Differential diagnosis of symptoms and integrated traditional Chinese and Western medicine treatment of chancroid, condyloma acuminata and lymphogranuloma venereum.

122. Clinical Manifestations and Treatment of Chancroid Chancroid is an acute selective localized disease caused by Haemophilus ducreyi. It is caused by infection through unclean sexual intercourse. The incubation period is 2 to 5 days. It usually affects the genital area, causing painful ulcers, and is complicated by lymphadenitis, balanitis and mixed chancre (infection with syphilis). It is common in tropical and subtropical regions and is mostly spread to my country from Southeast Asia. (1) Clinical Manifestations: The human body has no natural resistance to this bacillus, so it is easy to get infected. The incidence rate is even higher than that of syphilis. The disease is transmitted through direct contact with the secretions and pus of the patient's open wounds and ulcers during sexual intercourse, and enters the body through abrasions on the skin. Then the skin of the external genitalia becomes diseased, with local inflammation, degeneration and necrosis, leading to the formation of pus. The lesions start from vesicles and pustules, and finally form ulcers. The lesions can be self-inoculated and spread. The edges of the ulcers are irregular and serrated, the base is covered with purulent secretions, it bleeds easily, and there is an inflammatory halo around it. The patient experiences a burning sensation and pain upon touch. If there are no complications, it can heal on its own in about 3 to 8 weeks, but will leave obvious scars. This disease can be diagnosed by examining a smear of secretions from the ulcer to find Klebsiella chancroid. Gram staining will show short and thin negative streptococci. A positive culture will confirm the diagnosis. (2) Treatment ① Western medicine treatment. Compound sulfamethoxazole tablets, 4 tablets each time, twice a day, orally, for 7 days; or erythromycin 0.5g, 4 times a day, orally, for 7 days or 10 to 20 days. Doxycycline 100mg, twice a day, orally, can also be used for 14 days. If drug resistance occurs, streptomycin or kanamycin, 0.5g, intramuscular injection, twice a day, for 14 days as one course of treatment can be used. The local area can be soaked in hydrogen peroxide solution. If there is a lot of red pus, the pus can be punctured and aspirated before injecting the drug. ② Traditional Chinese medicine treatment ● Differentiation of syndromes and treatment. The treatment for the damp-heat type of lower jiao is to clear heat, detoxify and promote diuresis. Prescription: Gentian Liver-Clearing Decoction plus 10 grams each of Smilax glabra, Lonicera japonica, Forsythia suspensa, and Taraxacum mongolicum. ● Poultice therapy: Apply Zhuhuang Powder (a traditional Chinese medicine) to the affected area. ● Fumigation and washing therapy: Decoction of 30 grams of raw rhubarb, 12 grams each of Saposhnikovia divaricata, Isatis indigotica, Zanthoxylum bungeanum, and Artemisia argyi for washing the vulva 2-3 times daily; or decoction of 10 grams each of Cnidium monnieri, Zanthoxylum bungeanum, and Alum for fumigating and washing the vulva.

Clinical Manifestations and Treatment of Genital Warts Genital warts, also known as condyloma acuminata or venereal warts, are a common infectious disease caused by human papillomavirus (HPV) infection, occurring in the anal and genital areas. It is a benign skin tumor that mostly occurs in sexually active young people. The cause of genital warts is the human papillomavirus, which belongs to the Papillomavirus family. It has an icosahedral nucleocapsid structure without an envelope, with a diameter of 50-55 nanometers and 72 capsid particles. Most patients have a history of extramarital sexual intercourse or their spouse has a history of extramarital sexual intercourse. A few patients have unknown routes of infection, which may be related to indirect contact infection or changes in the body's immune function. (1) Clinical Manifestations of Genital Warts ① The incubation period varies from 2 weeks to 6 months, with an average of 3 months. ② It is more common in sexually active young adults. The skin and mucous membranes of the external genitalia are most susceptible to the disease, and the virus can be transmitted due to minor abrasions during sexual intercourse. ③ It can be single or multiple, mainly pink, varying in size, and soft in texture. The appearance can be papular, nipple-like, cockscomb-like, or cauliflower-like, and it bleeds easily. It is occasionally seen in areas other than the genitals. The main complications of condyloma acuminata are: the warts gradually enlarge and the genitals are completely eroded; cancer. (2) Treatment of condyloma acuminata ① Western medicine local treatment ● Keep the local area clean and dry. It is commonly used to wash with 3% hydrogen peroxide and 1:8000 potassium permanganate solution. ● Electrocoagulation can be performed under local anesthesia or 5% fluorouracil cream or 2% fluorouracil solution can be applied externally. 10% podophyllin alcohol solution or 33% trichloroacetic acid can also be applied externally. All of the above drugs are irritating, so 10% zinc oxide ointment should be used to protect the surrounding skin. ● 3%～5% phthalimide ointment is applied externally and the effect is better. ● Carbon dioxide laser treatment can be used. ● For severe recurrent condyloma acuminata, interferon can be used for treatment, once daily, intramuscular injection of 3×10⁶ IU, for 60 days as one course of treatment. Adverse reactions may include fever, headache, nausea, and muscle pain. ● Bath tubs and towels used by the patient should be disinfected. Sexual activity should be avoided until cured. ② Traditional Chinese Medicine Treatment ● Treatment based on syndrome differentiation. For the damp-heat accumulation and toxicity type, the treatment is to promote diuresis, clear heat, and detoxify. Formula: Caoxie Shenshi Decoction plus Atractylodes lancea, Smilax glabra, Lithospermum erythrorhizon, Isatis indigotica, and Paris polyphylla. ● Acupuncture therapy. Select ear acupoints Lung, Cheek, and Sympathetic, 1-2 points each time, once daily, retain needles for 30 minutes. ● Chinese patent medicines. Huang Sheng Dan, for external use, grind into fine powder and sprinkle on the affected area, then apply a plaster; Qianjin San or wart-removing ointment for external application. ● Moxibustion. Place moxa cones on the warts for moxibustion, once daily until they fall off. ● Fumigation and washing therapy. Formula 1: Decoct purslane, Atractylodes lancea, bee honeycomb, Angelica dahurica, Asarum sieboldii, Cnidium monnieri, Sophora flavescens, and Citrus reticulata peel in water and use the hot decoction to wash the affected area. Formula 2: Decoct 30g of Cibotium barometz and 30g of Kochia scoparia in water and use the decoction to wash the affected area. Formula 3: Decoct 60g of purslane, 30g of Isatis indigotica leaves, and 20g of alum in water. First fumigate, then wash, twice daily for 15 minutes each time. ● Poultice therapy: Soak 10g of Brucea javanica kernels and 30g of peanut oil for 15 days, then apply to the affected area. ● Single-herb prescriptions: Formula 1: Apply Brucea javanica oil to the affected area. Formula 2: Crush Brucea javanica into a paste, apply to the wart, and change the dressing every 3-5 days. Formula 3: Crush purslane and apply externally, or rub with fresh water chestnut stems.

Clinical Manifestations and Treatment of Lymphogranuloma Venereum This disease, also known as inguinal lymphogranuloma, is the fourth sexually transmitted disease. It is caused by Chlamydia trachomatis serotypes L1, L2, and L3 and is a sexually transmitted disease. (1) Clinical Manifestations ① After sexual intercourse, there is an incubation period of 5 to 21 days. The initial lesion occurs on the genitals (male glans penis or foreskin, female labia majora, vagina, or cervix). It is a small papule with no subjective symptoms and "heals on its own" within a few days, so it is often overlooked. ② 1 to 6 weeks after the initial lesion (average 3 weeks), local inguinal lymph node enlargement occurs. It is usually unilateral and tender. Later, they can merge to form irregular, uneven plaques that adhere to the skin and surrounding tissues. They are red (called buboes) and have diagnostic significance. After 1 to 2 weeks, they soften, rupture, and drain pus to form many fistulas. Healing is slow and scars remain after healing. However, some cases do not suppurate and are absorbed and disappear on their own. ③ When lymph nodes are swollen, there may be systemic symptoms such as fever, joint pain, loss of appetite, and anemia. In severe cases, the liver and spleen may be enlarged. ④ In the late stage, elephantiasis-like swelling of the external genitalia may occur. Female patients may develop anorectal inflammation and perianal inflammation, leading to rectal stenosis, manifested as difficulty in defecation and thinning of stool. Fistulas are commonly found around the anus. (2) Western medicine treatment ① Systemic treatment. Sulfathiazole, 4 grams daily, 4 times a day, after 1 week, reduce to 1-1.5 grams daily, continue for 3 weeks. ② Local treatment. For swollen lymph nodes, 10% ichthammol ointment can be applied. If pus has formed, it can be aspirated with a syringe, but incision and drainage are contraindicated. In the early stage of rectal stenosis, dilation can be performed, and surgical treatment can be used if necessary. (3) Traditional Chinese medicine and other treatments ① Differentiation of syndromes and treatment. For the type of insect poisoning and damp heat, the treatment method is to dispel wind and clear heat, promote diuresis and relieve itching. Formulas: ① Jingfang Baidu San (荆防败毒散) plus honeysuckle, forsythia, sophora flavescens, smilax glabra, lithospermum erythrorhizon, and kochia scoparia, minus notopterygium and angelica pubescens. For pustules, add peony bark, phellodendron bark, polygonum cuspidatum, and dandelion. ② Prepared Chinese medicines: Yi Sao Guang (一扫光), for external use, apply dry to the affected area or mix with sesame oil and apply to the affected area once daily or every other day; Huang Sheng Dan (黄升丹), for external use, mix with sesame oil and apply to the affected area. ③ Poultice therapy: ● First, decoct 9 grams of Sichuan pepper and 30 grams of kochia scoparia in water for bathing, then apply Yi Sao Guang or sulfur ointment twice daily, morning and evening, for 3 consecutive days as one course of treatment. Generally, 2-3 courses of treatment are needed. ● 10% Bai Bu Ding (百部酊), apply 2-3 times daily. ● 100g each of costus root and styrax resin, 50g each of frankincense and myrrh, grind into a fine powder. Take an appropriate amount of beeswax, heat it, and then add the powdered herbs while stirring to form a paste. Apply to the affected area while it is still hot. ● For impetigo, apply indigo ointment mixed with Jiu Yi Dan externally. ④ Fumigation and washing therapy. ● 20g each of sophora flavescens, alum, cnidium monnieri, and schizonepeta tenuifolia, decoct and wash externally. ● 30g each of salvia miltiorrhiza, sophora flavescens, and cnidium monnieri, decoct and wash. ● 80g of houttuynia cordata, 30g of walnut kernels, 15g of tobacco leaves, and 3g of sulfur powder. First, crush the first two herbs and mix with the sulfur powder, apply to the sores; then, ignite the tobacco leaves in a clay basin to produce smoke, and fumigate the affected area, once in the morning and once in the evening, 5-10 minutes each time. ⑤ Spring water bath method. Choose a sulfur spring or ferrous sulfate spring, with a water temperature of 39℃~42℃, for 20 minutes each time, once a day, for 15 times as one course of treatment. ⑥ Single-herb prescriptions. First, decoct 9 grams of Sichuan pepper, 15 grams of alum, and 30 grams of Kochia scoparia fruit into a soup for fumigation and washing. Then, mix 10 grams of sulfur powder with cooked lard to form an ointment for external application. Alternatively, grind 12 grams of sulfur, 10 grams of rosin, and 3 grams of litharge into a fine powder, mix with sesame oil, and apply to the affected area.