of the oral mucosa, in contrast to hard chancre, are usually multiple, painful, have uneven and undermined edges, yellow dots (Trela points) can often be seen around them. Traumatic erosion and ulcer of the oral mucosa and erosion in pemphigus, aphthae differ from hard chancre in the absence of its characteristic compaction at the base. In addition, traumatic erosion usually resolves quickly after the cause of the injury is removed.

Erosions on the mucous membrane of the mouth and lips that occur with other diseases (lichen planus, leukoplakia, lupus erythematosus) differ from chancre in the absence of compaction at their base, as well as the presence of mucosal changes characteristic of these diseases around erosions that are characteristic of hard chancre .

Thus, the diagnosis of primary syphilis is made on the basis of the clinical kargin of primary syphiloma and regional lymphadenitis, with the obligatory presence of pale treponema in the discharged chancre or punctate of the lymphatic regional nodes. Serological reactions (in the primary seropositive period) and the results of confrontation (examination of the person from whom, in the patient's opinion, infection could have occurred) are an important help in the diagnosis.

Histopathology. Hard chancre is a powerful inflammatory infiltrate in the connective tissue layer, consisting of lymphocytes and plasma cells, more compact in the central part. The walls of the blood and lymphatic vessels are permeated with cellular infiltrate, there is a significant proliferation of the endothelium, up to the obliteration of the vessels, some vessels are thrombosed. There is no epithelium in the central part above the compact infiltrate. When stained for pale treponema, it is found in large quantities inside and around the walls of blood vessels.

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

Features and classification

Chancre in medicine is called a morphological element on the skin and mucous membranes, having an ulceration in the center. Such education has an infectious nature.

There are several classifications of pathology:

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

Note! In more than 92% of clinical cases, the location of the syphilis chancre is observed in the area of the organs of the reproductive system. The growing "popularity" of extragenital defect localization is associated with the spread of non-traditional types of sex.

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

Hard chancre - a defect that develops at the point of introduction into the body of the spirochete Tr.pallidum. Because it is the first symptom of a sexually transmitted disease, it is often referred to as primary syphiloma. It appears 3-4 weeks after infection. A hard chancre with syphilis is distinguished by a staging of development: it forms in the form of a small red spot, then thickens at the base, and its center erodes.

A soft chancre is a consequence of infection of the body with Streptobacillus Ducrey. Like syphiloma, this defect also changes several successive stages in its development. The resulting red edematous spot eventually turns into an ulcer with uneven raised edges. To the touch, its base has an average density.

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

Table: Characteristics of primary syphiloma and chancroid

Due to its wide prevalence, the chancre that develops against the background of syphilis is of great interest to medical science. What is characterized and what are the clinical features of the primary skin defect in this dangerous venereal disease?

Symptoms

The mechanisms of the formation of syphiloma (chancre) at the site of the introduction of the pathogen into the body are complex and insufficiently studied. It is believed that treponema easily penetrates into tissues at the site of the smallest skin defects, however, it is not uncommon for spirochetes to "leak" through an intact integumentary membrane.

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

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

genital organs;
anal-rectal area;
other localizations.

In exceptional cases, symptoms in primary syphilis are absent. In this case, they talk about the "headless" course of the disease.

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

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

A skin defect at the site of introduction of the spirochete appears immediately after the end of the incubation period. Typical signs of hard chancre include:

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

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

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

Features of the course of the disease in recent years

Venereologists note that today syphilis does not proceed in the same way as 20-30 years ago. The number of patients with multiple chancres has increased significantly. More common are deep ulcerative defects that heal with scar formation. In addition, sometimes primary syphiloma is characterized by the absence of pronounced density at the base of the defect.

Variants of the course of the disease that do not follow the classical scenario have also become common. What are atypical forms of hard chancre: we will analyze in the section below.

Atypical forms

Felon

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

The following signs of chancre panaritium are distinguished:

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

This atypical variant of syphilis often develops in health workers who often have to come into contact with infected material.

Amygdalitis

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

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

Angina-like chancre

Another atypical variant of the course of syphilis is called an angina-like chancre. With this form of pathology, there is a unilateral increase in the palatal proliferation of lymphoid tissue (tonsils), which acquires a copper-red color and high density. The ulcerative defect at the same time cannot be found.

It is possible to differentiate pathology from angina according to the following signs: the absence of soreness, bright hyperemia and pronounced symptoms of intoxication (dizziness, headaches, weakness).

Indurated edema

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

Complications

As a rule, primary syphiloma does not cause any subjective sensations and eventually disappears without a trace. However, in some cases, it can lead to the development of serious diseases. Specialists distinguish the following complications of hard chancre:

balanitis / balanoposthitis;
phimosis;
gangrenization;
phagedenism.

Balanitis is a frequent consequence of a primary syphilitic lesion in men. It develops with the activation of pathogenic and opportunistic flora, its main pathogens are Trichomonas and nonspecific infection. The disease is accompanied by the development of edema, bright hyperemia around an ulcer-like defect. Prior to this, the meager serous discharge is replaced by abundant purulent. Such systematics can aggravate the course of syphilis and make it difficult to diagnose.

With balanoposthitis, accompanied by a more widespread inflammatory lesion, phimosis often develops - a narrowing of the skin cavity covering the head of the penis with the inability to expose it. Pathology is characterized by an increase, soreness and redness of the penis due to edema. If the edematous and infiltrated skin ring infringes on the head, it develops circulatory disorders and pronounced ischemic processes.

If you do not help the patient, the condition worsens and gangrene (necrosis) of the penis is formed.

A rare and very severe complication of chancre is called phagedenism. It is diagnosed in immunocompromised individuals and is characterized by the addition of a specific fusospirillosis infection. At the same time, a black scab is formed on the surface of the skin defect, consisting of necrotic tissues, which quickly spreads beyond the chancre.

Principles for diagnosing the early stages of syphilis

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

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

Standard serological tests such as RIBT, RIF, RPR remain negative for 3-4 weeks after the onset of the primary skin defect. Their use in the presence of a hard chancre in a patient is impractical.

How is chancre treated?

Treatment of primary syphilis is based on the use of antimicrobial agents. The drugs of choice are injectable penicillins (medium and high duration of action), to which pale treponema remains highly sensitive. If the use of Bicillin and BBP is not possible due to individual intolerance (allergy) in the patient, reserve drugs (Doxycycline, Tetracycline) are used.

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

BBP 2,400,000 units IM in each buttock (1.2 million units) once;
Procaine-benzylpenicillin (aqueous solution) 600,000 IU i / m × 1 r / d–10 days;
Tetracycline 500 mg orally × 4 r / d - 14-15 days;
Erythromycin 500 mg - according to the same scheme.

One of the most important principles in the treatment of hard chancre is its timeliness. WHO recommends starting specific antibiotic therapy as soon as clinical symptoms of the disease are detected, without waiting for the results of laboratory tests.

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

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

Among the main criteria for successful treatment are:

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

Prevention of infection with syphilis and the formation of a hard chancre consists in observing simple rules: it is necessary to avoid unprotected sexual contact with casual partners, always use barrier methods of protection (condoms), use antiseptics (Hexicon, Terzhinan) after "accidental" sex.

The method of primary treatment is also widespread, which is aimed at eliminating pale treponemas in case of probable infection during unprotected sexual contact. It allows you to defeat a possible disease even before the development of its clinical manifestations and consists in a single or double injection of a penicillin antibiotic.

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

A hard chancre is a serious call announcing the onset of a dangerous illness. If such a symptom appears, it is urgent to consult a doctor, and, before it is too late, begin effective treatment. This primary period of syphilis has not yet led to serious consequences, which means that modern medicine can provide real help.

Hard chancre is a dark red rounded ulcer with raised edges and a hard, cartilaginous base. It is not an independent disease, but expresses the main symptom of the primary stage of syphilis. With this in mind, such a manifestation is often called primary syphiloma.

Primary syphilis appears 3-4 weeks after infection with a pale treponema (spirochete), and the signs of syphilis begin precisely with the formation of a chancre. Such a manifestation of the first stage of syphilis is typical for both men and women, and hard chancre is sometimes recognized by experts as a marker of the disease, since its first location indicates the place where the pathogen enters the body.

Chancre with syphilis has its own characteristics: a limited area of localization; no effect on internal organs; positive cure prognosis. In other words, at the first stage, the disease does not penetrate deep into the body, and at this stage, treatment is carried out according to the standard scheme.

signs

Symptoms of primary syphilis in the form of a chancre may have different localization. Given the predominance of infection through sexual contact, the most typical localization of hard chancre is the external genitalia. Most often in women, the labia and clitoris are affected, in men - the head, the body of the penis, the inner and outer surface of the foreskin. Somewhat less often, pathology is noted in the male urethra, female vaginal walls and uterine cervix.

Almost every tenth case of the disease is characterized by an extragenital location of the first manifestations: mouth, tongue, lips, pharynx and tonsils, female mammary gland.

When primary syphilis develops, the symptoms are associated with the formation of a hard chancre. The initial signs of syphilis look like a red spot on the skin or mucous membrane. The epithelium is gradually destroyed with the formation of erosion. The appearance of a typical ulcer (chancre) is caused by the spirochete reaching the subcutaneous tissue, submucosal layer, and even into the muscle layer.

The following characteristic signs of syphilis in the form of a hard chancre can be distinguished: the formation of a rounded ulcer ranging in size from 2 to 50 mm (the most common size is 10-15 mm) with a hard brown-red bottom; purulent plaque at the bottom of the ulcer of a yellowish tint; the invariance of the form and the absence of an inflammatory reaction on the surrounding tissues. The most important feature - hard chancre does not itch and pain.

When you press the edges of the formation, a symptom of the so-called "weeping chancre" appears - the release of a clear liquid with a slight yellowish tint on the surface of the ulcer.

A chancre can be classified by size as follows:

Diameter 1.5-5 mm - miniature (dwarf), the most dangerous in terms of infecting ability.
10-25 mm - medium-sized chancre.
35-55 mm - a giant chancre with frequent localization on the hips, face, shoulders, pubis.

After 4-5 weeks (sometimes after 2.5-3 months), hard chancres disappear on their own, but this does not mean the end of the disease. If such a phenomenon is not the result of therapeutic measures, then the reasons lie in the transition of syphilis to the next phase - a latent clinical form, which then turns into pronounced secondary syphilis.

The final stage of advanced primary syphilis is an increase in the size of the lymph nodes.

Treatment

Primary syphilis is that stage of the disease when treatment allows you to permanently save a person from pathology.
Treatment at the same time sets the following tasks: elimination of the pathogen; blocking the spread of the disease; exclusion of relapses and complications; restoration of damaged tissues; boosting immunity. It should be clearly understood that it is not a hard chancre that should be treated, but syphilis directly. For this, complex conservative therapy is used with the appointment of systemic drugs and external agents (local therapy).

The basic drug for the fight against pale treponema is Extencillin, which is administered in 2 doses by intramuscular injection. In addition to the main remedy, Bicillin-5 injections are carried out, and Erythromycin and Doxycycline tablets are also taken.

Local therapy plays the role of symptomatic treatment. To eliminate ulcers and regenerate damaged tissues, they are treated with solutions of Benzylpenicillin and Dimexide. These procedures increase the effectiveness of basic therapy by ensuring the penetration of drugs. In order to accelerate the regenerating processes, external agents such as mercury, heparin, erythromycin, synthomycin and levorin ointment are prescribed. In the treatment of manifestations in the oral cavity, rinsing with a solution of furacillin, boric acid or gramicidin is used.

Treatment of primary syphilis is carried out strictly according to the scheme prescribed by the doctor. When developing such an algorithm, the severity of the course of the disease, the localization of hard chancres, the individual characteristics of the body, especially in terms of antibiotic tolerance, are taken into account. If necessary, antihistamines (Tavegil, Suprastin) are prescribed to exclude allergic reactions.

Hard chancre is a characteristic sign of the first stage of syphilis. If effective treatment is started at this stage, then a positive result is guaranteed.