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HOW I MANAGE?
Year : 2000  |  Volume : 66  |  Issue : 1  |  Page : 36

Inflammatory phimosis



Correspondence Address:
K Pavithran


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Source of Support: None, Conflict of Interest: None


PMID: 20877019

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How to cite this article:
Pavithran K. Inflammatory phimosis. Indian J Dermatol Venereol Leprol 2000;66:36

How to cite this URL:
Pavithran K. Inflammatory phimosis. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2019 Nov 15];66:36. Available from: http://www.ijdvl.com/text.asp?2000/66/1/36/4861


Secondary infection with fusospir­ochaetes resulting in inflammatory phimosis of the prepuce is a common complication in chancroid. How will you manage such a case?

When the chancroid ulcers develop in the mucosal aspect of prepuce or on the glans penis, and if the patient doesn't clean the glans penis regularly, it results in oedema of prepuce and inflammatory phimois. Due to secondary infection with anaerobic organisms there will be foul smelling subprepucial discharge. If not managed properly the whole prepuce and glans may be destroyed by the infecting organisms.

I usually admit such patients in the ward. The fusospirochaetal infection can be confirmed by dem­onstrating the fast moving spirochaetes in the subprepucial pus. The pus may be diluted with N. saline for darkfield microscopic examination. Blood VDRL test and HIV screening tests should be performed. Urine and blood should be tested to exclude diabetes mellitus.

Retraction of the prepuce is often impossible due to associated severe pain. Using a 20 ml syringe and scalp vein canula subprepucial irrigation with N. saline should be done every 2 hours for 12 hours. Insert the end of the canula in between the prepuce and glans penis and push N. saline all round the glans penis. If severe anaerobic bacterial infection is suspected, weak potassium permanganate solution (1:4000 to 1: 8000) is preferred since it releases nascent oxygen in presence of which anaerobic organisms cannot survive. For treatment of chancroid specific drugs such as erythromycin 250 mg qid for 7 days or tab. azithromycin 1g as single dose for one day only should be given. To treat infection by fusospirochaetes inj. benzyl penicillin 10 lakh units in every 6 hours should be started. If patient is allergic to penicillin erythromycin 250 mg qid is considered. Metronidazole 200 mg tid also is given orally. These drugs should be continued for 7 to 10 days. Fluctuant bubo if present should be aspirated with a widebore needle through healthy skin near the bubo.

Along with the above drugs, the patient is to be instructed to retract the prepuce 5 to 6 times daily. Each time the prepuce should be retracted 2-3 mm over the glans, clean the area with saline or warm water, dry with a towel and then release the prepuce to its original position. If expected response is not seen with the above line of management, a dorsal slit of prepuce should be considered so that the underlying ulcers can be visualised and cleaned properly. After healing of the wound and ulcers a circumcision of the prepuce can be done at a later date. Management of an STD case is never complete unless the sex partner is examined and treated if indicated. Serologic test for syphilis should be performed every month for 3 months




 

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Online since 15th March '04
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