TITLE:
Chronic Anogenital Ulcerations and Polymicrobial Pelvic Infections: About a Case
AUTHORS:
Michèle Florence Mendoua, Grâce Anita Nkoro, Lucie Nguizaye, Vanina Ngono Akam, Esther Ngo Um
KEYWORDS:
Anogenital, Ulceration, Polymicrobial, Infection
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.13 No.1,
January
30,
2023
ABSTRACT: Genital ulceration is the loss of integrity of the mucous membranes (or
genital skin) leaving the dermis uncovered and almost always accompanied by
satellite lymphadenopathies. Beyond a month of evolution, it is said to be
chronic. Sexually transmitted diseases are infections due to microbial agents
among which parasites, bacteria, viruses and fungi that can be associated with
each other to varying degrees. Sexually transmitted infections must be
mentioned before any genital ulceration. Hence the interest of the case that we
report of chronic anogenital ulcerations complicating a polymicrobial pelvic
infection in a patient immunocompromised to HIV. The physical examination
reveals a hypogastric sensitivity to deep palpation, the presence of a
superinfected anogenital ulceration exposing the deep dermis covered with
purulent serosities interesting the labia minora, the posterior vaginal fork, the
anal region, the clitoris and an extension of the lesions to the gluteal fold
is observed. We found a satellite lymphadenopathy in the right inguinal fold.
The screening finds the HIV1 positive serology with a viral load of 28,000
copies, the herpes simplex 1&2 and Chlamydia trachomatis serologies were
all positive. The genital samples are marked by the presence of bacterial
vaginosis with Candida Albicans and Gardnerella Vaginalis, the presence of
urogenital mycoplasmas of the Ureaplasma Urealyticum The pelvic ultrasound was
in favor of a bilateral adnexitis. A protocol was put in place: the first step
consisted of seat baths, antifungi and antibiotics administration: fluconazole
150 mg and tinidazole 2 g in single doses, then josamycin 1 g/24h in
two doses per os for two weeks. The second stage consists of the administration
of doxycycline 200 mg for 21 days, Aciclovir 500 mg for 10
days, and the administration of ARV (Tenofovir + Lamivudine + Dolutegravir) or
one tablet daily. The evolution is marked by a progressive healing of the
clitoris, the labia majora and labia minora, the posterior vaginal fork. In
case of chronicity, a biopsy in search of a tumor process is not mandatory when
there is a satisfactory response to treatment and good healing. The patient’s
death two weeks after the beginning of ARV treatment, can be explained by a
probable immune reconstitution syndrome.