Lymphogranuloma inguinale

• Hunter 1786
• Durand, Favre & Nicolas 1913
• Frei 1925

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

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

• Mostly found in the tropics and subtropics
• Males > females

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 progression in 3 stages:

Stage I:

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

Stage II:

• After up to 4 weeks, there is marked dolent swelling in the groin area. The surface of the nodes is reddened with inflammation and abscess formation/perforation may occur

Stage III:

• 5-10 yrs after primary infection, genitorectal symptoms (swelling, elephantiasis, ulcers, strictures, bloody diarrhoea) and ↓ AZ may occur.

• Always treat your partner as well!
• Anamnesis
  • Unprotected sexual intercourse?
  • Ulcera genitoanal remembered?
  • Swelling of the inguinal lymph nodes?
• Clinical picture
• Bact. Swab of the ulcer
  • PCR of chlamydial DNA from tissue secretion or LK punctate
• Laboratory
  • Serology for antibody detection
  • Chlamyidia antigen detection, (To confirm the diagnosis in suspected cases, an additional genotype determination should be carried out in a special laboratory)

• Stage I: Man: glans penis, coronary groove, prepuce, anterior urethral segment. Woman: vulva, vagina, cervix. In the current LGV epidemic in Europe and North America among MSM, the rectum represents the most common site of infection.

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

• Stage III: Genitoanal area

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

Use of condoms.

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

1. Rahman MU, Schumacher HR, Hudson AP. Recurrent arthritis in reiter's syndrome: A function of inapparent chlamydial infection of the synovium? Seminars in Arthritis and Rheumatism 1992;21:259-66.
2. Yealy DM, Greene TJ, Hobbs GD. Underrecognition of CervicalNeisseria gonorrhoeaeandChlamydia trachomatisInfections in the Emergency Department. Academic Emergency Medicine 1997;4:962-7.
3. Palladino S, Pearman JW, Kay ID, et al. Diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae genitourinary infections in males by the Amplicor PCR assay of urine. Diagnostic Microbiology and Infectious Disease 1999;33:141-6.
4. Schachter J. What Is the Minimally Effective Treatment for Chlamydia trachomatis Infection? Sexually Transmitted Diseases 1999;26:279-80.
5. Kyriakis KP, Hadjivassiliou M, Paparizos VA, Flemetakis A, Stavrianeas N, Katsambas A. Incidence determinants of gonorrhea, chlamydial genital infection, syphilis and chancroid in attendees at a sexually transmitted disease clinic in Athens, Greece. International Journal of Dermatology 2003;42:876-81.
6. Peipert JF. Genital Chlamydial Infections. New England Journal of Medicine 2003;349:2424-30.
7. Gaydos CA, Theodore M, Dalesio N, Wood BJ, Quinn TC. Comparison of Three Nucleic Acid Amplification Tests for Detection of Chlamydia trachomatis in Urine Specimens. Journal of Clinical Microbiology 2004;42:3041-5.
8. Low N, Bender N, Nartey L, Shang A, Stephenson JM. Effectiveness of chlamydia screening: systematic review. International Journal of Epidemiology 2008;38:435-48.
9. Carter JD, Gérard HC, Espinoza LR, et al. Chlamydiae as etiologic agents in chronic undifferentiated spondylarthritis. Arthritis Rheum 2009;60:1311-6.
10. Carter JD, Espinoza LR, Inman RD, et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: A double-blind, placebo-controlled, prospective trial. Arthritis & Rheumatism 2010;62:1298-307.
11. Gerard HC, Stanich JA, Whittum-Hudson JA, Schumacher HR, Carter JD, Hudson AP. Patients with Chlamydia-associated arthritis have ocular (trachoma), not genital, serovars of C. trachomatis in synovial tissue. Microbial Pathogenesis 2010;48:62-8.
12. Hislop J, Quayyum Z, Flett G, Boachie C, Fraser C, Mowatt G. Systematic review of the clinical effectiveness and cost-effectiveness of rapid point-of-care tests for the detection of genital chlamydia infection in women and men. Health Technology Assessment 2010;14.
13. Gérard HC, Hudson AP, Carter JD. Chlamydia trachomatis Is Present and Metabolically Active During the Remitting Phase in Synovial Tissues From Patients With Chronic Chlamydia-induced Reactive Arthritis. The American Journal of the Medical Sciences 2013;346:22-5.
14. Braun-Falco`s Dermatologie, Venerologie und Allergologie, 7. Auflage