Ulcus molle (chancroid), colloquially known as soft chancre, is a sexually transmitted disease caused by the bacterium Haemophilus ducreyi. The venereal disease causes ulcers on the genitals, accompanied by swelling of the lymph nodes. Ulcus molle can be successfully treated with antibiotics.
What is molle’s ulcer?
Ulcus molle is a sexually transmitted infectious disease. The disease is found predominantly in warmer countries and occurs only sporadically in Europe, usually in persons who have recently returned from endemic areas. Recent reports from South-East Asia and Africa show that the incidence of ulcus molle is currently decreasing in relation to genital herpes. It has now been demonstrated through various studies that ulcus molle is a significant co-factor in the transmission of immunodeficiency virus type 1 (HIV-1). Improved diagnosis and treatment of ulcus molle therefore also plays an essential role in combating the HIV-1 epidemic. Mainly men are affected by ulcus molle, while in women, the course of the disease is without apparent symptoms in about half of the infections.
Causes
Ulcus molle is caused by the streptobacillus Haemophilus ducreyi, which is transmitted through sexual intercourse with infected persons. The bacterium is very sensitive to dehydration and cold, which is why it is predominantly found in tropical countries (Africa, Latin America, or Asia). The infectious process of ulcus molle affects the genital skin as a result of tiny epidermal abrasions during sexual intercourse, during which time the pathogen settles under the skin. Initially, mildly inflamed vesicles develop 4-7 days after infection before pustules form. Lesions resulting from molle’s ulcer usually occur on the foreskin and penile shaft in men and on the vulva, cervix, or labia in women.
Symptoms, complaints, and signs
Ulcus molle is characterized by ulcers in the genital area. Both men and women can be affected. The disease begins with the formation of a small nodule at the site of entry of the pathogen. As the disease progresses, the small nodule develops into an ulcer. The ulcer appears irregularly bordered, flat, and red-tinged. It causes severe pain and forms foci of pus that can burst open. The edge of the ulcer is soft (lat. mollis). The soft chancre usually consists of several ulcers that may fuse together. In men, the ulcers appear mainly on the penis, under the foreskin or on the frenulum of skin, which is located below the glans. In women, the ulcers usually appear on the vagina. Because they often do not cause pain there, ulcers in women may go unnoticed. Depending on sexual intercourse practices, ulceration of the anus or oral mucosa is also possible. Half of the patients develop other symptoms due to spread of the pathogen through the lymphatic system. Painful [[Lymphadenitis|inflammation of the lymph nodes can occur in the groin area. They then swell and may also form ulcers and abscesses. Soft chancre is easily treatable. However, during infection, the risk of contracting other sexually transmitted diseases is greatly increased.
Diagnosis and course
If the pustules are not treated, flat, painful ulcers with nodular cell collections and purulent discharge form within 2-3 days. In addition, molle ulcers contain numerous positive T lymphocytes, which further increases the susceptibility of HIV-infected individuals. Complications resulting from ulcus molle in males include foreskin constriction and progressive ulceration. In addition, there are painful swollen lymph nodes, which may spontaneously rupture if there is severe suppuration. A timely diagnosis of ulcus molle is usually only possible with pathological changes. Therefore, a urologist should be consulted already at the first symptoms. For diagnosis, a clinical examination of a swab for the pathogen of ulcus molle from an ulcer or the lymph fluid is performed. In order to exclude an infection with another venereal disease, the diagnosis is additionally confirmed by a culture from the pathogen strain.In principle, HIV testing should be performed in parallel with the diagnosis of molle’s ulcer.
Complications
In the case of molle’s ulcer, patients primarily suffer from severe inflammation. This occurs mainly at the site where the pathogen has entered. The site itself is clearly reddened and may also be affected by itching. Furthermore, a very painful ulcer also forms there due to the ulcus molles, which significantly reduces and restricts the quality of life of the affected person. In many cases, these also suffer from inferiority complexes or reduced self-esteem, as the complaint can also have a very negative effect on the aesthetics of the affected person. Furthermore, the patient’s lymph nodes also swell significantly and the affected person feels weak and weary. Furthermore, the disease can also lead to painful foreskin constriction. In most cases, ulcus molle can be treated relatively easily and quickly with the help of medication. After about a week, the symptoms disappear and no further complications occur. However, patients are dependent on regular check-ups and examinations by a doctor to ensure that no further complaints occur. The patient’s life expectancy is not negatively affected if the treatment is successful.
When should one go to the doctor?
A doctor should always be consulted for molle’s ulcer. It is a serious disease that can lead to serious complications if not treated properly. Therefore, a doctor must be consulted for this disease at the first signs and symptoms to prevent further complications or discomfort. The sooner a doctor is consulted for this disease, the better the further course of the disease usually is. A doctor should be contacted if there is a very high fever. As a rule, patients feel tired and weary and can no longer actively participate in everyday life. Especially after unprotected sexual intercourse, a doctor should be consulted if these symptoms occur. Furthermore, there is also severe pain in the joints and general weakness. Krnakehit ulcus molle can be detected in a hospital or by a general practitioner. The earlier the doctor is visited, the better is usually the further course.
Treatment and therapy
Treatment of molle ulcer usually involves antibiotic therapy, although pregnant women should be treated with care. Typically, three days of oral therapy with 500 mg of ciprofloxacin twice daily has proven effective in the treatment of molle ulcer. It is also possible to take erythromycin for a period of 7-10 days. Ceftriaxone can also be administered as a single dose by intramuscular injection. Filled lymph nodes are opened, if necessary, to prevent subsequent inflammatory rupture of the nodes. In addition, thorough body hygiene in the genital area is recommended in the case of ulcus molle in order to dry the ulcers or keep them clean and thus counteract further inflammatory processes. Baths with quinosol, potassium permanganate or anti-inflammatory substances are suitable for this purpose. Successful therapy, in addition to the need for absolute sexual abstinence, necessarily involves the regular sexual partner(s) in the treatment to avoid repeated infection with ulcus molle. Follow-up after 3 months can confirm healing, ruling out a chronic condition.
Prevention
In general, protected sexual intercourse (safer sex) is recommended to avoid infection with ulcus molle. Preventing vaginal or seminal fluid from entering the body is ensured by using a condom. This is the only way to prevent the pathogenic bacterium from entering the body through the mucous membranes.
Aftercare
Medical aftercare is not necessary if the ulcer has been completely cured. It can be assumed, with early and consistent therapy with antibiotics, that the infection will not leave any serious late effects. The ulcers heal after some time. Sexual intercourse should be avoided until complete healing has occurred, so that the weakened tissue can recover and further risks of infection can be ruled out. Wearing loose-fitting underwear can facilitate healing of the affected areas of the body.Follow-up care may only be necessary in the case of molle’s ulcer if the bacterial infection has been carried over for some time. This is particularly true if the lymph nodes are already severely affected and purulent abscesses have formed. On the one hand, these require opening by the physician, and on the other hand, they represent an entry point for pathogens. In these cases, good wound care is important even after antibiotic treatment. In cases that are difficult to treat or have been carried over for a very long time, a follow-up examination should also be considered. This can determine whether antibiotic therapy for soft chancre has been completely successful or not. Nevertheless, ulcus molle does not usually lead to serious complications or secondary conditions. Therefore, medical follow-up is not necessary in most cases.
What you can do yourself
An important contribution to self-help in the case of an infection with the Haemophilus ducreyi bacterium is to pay attention to thorough cleanliness and hygiene in the intimate area. It is essential to keep the ulcers caused by the infection dry and clean in order to speed up healing. This is also how sufferers prevent secondary infections. The best way to clean the intimate area is to take a shower. However, sitz baths with anti-inflammatory substances such as potassium permanganate can also be helpful. A beneficial effect is also attributed to baths with highly concentrated salt from the Black Sea. However, salt baths can be painful for open ulcers, so this form of therapy is not recommended for pain-sensitive patients. In addition, sexual abstinence is important until the symptoms subside. A steady sexual partner should also be included in the therapy, otherwise there is a risk of permanent mutual infection. Ulcus molle is usually treated with antibiotics. Women who are sensitive to these agents should use lactic acid suppositories from the pharmacy as a precaution. These preparations stabilize the vaginal environment and can thus prevent treatment with antibiotics from leading to a vaginal fungal infection. To prevent renewed infections, unprotected sexual intercourse should be avoided after successful therapy. In particular, direct contact with vaginal and seminal fluids should be avoided.
