Generality
Venereal lymphogranuloma is a sexually transmitted disease (STD). The infection is caused by some serotypes of the bacterium Chlamydia trachomatis, which have the pathogenic peculiarity of invading and reproducing in the lymph nodes of the inguinal region.
The venereal lymphogranuloma occurs after a variable incubation period (3-21 days), at the entrance site of the bacterium (glans, vulva, vagina and rectum) with a papule that evolves into an asymptomatic ulcer.
Subsequently, the infection spreads along the lymphatic vessels up to the inguinal lymph glands, resulting in their painful swelling. At the same time, the patient suffering from venereal lymphogranuloma may present with fever, headache and abdominal pain.
In the most advanced stage, there is a difficulty in lymphatic drainage with chronic swelling of the genitals, proctitis and stenosis (narrowing) of the urethra and anus.
In the absence of treatment, the venereal lymphogranuloma can cause obstruction of the lymphatic flow, chronic pain and swelling of the genital tissues and skin sores.
Venereal lymphogranuloma therapy is based on antibiotic intake.
What's this
Venereum lymphogranuloma: what is it?
Venereal lymphogranuloma is a systemic sexually transmitted disease (STD), caused by some serotypes of the bacterium Chlamydia trachomatis .
The classical clinical manifestation of the infection occurs at the inguinal level and involves the appearance of genital or perianal ulcers and the increase in the volume of regional lymph nodes . In the advanced stages, the inflammatory lymph gland process can cause suppuration with the possibility of fistulas .
The venereal lymphogranuloma can also occur in the anorectal variant and, less often, in the oral-pharyngeal form (the latter mainly involves pharyngitis with lymphadenitis on the sides of the neck).
Venereous lymphogranuloma: synonyms
The venereal lymphogranuloma is also known as:
- Nicolas-Favre disease;
- Inguinal lymphogranuloma;
- Venereal lymphopathy.
Causes
What causes Venereous Lymphogranuloma?
The causative agent of venereal lymphogranuloma is Chlamydia trachomatis . In particular, some serotypes of this bacterium can cause the disease - L1, L2 and L3 . These take on a particular pathogenetic behavior, as they have the ability to invade, stationary and reproduce in the lymph nodes of the inguinal region.
Unlike the more known Chlamydia, the venereal lymphogranuloma has more aggressive clinical features.
To learn more: Chlamydia - Causes and Symptoms »Venereous lymphogranuloma: mode of transmission
The transmission of venereal lymphogranuloma occurs directly during unprotected anal, oral and vaginal sexual intercourse . The infection can contract more easily in the presence of small abrasions or cuts in the skin and mucous membranes .
Who is most at risk?
The venereal lymphogranuloma affects the male sex more frequently. Most at risk are people who have relationships without protection with multiple and occasional partners .
Venereous lymphogranuloma: how widespread is it?
- Venereal lymphogranuloma is an endemic infection in some areas of Africa, South East Asia, Central and South America.
- In Europe and North America, the infection is quite rare: the venereal lymphogranuloma had almost disappeared, but, in recent years, it is re-emerging. In the past, it was more likely that the disease was contracted abroad, during trips to areas where the infection was widespread.
- In Italy, the cases of venereal lymphogranuloma are so far sporadic and mostly imported from tropical and subtropical countries.
Symptoms and Complications
The venereal lymphogranuloma tends to manifest itself with genital, inguinal and anorectal symptoms and signs. As anticipated, in fact, the serotypes of Chlamydia trachomatis implicated in the disease have the ability to invade, stationary and reproduce in the lymph nodes of the inguinal region.
In some cases, the infection may be asymptomatic.
Venereous lymphogranuloma: course
Venereal lymphogranuloma is a disease which, if not readily recognized and treated, tends to become chronic. The incubation period is variable and between 3-21 days.
The clinical manifestations are presented in three phases:
- FIRST PHASE: papulo-erosive lesion
After an incubation period of about 3-5 days, the venereal lymphogranuloma appears as a small skin lesion, often asymptomatic, at the entrance site - in the genital, oral or anal area - of the pathogen.
At the site of inoculation of Chlamydia trachomatis, a painless swelling (similar to a boil) may appear. The papule with which the venereal lymphogranuloma begins may cause an ulceration of the overlying skin; however, healing is so rapid that it goes unnoticed.
At the same time, the venereal lymphogranuloma may involve symptoms similar to those of an inflammation of the urinary tract, associated with a slight unilateral enlargement of the inguinal lymph nodes.
In women, the initial lesion may occur at the level of the cervix or the upper vaginal portion.
- SECOND STAGE: enlargement of regional lymph nodes
After about 2-4 weeks, the venereal lymphogranuloma causes a swelling of the inguinal lymph glands. Lymphadenopathy tends to form, for confluence, very painful and large, soft and, in some cases, fluctuating masses.
Increased lymph nodes adhere to deep tissues and cause inflammation of the overlying skin, sometimes accompanied by:
- Temperature;
- Chills;
- General malaise;
- Cough;
- Headache;
- Back or pelvis pain;
- Joint and muscle pains;
- Anorexia;
- Disorders of the digestive system (diarrhea, constipation and abdominal pain).
After a few weeks, the enlarged lymph node undergoes suppuration and spontaneous rupture, causing the pus in it to escape; the wound that remains from this event heals leaving deep scars. The purulent material can make its way outward, creating fistulous tracts with vaginal or rectal involvement.
This second phase of the venereal lymphogranuloma can sometimes occur at the level of the anus, leading to itching, ulcers, pain and leakage of liquid or purulent material.
- THIRD PHASE: picture of elephantiasis and lymphangitis of the interested districts
If it is not treated with antibiotics, the third phase of the venereal lymphogranuloma takes place, during which the ulcers reappear in the genital area, accompanied by scars. After some time, these signs are associated with difficulties in lymphatic drainage (or even blockage of the lymphatic flow) from which it follows:
- Increase in the size of the external genitalia (in women);
- Elephantiasis of the penis and scrotum (in humans);
- Inflammation of the pelvic lymph vessels (lymphangitis);
- Development of fistulas from which purulent material or blood may escape;
- Narrowing (stenosis) of the urethra.
In the most advanced stage, men can present a proctitis with:
- Anal mucus-blood secretions;
- Anal pain;
- Constipation;
- Tenesmus (feeling of deep pain affecting the anus and bladder, accompanied by the frequent urge to defecate or urinate);
- Fibrosis around the rectum;
- Stenosis or obstruction of the last part of the intestine.
Venereous lymphogranuloma: anorectal variant
Recently, a clinical variant of venereal lymphogranuloma with anorectal involvement has been described. In this case, the disease is manifested by erosive proctitis and / or perianal ulcerative lesions and general symptoms (weight loss, fever, asthenia, etc.). This form of venereal lymphogranuloma has been observed in HIV-positive people (HIV-positive) and is more severe and difficult to treat than the classical inguinal variant.
Complications of the Veneral Lymphogranuloma
If the venereal lymphogranuloma is not treated, the disease becomes chronic, as well as keeping the subject in a position to transmit the infection. At the initial lymph gland focus, others take over with formation of fistulas and elimination of purulent material.
The venereal lymphogranuloma can also involve an enlargement of the liver (hepatomegaly) and the spleen (splenomegaly).
Venereous lymphogranuloma: coinfections
Often, venereal lymphogranuloma is concomitant with other infections supported by:
- HIV;
- Treponema pallidum (causal agent of syphilis);
- Gonococcus (bacterium responsible for gonorrhea);
- Hepatitis B virus (HBV).
Diagnosis
Venereous lymphogranuloma: how is it diagnosed?
The diagnosis of venereal lymphogranuloma is based on serological investigations and clinical evidence. The disease should be suspected in patients with genital ulcers, inguinal lymph nodes of increased size or proctitis, especially when:
- We have visited areas where the infection is endemic;
- We have had sexual contact with people who live or come from the same areas.
Confirmation of suspected lymphogranuloma can be obtained by laboratory analysis, such as:
- ELISA test for the detection of anti- Chlamydia trachomatis antibodies ;
- Immunofluorescence methods;
- Evidence of dermal hypersensitivity (Frei's intradermal reaction);
- Detection under the microscope of the infecting agent in the pus.
Treatment
Venereum lymphogranuloma: which treatment is necessary?
Treatment of venereal lymphogranuloma involves the use of specific drugs that must be taken under strict medical supervision.
In particular, the therapy uses antibiotics, such as doxycycline, tetracycline or erythromycin; usually, at least 21 days of treatment are required to completely eradicate the infection.
In the advanced stages of venereal lymphogranuloma, the swelling of the involved tissues may not decrease, despite the resolution of the infection and antibiotic therapy. In these cases, the lesions must be needle-aspirated or drained for symptomatic purposes.
Fistulas may require surgical repair instead.
Prevention
Venereous lymphogranuloma: can infection be prevented?
The prevention of venereal lymphogranuloma is based on the practice of safe sex (oral, vaginal and anal): using the condom correctly does not eliminate the risk of transmission of venereal lymphogranuloma, but helps to significantly reduce it.
