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Dermatology and Venereology 004 Biogenic Skin Diseases Section 4
004 Biogenic Skin Diseases Section 4, 1. STD: A general term for all diseases transmitted by sexual or similar sexual behaviors; it can not only cause urogenital organ lesions, but also invade the lymph nodes of the urogenital organs through the lymphatic system, and even It can spread to important organs and tissues throughout the body through hematogeny.
Edited at 2024-03-25 19:00:52
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Dermatology and Venereology 004 Biogenic Skin Diseases Section 4
- One Hundred Years of Solitude Character Relationship Chart
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
- One Hundred Years of Solitude Character Relationship Chart
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- Outline
Section 5 Sexually transmitted diseases (STD)
Overview
【definition】
1.STD: A general term for diseases transmitted by sexual or similar sexual behaviors; it can not only cause lesions in the urogenital organs, but also invade the lymph nodes belonging to the urogenital organs through the lymphatic system, and can even spread to important organs and tissues throughout the body through the bloodstream.
2. STD symptom management (syndromic management): It summarizes the clinical manifestations of patients. Each type of related symptoms and signs is a symptom, including abnormal male urethral secretions, abnormal female vaginal secretions, external genital ulcers, Eight major symptoms of external genital neoplasia, female lower abdominal pain, inguinal lymphadenopathy, scrotal swelling, and neonatal conjunctivitis; design a corresponding flow chart for the treatment of each symptom, and provide diagnosis, treatment, health education, consultation, and sexual partner support to the patient. Comprehensive treatment including notification, treatment targeting all pathogenic microorganisms that may cause the symptoms
[Types] Including classic sexually transmitted diseases (syphilis, gonorrhea, chancroid, LGV, granuloma inguinale), GH, CA, NGU, molluscum contagiosum, vaginal trichomoniasis, genital candidiasis, pubic lice, scabies, viral hepatitis , AIDS, etc.; the following only introduces the "eight major sexually transmitted diseases" that my country focuses on prevention and control.
[Transmission route] Sexual contact transmission (>95%), indirect direct transmission, blood transmission, vertical transmission, iatrogenic transmission, organ transplantation, artificial insemination
1. Gonorrhea (most common)
[Cause] Neisseria gonorrhoeae (gonococcus): Humans are the only natural host and source of infection; most are sexually transmitted
[Clinical manifestations] More common in sexually active young and middle-aged people
Gonorrhea without complications (simple)
Definition: Refers to a single local gonococcal infection of the mucosa in the genitourinary tract or other parts of the body
type
Gonococcal urethritis: urethral orifice redness, swelling, mild itching, and yellow mucus/purulent secretion will appear 3 to 5 days after unclean sexual intercourse. There may be pain/burning sensation during urination and frequent urination; it may spread if not treated in time. When reaching the posterior urethra, symptoms include frequent urination, low urination, posterior urethral pain, and terminal hematuria. There may be systemic symptoms such as fever, and inguinal lymph node redness and pain. Frequent urination and hematuria are more obvious in women.
Gonococcal cervicitis: The endocervix is the initial site of gonorrhea in women, but it is often asymptomatic; those with symptoms show abnormal and increased vaginal secretions, purulent leucorrhea, and vulvar itching; examination shows cervical erosion, congestion, and purulence Leucorrhea/discharge
Gonococcal conjunctivitis: It is more common in newborns 48 hours after birth (bilateral), and in adults it is mostly due to self-inoculation/contact with items contaminated by secretions (unilateral); in severe cases, it can cause blindness
Gonococcal pharyngitis: mostly manifests as acute pharyngitis/acute tonsillitis
Gonococcal anorectitis: mostly asymptomatic; those with symptoms may present with anal itching, rectal tingling/burning sensation, mucopurulent secretions, tenesmus, hematochezia, constipation, and may even cause perianal abscess and anal fistula.
Gonorrhea in children: ophthalmia neonatorum and gonococcal vulvovaginitis in young girls are more common
Comorbid gonorrhea
Definition: On the basis of the above simple gonorrhea, gonococcal infection of other tissues and organs occurs simultaneously
Men: gonococcal prostatitis, seminal vesiculitis, epididymitis, urethral stricture, balanitis, parafrenulum, paraurethritis, raphe abscess of the penis
Women: Gonococcal salpingitis, pelvic inflammatory disease, fallopian tube/ovarian abscess, peritonitis, perianitis, Bartholinitis, Bartholin abscess
Disseminated gonorrhea (1-3%)
Definition: Spread of gonorrhea throughout the body through blood/lymphatic vessels; seen in untreated women and gay men
Performance
bacteremia stage
Fever, chills, rash (hemorrhagic, erythematous suprapapular herpes), polyarticular arthritis; blood gonorrhea cultures were often positive
septic arthritis stages
A large joint is involved, and there is obvious exudate; but the rash is small and systemic symptoms are mild; blood gonorrhea cultures are often negative.
[Examination] ① Direct smear microscopy: only has diagnostic significance for male urethral secretions (typical gram-negative diplococci are seen in polymorphonuclear leukocytes); ② Gonococcal culture: the only recommended diagnostic method
【treat】
Treatment principles
① Early diagnosis and early treatment; ② Use medication in a timely, sufficient and regular manner, and adopt corresponding treatment plans according to different conditions; ③ Sexual intercourse is prohibited during treatment, and infected sexual partners should be treated at the same time; ④ Pay attention to the cleanliness of the external genitalia, and be strict with girls and children Isolate; ⑤ Pay attention to whether there are other STD pathogen infections at the same time; ⑥ Follow up and judge recovery after treatment
Criteria for recovery
① Within 2 weeks after the end of treatment, all symptoms and signs disappear without sexual contact; ② 4 to 7 days after the end of treatment, take materials from the affected area and make smear and culture negative
2. Nongonococcal urethritis (NGU)
[Definition] Refers to a type of urethritis that is sexually transmitted. The inflammation of the urethra is obvious but no gonococci can be found in the urethral secretions.
[Cause] Such as Chlamydia trachomatis (25~55%), Ureaplasma urealyticum (20~40%), Trichomonas vaginalis (2~5%), HSV
[Clinical manifestations] More common in sexually active young and middle-aged people
male
Symptoms are similar to gonococcal urethritis but milder; most of the time the urethra needs to be squeezed by hand to see the secretion overflowing, which is small and thin, serous/purulent; sometimes it can be seen after a long period of not urinating or before urinating for the first time in the morning. The secretion that overflows from the urethra contaminates the underwear, and when it becomes sticky, it can block the urethra (life)
female
Symptoms are not obvious or asymptomatic; when symptoms are present, they are often characterized by frequent urination and difficulty urinating, and rarely painful urination.
newborn
conjunctivitis, pneumonia
Comorbidities
Epididymitis, prostatitis, salpingitis, pelvic inflammatory disease, and Reiter's triad (urethritis, conjunctivitis, arthritis) may occur when treatment is not timely or thorough.
[Treatment] Azithromycin, doxycycline, and erythromycin are preferred; criteria for recovery: symptoms disappear 1 week after treatment, urethral secretion smear shows ≤4 polymorphonuclear leukocytes, and pathogen test is negative
3. Syphilis
[Cause] Treponema pallidum (TP): Artificial culture is difficult. It is generally inoculated into rabbit testicles for preservation and passage; through sexual contact (mainly; especially 1 to 2 years after infection), placenta, and other forms of contact, Blood transfusion transmission (blood of syphilis patients refrigerated within 3 days is still contagious)
[Clinical manifestations]
acquired syphilis
Early syphilis: duration <2 years
Primary syphilis: occurs 2 to 4 weeks after unclean sexual intercourse; it is most common in the genitals, mostly on the foreskin, coronal sulcus or glans in men, and on the labia majora or cervix in women; it can heal on its own in about 1 month, and can be left behind Scarring/Pigmentation
Typical manifestation - Chancre: Rice-like infiltration appears in the skin and mucous membranes, which gradually proliferates and expands into a round/oval shape higher than the skin surface, with clear boundaries, beef color, and a skin lesion that is as hard as cartilage when touched. The surface may be There are ulcers and serous secretions (containing a large amount of TP), without pain/tenderness; multiple single ones, about 1cm in diameter; with diagnostic value
Sclerosing lymphadenitis: 1 to 2 weeks after the onset of chancre, the ipsilateral lymph nodes are swollen but painless and non-adhesive; another 1 to 2 weeks later, the contralateral lymph nodes are also swollen; a large amount of TP can be seen in lymph node puncture examination
Generally, there are no systemic symptoms; in early chancre, there are many spirochetes but the seronegative reaction is negative; in the late chancre, there are very few spirochetes but the seropositive reaction is positive.
Secondary syphilis: If primary syphilis is left untreated/incompletely treated, TP enters the blood from the lymphatic system to form bacteremia and spreads throughout the body; it often occurs 1 month after the chancre subsides.
Systemic symptoms: sudden headache, dizziness, anorexia, fatigue, low fever, muscle aches throughout the body, flu-like symptoms, swollen lymph nodes throughout the body
Secondary cutaneous and mucosal syphilis: 3 to 4 days after the onset of systemic symptoms, symmetrical, widespread, and densely distributed macules appear all over the body. They do not merge with each other. They are slightly larger than soybeans, brown-red, have clear borders, and are consistent in size and shape. Painful or itchy; can disappear within days to weeks
Squamous annular syphilis rash on the palms: common, soybean-sized, round, with raised collar-like scales on the edges, not fused, with a certain degree of symmetry; distributed in the palms and adjacent wrists, with certain characteristics sex
Condyloma latum: Occurs in the moist parts of the anus and external genitalia. It proliferates and merges into thick flakes. It appears as flesh-red flat papules/plaques. The surface is eroded and moist or lightly crusted, and is hard and smooth to touch; Contains a large amount of TP and is highly contagious
Syphilitic alopecia (syphilitic alopecia): caused by TP invasion of hair follicles, resulting in insufficient blood supply to the hair area; manifestation
It is localized/diffuse hair loss with moth-eaten appearance; hair is sparse and uneven in length; but it is not permanent.
Other types: gray-black pigmented spots (most common on the forehead, head and occiput), syphilitic leukoplakia (depigmentation), papular syphilis, pustular syphilis, oyster shell-like syphilis, hair follicle papule type syphilis rash
Second stage bone damage: manifests as periostitis (most common) and arthritis; pain worsens at night/when resting, reduces during the day/during activities, and may be exacerbated when first receiving anti-pneumonia treatment
Secondary ocular syphilis: iritis, iridocyclitis, choroiditis, optic neuritis, retinitis
Secondary neurosyphilis: asymptomatic neurosyphilis (no clinical symptoms but cerebrospinal fluid abnormalities), syphilitic meningitis, cerebrovascular syphilis, meningovascular syphilis
Other manifestations of secondary syphilis: multiple sclerosis lymphadenitis, visceral syphilis (rare)
Secondary recurrent syphilis
Due to insufficient anti-tuberculosis treatment or reduced body immunity, secondary damage may reappear after subsidence (1 to 2 years after infection); relapse is more common in serum
Characteristics of rash: ① Large number and limited distribution; ② Clustering tendency is more obvious, and can be ring-shaped, arc-shaped, crescent-shaped, or flower-shaped; ③ More destructive; ④ Prevalent to occur on the forehead, corners of the mouth, neck, and genitals , palm soles
Secondary syphilis recurs several times, and the symptoms may disappear without treatment and enter the latent period.
Late syphilis/tertiary syphilis: disease duration >2 years
Tertiary stage cutaneous and mucosal syphilis: often occurs 3 to 5 years after infection; mostly localized, isolated, infiltrative plaques/nodules, asymmetrical, slow to develop, highly destructive, and leaving scars after healing
Nodular syphilid rash (nodular syphilid): It usually occurs on the head, face, shoulders, back and extensor sides of the limbs; it appears as copper-red nodules, clustered in groups without fusion, and are ring-shaped, snake-shaped, or star-shaped; after ulceration The bottom surface is uneven, the edge is dike-shaped, and there is a parchment-like scar after healing; no subjective symptoms
Syphilitic gumma/syphilitic tumor: usually occurs in the calf, usually solitary; it starts as a painless subcutaneous nodule, and then enlarges and becomes necrotic in the center, forming an ulcer with sharp edges, and the base is purple-red granulation tissue. , secretes bloody gum-like pus; atrophic scars remain after 1 to 2 years of absorption; it is the most destructive skin lesion: septal gum swelling can destroy the nasal bones and form a saddle nose, and palate gum swelling can cause perforation
Juxta-articular nodules: Commonly found near large joints such as elbows, knees, and hips; they appear as symmetrical subcutaneous nodules with no inflammatory changes in the surface skin and are slightly painful when pressed.
Mucosal syphilis: arc-shaped, dark red infiltrated spots with edges
Tertiary stage bone syphilis and ocular syphilis: similar to the second stage
Late cardiovascular syphilis: mostly occurs 10 to 20 years after infection; manifests as syphilitic aortitis, aortic aneurysm, aortic valve insufficiency, coronary artery stenosis, and myocardial gumma
Tertiary neurosyphilis: mostly occurs 3 to 20 years after infection
Asymptomatic neurosyphilis
Meningovascular syphilis: focal meningeal syphilis, cerebrovascular syphilis, spinal meningovascular syphilis
Cerebral parenchymal syphilis: paralytic dementia, tuberculosis, optic atrophy
Latent syphilis/latent syphilis
When the disease duration is <2 years, it is called early latent syphilis, and when the disease duration is >2 years, it is called late latent syphilis.
Characteristics: There is a history of syphilis infection, no clinical symptoms or the clinical symptoms have disappeared, the cerebrospinal fluid is normal but the serum reaction is positive; its occurrence is related to the body's strong immunity or temporary suppression of TP by treatment; Treponema pallidum can still appear intermittently in the blood/body fluids , and then infect others and placental transmission (the most dangerous source of infection)
Prenatally transmitted syphilis
Characteristics: No chancre, early lesions are more serious than acquired syphilis, bones and sensory organs are more involved, and cardiovascular disease is less involved.
Early fetal-transmitted syphilis: age <2 years
Newborns: often born prematurely; emaciated, loose skin, multiple facial wrinkles, hoarse crying, and delayed development
Syphilitic rhinitis: usually appears 1 to 2 months after birth; causing nostril obstruction can cause difficulty in breathing and breastfeeding.
Skin lesions: Most appear 3 weeks after birth; manifestations are diverse, mostly seen on the head, face, extremities and arms, similar to second-stage acquired skin lesions; radial fissures can be seen around the mouth, and radial scars appear after healing (characteristic); anus and Condyloma-like lesions can be seen on the vulva
Syphilitic pseudoparalysis: Osteochondritis of long bones causes pain in the limbs and inability to move
With: anemia, thrombocytopenia, hepatosplenomegaly and systemic lymphadenopathy, nephrotic syndrome, meningitis
Late fetal-transmitted syphilis: age >2 years
Permanent marks: remnants of early lesions, but inactive; manifested as forehead convexity, saber shins, Hutchinson teeth, mulberry teeth, saddle nose, clavicle-sternal joint osteohypertrophy, and retinitis
Active damage: stromal keratitis, neurological deafness, cerebrospinal fluid abnormality, hepatosplenomegaly, nasal/palatal gumma, Clutton's joint swelling, arthritis, skin and mucosal damage
Clutton's joint: rare; manifests as painless swelling of bilateral knee joints, mild ankylosis, and joint effusion
Prenatally transmitted latent syphilis: untreated, asymptomatic but seropositive
【examine】
1. Treponema pallidum examination: dark field microscopy to detect Treponema pallidum in chancre, flat condyloma, and mucosal lesions
2. Syphilis serology test
(1) Non-treponemal pallidum antigen serum test
[1] Principle: Use cardiolipin (reactin) as antigen to measure anti-cardiolipin antibodies in serum
[2]Examples: VDRL test, RPR test, USR test
[3]Evaluation
The sensitivity is high but the specificity is low; it is generally positive 1 to 2 weeks after the appearance of chancre, 100% of secondary syphilis is positive, and weakens in the late stage (the diagnosis of latent syphilis is not ideal)
False positives: ①Technical false positives: such as improper specimen preservation; ②Biological false positives: certain infectious diseases (such as relapsing fever), collagen diseases (such as SLE, rheumatoid arthritis), heroin addicts, a small number of pregnant women and elderly
False negative: ① The patient's own reasons: such as primary syphilis within 1 to 2 weeks after the onset of chancre (antibodies have not yet been produced), some late-stage syphilis; ② after formal anti-syphilis treatment; ③ prozone phenomenon: clinically consistent with the signs of syphilis, However, the RPR test of the original serum is negative; if the serum is further diluted and then the RPR test is performed, a positive result may appear; the reason is that there is too much anti-cardiolipin antibody in the serum, which inhibits the positive reaction.
[4] Clinical significance: ① Used as a routine test for screening a large number of people; ② Used as a quantitative test to observe efficacy, recurrence and reinfection; ③ Identify early and late latent syphilis (the titer decreases quickly after treatment for early syphilis and late then slowly or even unchanged); ④ Helps to identify congenital syphilis and passive antibody (reagin)emia: the latter can automatically turn negative 3 to 4 months after birth
(2) Treponema pallidum antigen serum test
[1] Principle: Use live/dead Treponema pallidum or its components as antigens to determine anti-Treponema pallidum antibodies in serum
[2]Examples: FTA-ABS, TPHA, TPI
[3] Evaluation: Both sensitivity and specificity are high. It is used as a diagnostic test but not for observing efficacy.
(3) Supplement: Combined non-Treponemal pallidum antigen serum test and Treponema pallidum antigen serum test to determine the patient’s condition
3. Cerebrospinal fluid examination: It is helpful for the diagnosis, treatment and prognosis of neurosyphilis; the VDRL test is commonly used; the increased number of white blood cells in cerebrospinal fluid can be used as a sensitive indicator to judge the therapeutic effect.
【treat】
Treatment principles
① Early, sufficient and regular; ② Find the source of infection and treat it; ③ No sexual intercourse during treatment; ④ Regular follow-up after treatment
Drugs to drive away edema
Penicillins: the drug of choice; when the serum concentration reaches 0.03IU/ml, it has the effect of killing TP, but it must be maintained stably for more than 10 days before it can be completely eliminated; commonly used benzathine penicillin, procaine penicillin G, and aqueous penicillin G, please note Cardiovascular syphilis without benzathine penicillin
Ceftriaxone sodium: a preferred alternative treatment for patients with penicillin allergy
Tetracyclines and macrolides: alternative treatments for penicillin allergy
treatment method
Early syphilis (primary, secondary, early latent syphilis): procaine penicillin G, benzathine penicillin; for those with allergies, ceftriaxone sodium/doxycycline/erythromycin
Late syphilis and secondary recurrent syphilis: procaine penicillin G, benzathine penicillin; if allergic, use doxycycline/erythromycin
Cardiovascular syphilis: hospitalization, first treat heart failure and then drive out syphilis; aqueous penicillin G and procaine penicillin G are preferred
Neurosyphilis: hospitalization; aqueous penicillin G, benzathine penicillin, or procaine penicillin G, probenecid, benzathine penicillin is preferred; to avoid Jarisch-Herxheimer reaction ① prednisone can be added
Jihai reaction: refers to an acute allergic reaction that occurs in the body after syphilis patients receive highly effective anti-TP drug treatment because TP is quickly killed and a large amount of heterogeneous proteins are released. It usually occurs within a few hours after taking the drug and is manifested by chills, high fever, and headache. , accelerated breathing, tachycardia, general malaise, and aggravation of the primary disease. In severe cases, patients with cardiovascular syphilis may suffer from aortic rupture; usually prednisone is started 1 day before anti-syphilis treatment for prevention.
Pregnancy syphilis: Generally, intramuscular injection of procaine penicillin G is used from the first 3 months of pregnancy to the last 3 months of pregnancy plus one course of treatment; for those with allergies, erythromycin is used (tetracycline is prohibited)
Prenatally transmitted syphilis: aqueous penicillin G or procaine penicillin G; if allergic, use erythromycin
Post-treatment follow-up
Time: Follow-up for 3 years, every 3 months in the 1st year, every 6 months in the 2nd year, reexamination at the end of the 3rd year Contents: Clinical examination Serum RPR/VDRL test
Serum fixed reaction: fetal-transmitted syphilis and other late-stage syphilis, serological indicators do not decline (always remain strongly positive) despite adequate treatment; no further treatment is required
4. Condyloma acuminatum (CA)/genital warts/venereal warts
[Clinical manifestations] ① The incubation period is long (average 3 months); it is more likely to occur in the external genitalia and perianal skin and mucous membranes; ② It initially appears as soft light red papules with a soft texture and a sharp tip; later it gradually enlarges to a papillary fleshy texture. The vegetations have rough and uneven surfaces and can fuse into cauliflower-like, comb-shaped or huge masses; ③ Bleeding is easy during sexual intercourse, and erosion and ulcers may occur during secondary infection; ④ Some may appear as keratinized plaques, and a few may Excessive proliferation forms giant genital warts (Buschke-loewenstein tumors, often related to HPV-6 infection, and some can become cancerous); ⑤ Usually there are no subjective symptoms; ⑥ A few may show latent infection (negative acetic acid white test), subclinical infection (Acetic acid white test positive)
[Differential Diagnosis] Genital warts vs. flat condyloma: The latter is a common skin lesion caused by syphilis. The skin lesions are flat and moist papules with a smooth surface and are distributed in sheets or clusters. Treponema pallidum can be found in the lesions, and the syphilis serum reaction is strongly positive.
[Treatment] ① Local drug treatment; ② Physical therapy; ③ Surgical treatment: suitable for giant cases; ④ Criteria for recovery: warts disappear, and no new warts appear within 3 months after treatment
5. Genital herpes (GH)
[Cause] HSV-2; HIV infection risk doubled
[Clinical manifestations]
primary
It usually occurs in the glans, foreskin, coronal sulcus, etc. in men, and in the labia, mons pubis, clitoris, etc. in women. It initially appears as one/multiple small red papules, and then quickly develops into isolated/clustered small blisters. There may be burning discomfort or pain; after the blisters rupture, erosion may form, and ulcers may form during secondary infection; the duration of the disease is 2 to 3 weeks.
Accompanied by: Cervical redness/ulcer, increased vaginal discharge, inguinal lymphadenopathy/tenderness, systemic symptoms
Recurrent
It usually recurs 1 to 4 months after the primary skin lesions subside. The skin lesions usually appear at the original site, similar to primary herpes, but are milder, generally have no systemic symptoms, and have a short course (8 to 12 days); although some cases There are prodromal symptoms but no damage (pseudo prodromal), which may be due to strong immune function; most relapses 5 to 8 times in the first year, and then decrease
Special case
Subclinical type: lacks typical clinical manifestations and is the main source of infection
Pregnancy: clinical manifestations are the same as those of non-pregnant women; the possibility of birth canal infection is 50%, so cesarean section should be performed
Neonatal infection: severe symptoms, high mortality; manifested as herpes zoster, epileptic seizures, bleeding tendencies, hepatosplenomegaly
HIV-infected patients complicated by genital herpes: ① The condition is severe and has a long course, which can manifest as generalized chronic persistent ulcers and necrosis, with severe pain; ② Clinical relapses are more frequent; ③ Complications are numerous and serious, often combined with bacterial/fungal infections, Herpetic meningitis is prone to occur; ④ treatment is difficult, resistance to acyclovir is easy to occur, and viral suppression treatment is often required
【treat】
General treatment
① Pay attention to rest, avoid drinking alcohol and excessive sexual life; ② Avoid sexual life when clinical symptoms appear; ③ Cesarean section should be performed when genital herpes during pregnancy becomes active before delivery.
systemic treatment
Acyclovir is the first choice; it can reduce the recurrence rate, but it cannot cure it
topical treatment
Keep the area dry and clean, and apply 5% acyclovir ointment or 3% phthalamide cream
6. Chancroid, soft chancre
[Cause] Haemophilus ducreyi: short rod-shaped Gram-negative facultative anaerobic bacterium
[Clinical manifestations]
Skin lesions
It starts out as a large red papule on the external genital area, which instantly turns into a pustule the size of a soybean. After rupture, it forms a painful ulcer. The edge of the ulcer is irregular (jagged/sneak-shaped), surrounded by redness, and the base is soft to the touch. , tender to touch, easy to bleed, and gray-yellow dirty purulent secretions visible on the surface
Clusters of satellite lesions may appear around the primary skin lesion due to autoinoculation
complication
Inguinal lymphadenitis: Acute inguinal lymphadenitis may occur after a few days, often unilaterally; the enlarged lymph nodes may fuse with each other to form a red, swollen, and painful mass (painful transverse fistula). When suppurative and ulcerated, there is only one fistula.
Phimosis, incarcerated phimosis, labial adhesions/strictures, urethral fistulas, and urethral strictures
Penile shaft lymphangitis, scrotal/labial elephantiasis
Hematogenous dissemination generally does not occur, but local secondary bacterial infection may occur; when combined with syphilis, it is called mixed chancre
systemic symptoms
May be accompanied by systemic symptoms
[Examination] Smear staining shows Gram-negative short bacilli arranged in a "fish school"; culture can confirm the diagnosis
[Treatment] Choose azithromycin, ceftriaxone, erythromycin, ciprofloxacin or spectinomycin
7. Lymphogranuloma venereum (LGV)/fourth sexually transmitted disease
[Cause] Chlamydia trachomatis L1, L2, L3 types
[Clinical manifestations]
[Treatment] ① Choose doxycycline, erythromycin, tetracycline, etc.; ② Transverse abscess can be punctured and aspirated to promote healing, but incision and drainage should be avoided; ③ Rectal stenosis and elephantiasis can be treated surgically