Ulcus molle

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Classification according to ICD-10
A57 Ulcus molle (venereum)
ICD-10 online (WHO version 2019)

Ulcus molle or soft chancre (English chancroid , Latin also earlier cambuca ) is a sexually transmitted infectious disease that is rare in Europe and caused by the bacterium Haemophilus ducreyi . It occurs mainly in tropical countries (e.g. Southeast Asia, Africa) but also in Latin America. The disease affects men about five times as often as women. Ulcus molle is notifiable in Austria (but not in Germany) according to the Venereal Diseases Act.

root cause

The disease, which was already known in the 15th century, is caused by infection with the gram-negative bacterium Haemophilus ducreyi, discovered by Augusto Ducrey and described in 1889, and is specific to humans. The bacterium enters the new organism through direct contact with the mucous membrane of the infectious liquid. The germs are very sensitive to cold and dehydration, their transmission occurs almost exclusively through sexual intercourse.

Ulcus molle on the glans glans penis and on the penile furrow, sulcus coronarius

Course of the disease and clinic

After the pathogen has penetrated through sexual contact, the incubation period is between three and seven days. Incubation times of up to 14 days are also described.

After this time, the first skin changes, such as single or multiple erythematous papules, may appear. The most common locations are the foreskin of the penis in men , and the perianal skin in women in addition to the vulva and cervix . The papules first develop into pustules , which then rupture after a few days. This results in painful ulcerations with a soft edge, which are eponymous for the disease and can persist for up to several months if left untreated.

Without treatment, the bacteria can spread along the lymph vessels ( lymphangitis ) to the lymph nodes in the groin. As a result, the skin turns red and in half of the patients there is a painful, usually one-sided swelling of the lymph nodes, which can burst outward with purulent pus. The inflammatory swelling of a lymph node is called a bubo . At this point, the disease can usually be stopped by the immune system .

As with most skin diseases, the wound can become superinfected .

In women in particular, the infection can also be completely symptom-free.

diagnosis

The diagnosis is made according to the clinical picture.

After the smear has been smeared, the Gram- negative rods can be made visible under the microscope using Gram staining . However, pure microscopy does not have a high sensitivity and specificity . The very demanding bacteria can also be cultivated on specially enriched nutrient media.

Nucleic Acid Amplification Technology methods (e.g. PCR ) are a good way of detecting the bacterium in laboratory samples . Antigen detection using monoclonal antibodies is also increasingly used.

In particular, syphilis (risk of confusion in the early stages), but also other sexually transmitted diseases, should also be excluded by laboratory tests.

Differential diagnoses
  • Primary stage of syphilis : Here, however, a painless , rather hard ulcer ( ulcus durum ) is present.
  • Genital herpes : small, possibly constricting blisters
  • Lymphogranuloma venereum, granuloma inguinale

It should be noted that mixed infections can occur at any time. A ulcus molle can serve as a gateway for other diseases.

therapy

The ulcus molle is treated with antibiotics . Recommended by the Robert Koch Institute are currently (as of July 2020):

The prognosis is good. It is important to abstain from sexual activity until it is completely healed, so that the further spread of the disease can be prevented.

Co-treatment with a sexual partner should be considered in order to avoid a ping-pong effect .

prevention

The following prophylactic procedures should be mentioned:

  • Use of condoms during sexual intercourse
  • Avoidance of risky contact (e.g. unprotected sexual intercourse with people from risk areas)
  • Education of people in risk groups
  • Sufferers should maintain sexual abstinence until treatment is complete and the skin lesions have completely healed.
  • Testing for other sexually transmitted diseases should be considered.

Reporting requirement

According to the Austrian Venereal Diseases Act, the disease of soft chocolates is subject to limited reporting ( Section 4 in conjunction with Section 1 Venereal Diseases Act).

In Germany there is no pathogen or disease-specific reporting requirement. However, a report should be made in the event of a presumably related accumulation of diseases.

literature

  • DA Lewis: Chancroid: clinical manifestations, diagnosis, and management . In: Sexually Transmitted Infections , 2003 Feb, 79 (1), pp. 68-71. Review. PMID 12576620
  • Spinola SM, Bauer ME, Munson RS, Jr: Immunopathogenesis of Haemophilus ducreyi infection (chancroid) . In: Infection and Immunity 2002 Apr, 70 (4), pp. 1667-1676. Review. PMID 11895928
  • DA Lewis: Diagnostic tests for chancroid . In: Sexually Transmitted Infections. 2000 Apr, 76 (2), pp. 137-141. Review. PMID 10858718
  • Birgit Adam : The punishment of Venus. A cultural history of venereal diseases. Orbis, Munich 2001, ISBN 3-572-01268-6 , p. 21 and more.

Web links

Individual evidence

  1. a b c d e f g h M Kemp, JJ Christensen, S Lautenschlager, M Vall-Mayans, H Moi: European guideline for the management of chancroid, 2011 . In: International Journal of STD & AIDS . tape 22 , no. 5 , May 2011, ISSN  0956-4624 , p. 241–244 , doi : 10.1258 / ijsa.2010.010432 ( sagepub.com [accessed July 5, 2020]).
  2. a b c d e f g h i j k l m n Robert Koch Institute: Profiles of rare and imported infectious diseases . Robert Koch Institute, September 15, 2011 ( rki.de [accessed July 5, 2020]).
  3. ^ Wolfgang Wegner: Friday to Boll. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 437 (on the author of a recipe against the soft chancre).
  4. Gundolf Keil: "blutken - bloedekijn". Notes on the etiology of the hyposphagma genesis in the 'Pommersfeld Silesian Eye Booklet' (1st third of the 15th century). With an overview of the ophthalmological texts of the German Middle Ages. In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013, pp. 7–175, here (especially on cambuca ): pp. 39 and 44.
  5. Barbara I. Tshisuaka: Ducrey, Augusto. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. 2005, p. 325.