Physical Presentation Of Lymphogranuloma venereum
Lymphogranuloma venereum is a common sexually transmitted disease caused by Chlamydia trachomatis strains Li, Lii and Liii, manifesting as inguinal buboes, pseudo-elephantiasis of the genitals and anorectal involvement in the late stages.
Distribution: It is present all over the world, more frequently in developing countries.
Incubation period: The incubation period rangers from 2 weeks to several weeks.
The organisms enter by sexual intercourse and a small herpetiform ulcer develops under the prepuce or the labia. This ulcer disappears within 24 to 48 hours. Rarely, it may become secondarily infected and persistent.
Inguibal bubo: This is more common in males, since lymphatics from the male genitalia drain mostly into the inguinal group of lymph glands. On the other hand, in the females they drain into the anorectal lymph nodes or directly into the hypograstric lymph nodes. The buboes are usually unilateral, painful, matted, firm or fluctuant and tender. The overlying skin is indurated. Buboes may be bilateral at times. Sooner or later, the bubo suppurates and multiple sinuses develop and discharge pus. Some buboes may remain indolent for a long time.
LGV in the female: Mild constitutional symptoms like fever, malaise and lower abdominal pain, on the side of the bubo are fairly common. Local peritonitis may develop through peritoneal lymphatics. Other lesions in the female include stricture of the urethra, destruction of the floor of urethra and rectovaginal, urethra-vaginal or vesico-vaginal fistulae. In debilitated patients, extensive tissue damage may develop. Pelvic inflammation may follow.
Esthiomene: Esthiomene is a pseudo- elephantoid condition of the genitalia caused by lymphatic obstruction, due to extensive involvement of deeper pelvic lymph nodes and lymphatics. It is more common in women. Hypertrophy involves the labia, prepuce of the clitoris and sometimes the clitoris. They enlarge to big sizes and the surface is warty. Mammilated, verrucous or ulcerated.
Anorectal lesions: These develop late in the disease and are more common in women and in male passive homosexuals. Initial lesion is anoproctitis which may resemble dysentery, but does not respond to usual treatment. Finally, it leads to rectal stricture. Rarely stricture may develop without evidence of preceding anoproctitis. Below the stricture extensive polyposis and cockscomb like condylomatous masses may develop in the perianal region.
Extragenital manifestations are rare in LGV. These are meningitis, cutanoeus eruptions, episcleritis, iridocyclitis and arthritis.
Ulcerated Lesions With Rash Surfaces In Lymphogranuloma Venerum
Diagnosis And Treatment
Diagnosis: Diagnosis is clinical. The causative organism can be grown in chick embryo or tissue culture, where facilities exist. The Frei skin test is reliable and easy to perform. The test is positive 2 to 6 weeks after infection and it remains so for life. Since there is cross- reaction with other species of Chlamydia, the test is not specific.
The LGV complements fixation test becomes positive in 1 to 3 weeks in 90 to 95% cases. This test is nonspecific since other chlamydiae may give rise to positive reactions, though not in the same titers can be taken as diagnostic of LGV. Other more specific tests are the immunofluorescent tests and radio-isotope precipitation tests (RIP).
Treatment: Early cases respond to oral tetracycline in doses of 500 mg, four times a day for 10 to 20 days. The suppurating buboes should be aspirated and not incised. Surgery is required for excising elephantoid lesions and dilating strictures after treating adequate with tetracycline. Sometimes even established strictures resolve with simple medical treatment.
© 2014 Funom Theophilus Makama