Lymphogranuloma inguinale

Last Updated: 2020-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: 1A80

  • Hunter 1786
  • Durand, Favre u. Nicolas 1913
  • Frei 1925

Lymphogranuloma venereum, lymphogranulomatosis inguinalis, climatic bubo, fourth venereal disease.

Notifiable sexually transmitted disease caused by Chlamydia trachomatis serotype L1-L3.

  • Especially found in the tropics and subtropics.
  • Men > Women. 

Infection occurs through sexual intercourse.

After an incubation period of 1 to several weeks, skin changes occur in the area of the penis/ vulva, cervix or portio.

 

With a course in 3 stages:

Stage I:

  • Primary lesion which may ulcerate as a painless papule/papulovesicle/papulopustule in the course of the disease. Serous secretion is evacuated.

Stage II:

  • After up to 4 weeks there is pronounced dolent swelling in the groin area. The surface of the nodules is inflammatory reddened and abscess formation/perforation may occur.

Stage II:

  • 5-10 years after the primary infection genito-rectal symptoms (swelling, elephantiasis, ulcers, strictures, bloody diarrhoea) and ↓ general condition may occur.
  • Always co-treatment of the partner!
  • Medical history
    • Unprotected sexual intercourse?
    • Genito-anal ulcers recall?
    • Swelling of the inguinal lymph nodes?
  • Clinical picture
  • Bakt. Smear of the ulcer
    • PCR of Chlamydia DNA from tissue secretion or LK puncture
  • Laboratory
    • Serology for antibody detection
    • Chlamyidia antigen detection, (To confirm the diagnosis in case of suspicion an additional genotype determination should be carried out in a special laboratory).

Stage I: Male: Glans penis, coronal furrow, prepuce, anterior urethral segment. Woman: Vulva, vagina, cervix.  In the current LGV epidemic in Europe and North America under MSM, the rectum is the most common site of infection.

Stage II: Boils. After the appearance of the primary lesion, the inflammation spreads via the lymphatic system.

Stage III: Genitoanal area.

Elephantiasis genitoanorectalis ulcerosa and anorectal syndrome complex, abscesses, fistulas, strictures.

Use of condoms.

Good prognosis with early therapy (stage I and II). In pronounced stage III residuals with fibrosis, genital elephanitasis and anorectal symptom complex remain.

Always treat a partner as well!


Stage I and II

  • Doxycycline p.o. 100 mg 2x daily for 21 days
  • Erythromycin p.o. 500 mg 4x daily for 7-14 days
  • Azithromycin 1.5g p.o. Day 1, 8 and 15

Stage III

  • For elephantiasis, surgical procedure.
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