Definition
Cancer (or soft ulcer) is a sexually transmitted disease that causes papules and genital ulcers. The infection is caused by a small Gram-negative bacillus, called Haemophilus ducreyi, which penetrates through small lesions of genital skin or mucous membranes.
The cancer contracts, therefore, during sexual intercourse with infected people or indirect infection through contaminated objects (rare occurrence, as the germ dies quickly in the external environment).
Cancer is more common in Africa, South East Asia and other developing countries. As with other sexually transmitted infections that cause genital ulceration, the cancer increases the risk of HIV transmission.
Most common symptoms and signs *
- Pus emission from the penis
- lymphadenitis
Further indications
After an incubation period of 3-10 days, the cancer causes the appearance of one or more papules, with an erythematous border, on the skin or on the mucous membranes of the genitals. In humans, these lesions are mainly located at the level of the prepuce, frenulum, balanopreputial sulcus and perianal region, whereas in women they occur mainly on small and large labia, vulva and cervix.
After about 24-48 hours, the papules evolve first into pustules, then into superficial, painful and soft consistency ulcers. These lesions have jagged margins, an erythematous halo and a bottom covered with necrotic-purulent exudate (therefore it appears gray-yellowish).
The cancer is also characterized by a painful inguinal lymphadenopathy with a suppurative tendency. The enlargement of the lymph nodes can lead, therefore, to their coalescence and, within a week of the genital lesion, to the formation of a floating abscess (bubo) in the groin. The skin above this swelling can become red and shiny. In some cases, the bubo can break and form a fistula, other times it tends to spontaneous resolution.
Cancer can also cause pain in the anus and dysuria due to the particularly painful contact between ulcers and urine, urethral leaks in men and vaginal secretions in women.
As the condition progresses, ulcers may flow together or may resolve, leaving depressed scars on the skin surface. The infection can spread to other skin areas, even extra-genital, causing the onset of new lesions by self-inoculation.
Cancer can result in urethral strictures and fistulas. In some cases, deeper erosions can lead to marked tissue destruction. In humans, another possible complication is phimosis, the narrowing of the preputial orifice, often associated with balanitis or balanoposthitis.
The diagnosis is usually formulated based on clinical findings, given the difficulty of growth of the microorganism in culture (note: it grows slowly only on culture media containing emina and albumin). In any case, the identification of the pathogen in exudates taken from the margins of ulcerations or in the pus of a bubo must be attempted. Cancer must be differentiated from genital herpes, venereal lymphogranuloma and syphilis.
Therapy involves the immediate administration of macrolides, ceftriaxone or ciprofloxacin. Patients should be kept under observation for 3 months, and all sexual partners must also be evaluated.