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Complications of hard chancre

Various external influences (trauma, non-compliance of the patient with hygienic rules, irrational treatment, the addition of secondary pyogenic and opportunistic infections), as well as factors that reduce the overall reactivity of the body (elderly and early childhood, chronic common diseases of the body: diabetes, berculosis, anemia, etc .; chronic intoxication, especially alcoholism and drug addiction), can complicate the flow of chancre. The above external influences lead to the transformation of erosive hard chancre into ulcerative and to the occurrence of inflammatory phenomena around it (pronounced redness, skin puffiness, pain, etc.). In some cases, the initial appearance of an ulcer hard chancre is in itself a complication.

The complication of hard chancre by secondary infection can be observed spontaneously or after traumatization. In men, with localization of hard chancre, balanitis (inflammation of the head) or balanoposthitis (inflammation of the head and the inner sheet of the foreskin) occurs on the penis. When balanopostitis occurs in the affected areas, erosion often occurs (erosive balanopostitis). Balanitis and balanoposthitis are characterized by the appearance of acute inflammatory phenomena around the chancre, the discharge becomes serous purulent.

As a result of inflammation of the foreskin, phimosis can occur (narrowing of the ring of the foreskin). The penis increases due to edema of the foreskin, takes the form of a flask, becomes painful, hyperemic.

Due to edema and infiltration, exposure of the head becomes impossible; pus is excreted from the narrow opening of the preputial sac. Sometimes, through a swollen foreskin, it is possible to palpate a limited focus of inflammation, which, however, may be trivial and does not prove the presence of syphilis. In case of forcible removal of the head for the narrowed ring of the foreskin, it can be infringed, the foreskin dramatically swells, paraphimosis occurs. If the head of the penis is not timely adjusted, the process ends with necrosis of the ring of the foreskin or the head of the penis.

Rare complications of hard chancre include gangrenization and fagedenism. Gangrene occurs on its own or more often as a result of joining a fuzzyrillus infection. In this case, necrosis occurs, rapidly spreading deep into and over the entire surface of the syphiloma. A scab of dirty gray or black color appears on it, tightly welded to the underlying tissues and completely painless. After the scab is rejected, an ulcer is covered with bright red granulations, quickly healing with scar formation. Gangrene, as a rule, does not go beyond the limits of primary syphiloma and does not destroy healthy tissues.

Phagedenism is much less common than gangrenization and is characterized by the spread of necrosis not only deep into the primary syphiloma, but also beyond its borders, with the involvement of surrounding healthy tissues in the process. Phagedenism begins as gangrenization, but tissue necrosis does not stop with the scab rejection, but is constantly renewed, destroying all new areas of surrounding tissues. Necrosis can lead to the destruction of the foreskin, glans penis, perforation and destruction of the urethra wall, and its narrowing; severe bleeding may occur.

The so-called red phagedenism is rarely observed [Fournier A., ​​1899], which is characterized by the presence of an extensive juicy bright red ulcer with a smooth or uneven surface, dense base, swollen hyperemia of the hyperemia along the periphery that separates a fairly large amount of bloody liquid.
A scab is not formed. Red phagedenism can lead to severe damage to the affected tissues. The etiological diagnosis of phagedenic chancre presents certain difficulties, since the presence of abundant secondary flora (staphylococci, streptococci, fuzospirillosa infection, etc.) limits the possibilities of microscopic detection of pale treponemas. Complications of hard chancre, especially gang, and phagedenism, as a rule, are accompanied by general phenomena (chills, fever, headache, insomnia, etc.) caused by intoxication and septicopyemia. In case of complicated hard chancre, the regional lymph nodes become painful, and the skin above them may become inflamed.

Mixed chancre occurs when you are simultaneously infected with syphilis and chancroid. According to S. T. Pavlova (1960), initially, a few days after infection, the patient formed a typical soft chancre. After 3-4 weeks, the ulcer of the soft chancre begins to level off somewhat, and its base is consolidated. By this time, if the patient has a characteristic for a soft chancre lymphadenitis, the regional lymph nodes of the lymphadenitis welded to each other and the surrounding tissues become denser and the inflammatory process becomes dull with no tendency to resolve; in the absence of bubo, syphilis scleradenitis appears. The diagnosis of mixed chancre before the introduction of soft chancre sulfa drugs into therapy was very difficult, since finding pale treponem in a mixed ulcer is difficult. Appointment of sulfonamide drugs to the patient leads to the resolution of soft chancre, and the clinical picture of the primary syphiloma, which is not affected by the treatment, becomes distinct, and the treponema is easily detected in the discharge. Early administration to a patient with a mixed chancre of sulfanilamide preparations leads to the complete healing of a soft chancre ulcer even before the end of the incubation period of syphilis, and after some time a typical primary syphiloma occurs in its place.

Flow. In patients with syphilis who do not receive specific treatment, solid chancre independently heals on average in 3–6 weeks, with benzylpenicillin prescribed in 10–14 days. The infiltrate at the base of a hard chancre lasts longer and undergoes reverse development after several weeks or not. By the time a patient develops secondary fresh syphilis, hard chancre, especially ulcerative, as a rule, always remains. The ulcer hard chancre heals with the formation of a scar round or about a long form with clear boundaries and a smooth surface, with a narrow hyperchromic rim around the periphery. Erosion heals completely, leaving behind only a temporary pigmentation.
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Complications of hard chancre

  1. Complications of hard chancre
    Balanitis, balanoposthitis, phimosis, paraphimosis, gangrenization, fagedenism. Balanitis and balonapostitis - a bacterial infection joins. Appears puffiness, bright erythema, epithelial maceration. Separated on the surface of the chancre becomes seroz. - purulent .. Phimosis is a narrowing of the cavity of the foreskin, which does not allow to open the head of the penis. Due to edema of the foreskin, the penis appears
  2. Chancre
    Formed after the end of the incubus. period and is located on the site of the introduction of pale treponema in the skin or mucus. obol. Localization: head floor. penis, anus, large and small labia, posterior commissure, region cervix. Chancre is a single erosion of a rounded shape, saucer-shaped with clear boundaries. The color of eroded meat is red. Discharge erosive serous, scanty. Characteristic
  3. Primary syphiloma (hard chancre)
    Clinical manifestations of primary syphilis are characterized by the presence of solid chancre (primary syphiloma) and damage to the lymph nodes and blood vessels. At the end of the incubation period, the first symptom and the main manifestation of the primary period of syphilis - primary syphiloma (synonyms: chancre, primary sclerosis, primary erosion,
  4. Atypical solid chancre
    Shankr-panaritium is a club-shaped swelling of the terminal phalanx with sharp pain. There is a lack of acute inflammatory erythema, the presence of dense infiltration and regional lymphadenitis. More often sick honey. staff. Inductive edema - located in the region. large labia, scrotum or foreskin, i.e. in places with a large number of lymphatic vessels. There is swelling of these
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