Definition
Venereal lymphogranuloma is a sexually transmitted disease caused by some serotypes of the bacterium Chlamydia trachomatis (L1, L2, L3), which have the ability to invade regional lymph nodes and reproduce there. Venereal lymphogranuloma is endemic in parts of Africa, India, Southeast Asia, South America and the Caribbean.
Most common symptoms and signs *
- Anal burning
- Diarrhea
- Anal pain
- Pelvic pain
- Testicular pain
- Edema
- Pus emission from the penis
- Temperature
- Pus formation
- Swelling in the anal area
- lymphadenitis
- Swollen lymph nodes
- Backache
- Mass or swelling in the testicle
- Mass or swelling in the groin
- Mucorrea
- papules
- Urethral leaks, sometimes visible only after squeezing the glans
- Vaginal discharge
- Anal itching
- Pustules
- Blood in the stool
- Vaginal bleeding
- Constipation
- Rectal tenesmus
- Skin Ulcers
Further indications
After an incubation period of about 3 days, the venereal lymphogranuloma appears as a small skin lesion, often asymptomatic, at the site of entry of the pathogen. This painless papule or pustule can cause an ulceration of the overlying skin; however, healing is so rapid that it goes unnoticed.
After 2-4 weeks, venereal lymphogranuloma causes bilateral enlargement of the inguinal lymph nodes.
Lymphadenopathy tends to form large, soft and, in some cases, fluctuating masses. These adhere to deep tissues and cause inflammation of the overlying skin, sometimes accompanied by fever and malaise.
In women, back or pelvic pain is common; the initial lesion may occur at the level of the cervix or the upper vaginal portion. In some cases, this leads to inflammation of the pelvic lymph vessels and the development of fistulas from which purulent material or blood can escape.
In men, however, proctitis or proctocolitis may occur, with purulent-bloody rectal discharges. In chronic phases, the latter condition simulates Crohn's disease and can cause tenesmus and stenosis of the rectum.
In the absence of treatment, the venereal lymphogranuloma can cause lymphatic flow obstruction, inflammation of the pelvic lymph nodes, chronic pain and swelling of the genital tissues and skin sores.
The diagnosis is clinical, but it is possible to have laboratory confirmation by serological or immunofluorescence methods. The venereal lymphogranuloma should be suspected in patients with genital ulcers, inguinal lymph nodes of increased size or proctitis, especially if they have visited areas where the infection is endemic or bark had sexual contact with people who live or come from the same areas.
The treatment uses doxycycline, tetracycline or erythromycin for 21 days. In advanced stages, swelling in damaged tissues may not resolve, despite resolution of infection and antibiotic therapy. In these cases, the lesions must be needle aspirated or surgically drained for symptomatic purposes. Fistulas, on the other hand, may require surgical repair.
