Section I: Glans penis inflammation Glans penis inflammation refers to the inflammation of the inner plate of the foreskin and the head of the penis. Normal foreskin cavity secretion of a kind of fat-like substances, in the foreskin is too long or circumcision, such substances can accumulate into foreskin scale stimulation of the foreskin and the head of the penis caused by the foreskin and glans phimosis. The glans phimosis is also divided into phimosis and glans phimosis, because it often occurs at the same time, so it is called penile glans phimosis. Causes] This inflammation can be infectious and non-infectious, clinically infectious glans penis is more common. Infectious often due to unclean sexual intercourse, infected with Candida albicans, trichomonas, chlamydia, mycoplasma, gonorrhea diplococcus or other bacteria; non-infectious factors are mostly due to the foreskin is too long, not enough to clean, between the foreskin and the glans unclean things, that is, the foreskin scales, will be built up, stimulate the localized inflammation of the foreskin and mucous membrane. Clinical manifestations] The following are the common types of circumcision and glansitis in clinic. 1, acute superficial glans phimosis: mostly due to underwear friction, trauma or soap, detergent local stimulation caused. At the beginning of the local flushing, the skin of the penis is red and swollen, and there is a burning and itching sensation on the glans. Turn over the foreskin, the inner surface of the foreskin and glans can be seen to be congested and vesicular, with oozing, and even bleeding. Secondary infection can be seen in small ulcers, with foul-smelling milky white purulent discharge. If rubbed with the underwear is painful, patients often have difficulty moving. May be accompanied by inguinal lymph node enlargement and pressure pain. 2, ring ulcerative prepuce glans: in the glans and prepuce, can be seen on the erythema gradually expanding ring, or ring with cheese-like prepuce scale, easy to break into superficial ulcers over time. If the ring-shaped feature is lost, it is not easy to distinguish from superficial glans. 3, plasma cell glans: common in middle age, for a single or more chronic inflammation that does not go away, the damage is plaque-like, the surface is smooth or desquamated or moist, infiltration is more obvious. The boundary is clear and not easy to break, the surface can be seen like chili powder-like tiny spots. The appearance is difficult to distinguish from the proliferative erythema of the glans. If similar damage occurs in the female genitalia, it is called plasma cell vulvovaginitis. Histopathology has specificity, a large number of plasma cell infiltration in the dermis, capillary dilatation, ferrous hemosiderin deposition. 4, mica-like and keratinized pseudoepitheliomatous glans: glans damage infiltration hypertrophy, hyperkeratosis and mica-like scab, the affected areas lose normal elasticity, atrophy over time. Histopathology shows hyperkeratosis, hypertrophy of the stratum spinosum, prolongation of the epidermal protrusion is pseudoepithelioma-like hyperplasia. Treatment: The foreskin of the head of the penis should be turned up during acute episodes, and can be washed with 1:5000 potassium permanganate solution, and then coated with antibiotic ointment. If the foreskin can not be upturned, it should be incised and drained. Oral or injectable antibiotics are needed along with local treatment. Those caused by drug allergy should also take anti-allergy drugs. Those whose phimosis or circumcision repeatedly cause inflammation of the penile head and foreskin should be circumcised to prevent recurrence. Section 2 Trichomoniasis Trichomoniasis is mostly transmitted because the spouse suffers from vaginal trichomoniasis. In male urethral trichomonas patients, there is a history of sexual intercourse with women who have trichomonas. Daily symptoms of trichomoniasis are subtle or even asymptomatic. Clinical manifestations] The symptoms are mild, mainly manifested as erythematous papules on the glans. Gradually expand, the edge is clear, erythema can be seen on the pinhead size of small blisters, and finally formed erosion surface. Patients often feel itching. Trichomonas glans can be serious urethritis cystitis. Prostatitis, and orchitis, can also show thick discharge and urinary distress can also occur glans, glans papules, erythema. Blisters and erosions. Trichomonas glans can do urethral swab Gram stain smear microscopic visual trichomonas. Treatment] 1, general treatment: remove the stimulus, keep local clean, avoid stimulating pollution. During the treatment period strictly restrain couples sexual life. 2, local treatment: vesicles oozing, with 3% boric acid solution, 0.1% Leifenur or 0.05% Huanglian Su liquid wet compress. Allergic factors caused by the external use of corticosteroid hormone preparations. You can also use traditional Chinese medicine to apply the formula “Miaoshan anti-inflammatory spirit” for treatment. 3, systemic treatment: anti-infection treatment, for different pathogens, the use of antifungal, anti-trichomonas and other drugs. For example, cephalosporin, fluazinic acid. 4, surgical treatment: circumcision, once the inflammation subsides, circumcision. Section III Candida glans this disease for the infection of candida and the onset of the disease, mainly in the glans, most patients are sexually active young adults, before the onset of the history of prostitution, or have more sexual partners, or spouse has candida vaginitis and in the onset of the period of coitus can also cause the onset of 【Clinical manifestations】 Commonly is the penile foreskin and glans is mildly red, dry and smooth, the inner plate of the foreskin and glans coronal inguinal with white cheese-like plaques. The inner plate of the foreskin and the coronal groove of the glans are accompanied by white cheese-like patches. When the scrotum is involved, a scaly erythematous rash can be seen on the contact surface with the penis, with obvious prickling and itching, and when the urethra is involved, urinary frequency and urgency can occur. A small number of patients may manifest acute edematous glans phimosis, with obvious edema of the foreskin accompanied by tingling and itching, small ulcers may appear, sometimes accompanied by diabetes mellitus. A very small number of men who have sexual intercourse with women suffering from Candida vaginitis develop a tingling, burning sensation in the penis within a few hours, with flushing of the foreskin and glans. The appearance of this symptom may be caused by the patient’s high allergy to Candida albicans. 【Treatment】 1, pay attention to cleanliness and hygiene, take baths and change underwear frequently, do not have sex outside of marriage, and should abide by behavioral ethics. In case of similar situation should wear a condom, pay attention to cleaning. 2, external treatment with 1:5000 potassium permanganate cleaning and then smear the affected area “Miao Shan dispel inflammation spirit” 3 ~ 5 minutes; or with local external non-irritating antifungal creams, etc., 3, such as the external effect is not good, can be taken orally itraconazole 200mg, 1 time a week for 2 consecutive times, and then the external use of antifungal drugs to maintain the efficacy of the treatment. Prohibit the abuse of antibiotics and hormone drugs. 4, active treatment of systemic diseases, such as hyperadrenocorticism, diabetes mellitus. To increase the body resistance. 5, circumcised patients, mycobacterial infection cured, should be performed as early as possible circumcision. Section IV vulvovaginal candidiasis Candida can invade human tissues causing inflammation, its infection in the female reproductive tract often invades the vagina, and secondary causes inflammation of the vulvar skin and mucous membranes, so it is called vulvovaginal candidiasis (VVC), has been used in the past Candida vaginitis, fungal vaginitis and mycosis fungoides vaginitis and so on the name. According to statistics, 70% of women have suffered from VVC at least once in their lifetime, and about 10-20% of healthy women have Candida in their vagina. [Etiology and pathogenesis] 80-90% of VVC is caused by Candida albicans, and a few VVC can be caused by Candida smooth, Candida near smooth or Candida tropicalis. Candida albicans is ovoid single-walled cells, distributed in groups, with germinating spores and pseudomycelium formed by cell germination and elongation. Candida is not heat-resistant, heating to 60 ℃ for 1 hour can die, but the resistance to dryness, sunlight, ultraviolet light and chemical agents, etc. stronger. About 10% of non-pregnant women and 30% of pregnant women have Candida parasites in the vagina without symptoms. When the increase of glycogen in the vagina, the pH value decreases when Candida easy to reproduce and cause inflammation, so it is mostly seen in pregnant women, diabetic patients and the application of estrogen; a large number of long-term use of antibiotics, the normal flora of the vagina is inhibited by the overgrowth of Candida; long-term application of immunosuppressant or glucocorticosteroids, which can make the patient’s immune function decline. All these factors can contribute to the vaginal infection and the occurrence of VVC. 【Clinical manifestations】 The leukorrhea of the patient is in the form of white flakes, such as curdled milk or soya bean dregs, with a slight odor. It may be accompanied by burning sensation in the vulva, urgency of urination, pain of urination and pain of sexual intercourse. Symptoms are severe with restlessness and unusual pain. Examination shows swelling of the vulva, the epidermis may be peeled off and there may be scratches. In severe cases, the labia major and minora are swollen and flushed, and the vaginal mucosa, inner labia minora and vaginal mucosa are attached with white membranous material, which can be seen as redness and swelling of the vaginal mucosa or vesicles and superficial ulcers after erasure. Diagnosis] It is not difficult to diagnose a typical patient, but it is easy to be confused with other vulvar lesions, so it is necessary to do pathogen examination to confirm the diagnosis. Directly do vaginal secretion smear examination can be diagnosed. 1, using 10% KOH droplet method under the microscope to find spores and pseudohyphae, the positive rate of up to 60% . 2. With Gram staining method, the positive rate can reach 80%. 3, culture method is more positive, and can determine the sensitive antifungal drugs, but it takes a period of time to confirm the diagnosis, can be used for refractory VVC or recurrent VVC. 4, for stubborn cases should be actively looking for the application of estrogen or antibiotic history, and check the glucose in order to exclude diabetes mellitus. (A) General treatment Remove the causative factors, stop using antibiotics and estrogen, etc., and actively treat diabetes mellitus. (B) Topical medication Choose one of the following. 1.Miconazole soft capsule 1200mg, single dose. 2.Miconazole suppository/soft capsule 400mg, once a night for 3 days. 3.Miconazole suppository 200mg once a night for 7 days. 4.Clotrimazole suppository/tablet 500mg, single dose. 5, Clotrimazole suppository 100mg, once a night, a total of 7 days. 6.Producing mycotoxin effervescent tablets 100,000U, once every night, a total of 14 days. 7.Producing mycotoxin tablets 500,000 U, once a night, a total of 14 days. (C) Systemic medication For unmarried women without sexual life, out of the inconvenience of topical medication and will menstruate. Fluconazole 150mg, take 1 time at once.