Vulvar Elephantiasis

　　1. Etiology

　　After the filarial infection of the vulva, the female worm continuously produces microfilariae in the human lymphatic vessels, which寄生 in the lymphatic system, causing lymphangitis, lymphatic obstruction, and finally, the obstructed lymphatic vessels become varicose. The skin nutrition in the controlled area is impaired, leading to chronic thickening of the skin, forming vulvar elephantiasis.

　　In addition, recurrent vulvar cellulitis and chronic inflammation of the vulva, such as tuberculosis and syphilis, can cause fibrosis of connective tissue, obstruction of venous and lymphatic return, and finally lead to vulvar elephantiasis.

　　Second, pathogenesis

　　1. Elephantiasis caused by filariasis: Through mosquito bites, the infective larvae (microfilariae) can enter the human body through the wound, and then develop into adults in the lymphatic system. The toxins and metabolic products secreted by the adults affect the lymphatic tissues of the urinary and reproductive systems, causing chyluria and vulvar elephantiasis. In recent years, many scholars in China have confirmed through lymphography that filarial elephantiasis is due to lymphatic varices and severe pathological and physiological changes in lymphatic circulation dynamics, not due to mechanical obstruction.

　　2. Elephantiasis caused by syphilis: It is more common in late syphilis. It is the result of an exaggerated hypersensitive reaction of the body's tissues to syphilis spirochetes, causing inflammatory granuloma in the vulvar tissues.

　　3. Elephantiasis caused by tuberculosis: When tuberculosis spreads through the lymphatic system or directly spreads from adjacent lesions to the vulvar skin, it produces vulvar tuberculous granuloma, forming confluent nodules.

　　The skin of the vulva (clitoris, labia majora and minora) presents localized or diffuse thickening. The clitoris may be enlarged, with a rough surface that can be sausage-shaped, barrel-shaped, or breast-shaped. It may be uneven, nodular, warty, or乳头状, and the skin color can change to light brown, purple red, accompanied by desquamation, and is prone to secondary infection. Severe rubber disease may cause one side or the entire vulva to swell, sometimes resembling a tumor, hanging between the thighs. Infection may occur, and during the acute phase, systemic symptoms such as chills, high fever, and headache may occur.

　　The skin of the vulva (clitoris, labia majora and minora) presents localized or diffuse thickening. The clitoris may be enlarged, with a rough surface that can be sausage-shaped, barrel-shaped, or breast-shaped. It may be uneven, nodular, warty, or乳头状, and the skin color can change to light brown, purple red, accompanied by desquamation, and is prone to secondary infection. Severe rubber disease may cause one side or the entire vulva to swell, sometimes resembling a tumor, hanging between the thighs.

　　Due to the thickening and swelling of the vulvar skin, the patient may experience discomfort in sitting or standing, difficulties in urination and defecation, and sexual life affected. Owing to the obstruction of venous and lymphatic return, skin nutrition disorders can cause itching, and secondary infections are easy to occur after scratching, leading to ulcers, pain, and secretion. Some may even develop chronic ulcers that are difficult to heal, and lymphangitis often has an acute attack once every few months, lasting for 1 to 2 days, with a few cases lasting up to 10 days.

　　Due to the thickening and swelling of the vulvar skin, the patient may experience discomfort in sitting or standing, difficulties in urination and defecation, and sexual life affected. Owing to the obstruction of venous and lymphatic return, skin nutrition disorders can cause itching, and secondary infections are easy to occur after scratching, leading to ulcers, pain, and secretion. Some may even develop chronic ulcers that are difficult to heal. Lymphangitis often has an acute attack once every few months, lasting for 1 to 2 days, with a few cases lasting up to 10 days. Prevention should be emphasized, and mosquito control measures should be taken to eliminate the transmission媒介; actively prevent and treat syphilis, tuberculosis, vulvar cellulitis, and various chronic inflammations to prevent the occurrence of elephantiasis.

　　1. Filariasis

　　Blood examination of microfilariae: from 9 p.m. to 2 a.m. the next day, take 3 large drops of earlobe blood and place them on a clean glass slide, spread them into a 2×3 thick blood film, let it dry, dissolve the blood, stain, examine under a microscope, and check for microfilariae in body fluids. Directly smear the lymph fluid for examination and staining under a microscope.

　　2. Syphilis

　　Dark field microscopy: finding typical morphological Treponema pallidum with characteristic motility is a positive result and has diagnostic value. It can also be performed with Treponema pallidum antigen test, TPHA, TPPA, FFA-ABS test, which are diagnostic tests. Positive after infection with syphilis.

　　3. Tuberculosis

　　Tuberculin skin test: strong positivity indicates that there are still active foci at present, and if negative, it generally indicates that there has been no infection with Mycobacterium tuberculosis. Smear the local secretion and perform acid-fast staining to find tuberculosis bacteria or culture the local secretion to find tuberculosis bacteria.

　　One. Dietetic recipe for vulvar elephantiasis

　　1. Portulaca with celery: equal amounts of portulaca, side root (Houttuynia cordata), and celery (fresh) are washed, scalded with boiling water, seasoned with salt, sugar, vinegar, garlic, monosodium glutamate, sesame oil, and served cold with meals.

　　2. Mugwort and soybean egg soup: 10g of mugwort, 30g of soybeans, 2 eggs, put them into the pot with clean water and boil until the soybeans are soft, remove the dregs and keep the juice, then beat the eggs into the juice and cook for a few minutes, and it can be eaten once a day, and it should be taken for 2-3 days consecutively.

　　Two. Foods that are good for vulvar elephantiasis

　　1. Amaranth without restriction, cook into soup and eat regularly, treating elephantiasis of blood filariasis and goiter.

　　2. Eat more vegetables and fruits. Drink more tea or light beverages.

　　3. Prefer cool blood and detoxifying foods. Such as: mung beans, glutinous rice, cucumber, bitter melon, portulaca oleracea, green tea, etc.

　　Three. It is best not to eat those foods for vulvar elephantiasis

　　1. Abstain from foods that produce heat. For example: fish, shrimp, crab, chicken head, pork head meat, goose meat, chicken wings, chicken feet, etc., which will worsen the itching and inflammation of the genitals after eating.

　　2. Eat less spicy and stimulating foods. For example: onions, black pepper, chili, Sichuan pepper, mustard greens, fennel.

　　3. Avoid eating fried and greasy foods. For example, oil sticks, butter, butter, chocolate, etc., these foods have the effect of moistening and increasing heat, which will increase the secretion of leukorrhea and is not conducive to the treatment of the disease.

　　4. Quit smoking, drinking, and caffeine and other stimulant drinks.

　　One. Western medical treatment for vulvar elephantiasis: drug treatment:

　　1. Treatment of filariasis:

　　Diethylcarbamazine (Hydroxynaphthoquine) is the main drug for treating lymphatic filariasis and can kill microfilariae. The common method for treating Bancroftian filariasis is: Diethylcarbamazine (Hydroxynaphthoquine) 300mg, twice a day, for 7 days, with an interval of 2-3 courses, and the negative conversion rate can reach above 90%. For treating Malayan filariasis, Diethylcarbamazine (Hydroxynaphthoquine) 300mg, twice a day, for 3-4 days, only one course is needed.

　　2. Syphilis Treatment:

　　① Early syphilis (including primary, secondary, and early latent syphilis):

　　A, 2.4 million units of benzathine penicillin, injected into both gluteal muscles, once a week, for a total of 2-3 times.

　　B, 800,000 units of procaine penicillin, once a day, intramuscular injection, for a continuous period of 10-15 days. Total dose: 8-12 million units.

　　C, for patients allergic to penicillin, 500mg of tetracycline hydrochloride, 4 times a day, taken orally, for a continuous period of 15 days, or doxycycline 100mg, 2 times a day, taken orally, for a continuous period of 15 days.

　　② Late syphilis (including tertiary skin, mucosal, or skeletal syphilis), late latent syphilis or latent syphilis whose disease stage cannot be determined, and recurrent syphilis in the second stage.

　　A, 2.4 million units of benzathine penicillin, injected into both gluteal muscles, once a week, for a total of 3 times, with a total dose of 7.2 million units.

　　B, 800,000 units of procaine penicillin, once a day, intramuscular injection, for a continuous period of 20 days as one course.

　　C, for patients allergic to penicillin, 500mg of tetracycline hydrochloride, 4 times a day, taken orally, for a continuous period of 30 days or more, or doxycycline 100mg, 2 times a day, taken orally, for a continuous period of 30 days.

　　③ Tuberculosis Treatment: Currently, the two-stage short-course drug treatment regimen is promoted, with the first 2-3 months being the intensive phase and the subsequent 4-6 months being the consolidation phase.

　　A, 2SHRZ/4HR, the intensive phase lasts for 2 months, with streptomycin (0.75g, intramuscular injection) every day, isoniazid (300mg, once a day, taken in one dose), rifampicin (450-600mg, taken before breakfast in one dose), pyrazinamide (1.5-2.0g/d, taken in three doses), and the subsequent 4 months are the consolidation phase with the continuous application of isoniazid and rifampicin every day.

　　B, 2SHRZ/6HRE, the intensive phase involves the combined application of streptomycin, isoniazid, rifampicin, and pyrazinamide every day for 2 months, and the consolidation phase involves the application of isoniazid, rifampicin, and ethambutol every day for 6 months. The first regimen is used for patients receiving initial treatment, and the second regimen is more commonly used for patients with treatment failure or recurrence.

　　2. Surgical Treatment:

　　Surgical treatment is applicable for patients with giant vulvar elephantiasis who are seriously affected by urination or sexual life. The operation completely removes the diseased tissue, repairs the defect area of the labia majora with a thigh medial pedicle skin flap, or performs a medium-thickness free skin grafting surgery.