Transcript Clinical picture

VENEREAL DISEASES; OTHER THAN
GONORRHEA AND SYPHILIS
Dr.MOHAMED NASR
Lecturer Of
Dermatology & Venereology
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Chancroid (soft sore).
Lymphogranuloma venereum.
Granuloma inguinale.
Herpes genitalis.
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Definition
Incubation period
Clinical picture
Complications
Diagnosis
Treatment
CHANCROID (SOFT SORE)
• Chancroid is an acute infectious disease
of the genitalia caused by a Gramnegative bacillus, Haemophilus ducreyi.
• Incubation period: 3 - 7 days
Clinical picture:
• One or more small red painful papules or
pustules appear at the site of inoculation
and rapidly break down to form multiple
rounded or oval ulcers which are:
1- Painful and have ragged edges and
sloughing bases.
2- Bleed easily on touch.
3- Soft and non indurated to touch and
surrounded by a red areola.
• One week after the appearance of
ulcer; the inguinal lymph nodes in one
or both groins become enlarged and
tender.
• The nodes tend to become matted
together forming an oval mass, which
is called bubo.
• Suppuration commonly occurs and in
untreated patient the skin will break
down leading to sinus formation and
discharging pus.
Complications:
1- Spreading gangrene of the external
genitalia.
2- Hemorrhage from an ulcer.
3- Urethral stricture.
4- Fistula, phimosis and paraphimosis.
5- Sinus from lymph nodes discharging
pus.
Diagnosis:
1- Clinical picture.
2- Gram-stained smears reveal small Gramnegative bacilli frequently arranged in chains or
pairs giving the appearance of a "school of
fish".
3- Culture, using selective media containing
defibrinated rabbit’s blood as the organism
needs haematin at temperature 33°C and high
humidity.
4- Serological tests.
5- Skin biopsy.
Differential diagnosis:
Chancroid
Causative organism
I.P.
Number of lesions
Consistency
Base
Regional lymph nodes
V.D.R.L.
Treatment
Chancre
Haemophilus ducreyi
Treponema pallidum
3-7 days
9-90 days
Usually multiple
Usually single
Soft
Hard
Flat and soft
Raised and indurated
Enlarged, painful, matted and
suppurate
Enlarged, not matted, not
painful and do not suppurate.
Negative
Positive usually after 15-30
days from its appearance.
Azithromycin
Penicillin
Treatment:
1- Azithromycin 1 g orally in a single dose.
2- Or Ceftriaxone 250 mg intramuscularly
(IM) in a single dose.
3- Or Ciprofloxacin 500 mg orally twice a
day for 3 days.
4- Or Erythromycin base 500 mg orally
three times a day for 7 days.
LYMPHOGRANULOMA
VENEREUM
• Lymphogranuloma venereum is an infectious
disease, caused by Chlamydia trachomatis
types L1, L2, L3 and is usually transmitted
by sexual contact.
• Chlamydia trachomatis is no longer
considered as a virus. It is now considered
as bacteria and belongs to the Rickettsiae
family.
• Incubation period:
1 - 4 weeks.
Clinical picture:
• A small papulovesicle develops turning rapidly
into a transient ulcer which heals rapidly.
• The inguinal syndrome: the inguinal lymph nodes
become enlarged and tender, then they become
matted together into a sausage-shaped mass
(climatic bubo).
• The nodes eventually break down with abscess
formation and rupture of the skin leads to
multiple sinuses.
• The inguinal ligament and the groin fold divides
the glands into upper and lower groups (groove
sign). These inguinal manifestations are more
common in men.
Complications:
1- Rectal syndrome (much more common in
females): proctatitis, rectal stricture, perirectal abscess, rectovesical and rectovaginal
fistulae.
2- Elephantiasis: induration and slowly developing
enlargement of the penis and scrotum
(saxophone penis).
3- Esthiomene: edema and enlargement of the
vulva associated with ulceration, fistula and
scarring of the buttocks and thighs.
4- Urethral stricture and fistulae.
Diagnosis:
1- Clinical picture
2- A smear stained with Micuvali or Geimsa
stain.
3- Complement fixation test. Fluorescent
antibody test is more specific
4- Culture on yolk sac or tissue cultre
containing cyclohexaphosphamide.
Treatment:
1- Doxycycline 100 mg orally twice a day for
21 days.
2- Erythromycin base 500 mg orally four
times a day for 21 days.
3- Aspiration of fluctuant lymph nodes to
avoid rupture.
GRANULOMA INGUINALE
• It is a chronic progressive granulomatous
disease affecting the skin and S.C. tissue
of the genitalia, perineum and groins.
• It is caused by Donovan bodies or
Donovania granulomatis which are believed
to be bacteria related to the klebsiella
group and are called Calymatobacterium
granulomatis.
Incubation period:
• Uncertain, it is around 50 days and may
range (8-80 days).
Clinical picture:
• A red painless papule appears on the
genitalia, in the pubic or inguinal region. It
is painless and grows slowly to produce a
chronic granuloma. The lesions are beefy
red in color and raised above the surface.
• The granuloma advances slowly destroying
tissue lying in its course. The regional
lymph nodes are not involved (pseudobubo).
Complications:
1- Secondary infection.
2- Rectovaginal fistula, urethral stricture,
cystitis and marked scar formation.
3- Genital edema (due to infiltration or
pressure on lymphatics by the granuloma).
Diagnosis:
1- Clinical picture
2- Stained smears with wright’s or Giemsa
stain will show the organisms within
mononuclear cells. They appear as
encapsulated rods with pink capsule and
bipolar condensation of chromatin material
giving the appearance of a safety pin.
Treatment:
1- Doxycycline 100 mg orally twice a day for at least 3
weeks and until all lesions have completely healed.
2- Or Azithromycin 1 g orally once per week for at least 3
weeks and until all lesions have completely healed.
3- Or Ciprofloxacin 750 mg orally twice a day for at least
3 weeks and until all lesions have completely healed.
4- Or Erythromycin base 500 mg orally four times a day
for at least 3 weeks and until all lesions have completely
healed.
5- Or Trimethoprim-sulfamethoxazole one tablet (160
mg/800 mg) orally twice a day for at least 3 weeks and
until all lesions have completely healed.
Herpes genitalis
It is an acute inflammatory disease of the
male and female genital tract due to
infection with Herpes simplex virus (HSV-2).
·Incubation period: 2-7 days (2-21 days).
Clinical picture:
• Initial manifestations: include local pain,
tenderness, itching sensation, dysuria and in
females, a profuse watery vaginal discharge.
• Initial lesions are papules on a red erythematous
base but they rapidly develop into vesicles and
later ulcers covered with a grayish exudate.
· The manifestations of recurrent genital herpes
are similar but less severe, and resolve faster.
Diagnosis:
• A clinical diagnosis.
• Laboratory approaches for the
diagnosis of genital herpes include:
– Cytologic examination multi-nucleated
giant cells.
– Direct immune fluorescent
Treatment:
• First clinical episode:
Acyclovir 400 mg orally three
times a day for 7-10 days.
• Recurrent Genital Herpes:
Acyclovir 400 mg orally three
times a day for 5 days.