lymphogranuloma venereum (inguinale); Favre-Durand-Nicholas disease; tropical bubo
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Etiology
- Chlamydia trachomatis (serovars L1, L2, & L3)
Epidemiology
- 3rd decade, while most sexually active
- most cases in non whites, but probably no racial difference
- acute infection is more common in males
- anogenitorectal syndrome more common in females & homosexual men
- sporadic in North America, Europe, Australia & most of Asia & South America
- endemic in east & west Africa, parts of southeast Asia, parts of South America & the Caribbean
Pathology
- chlamydia in purulent exudate is inoculated onto skin or mucosa of sexual partner & gains entry through minute lacerations & abrasions
- incubation period 3-12 days for primary stage; 10-30 days for secondary stage
- lymphatic obstruction of genitalia may occur
- perirectal abscesses
- fistulas
Clinical manifestations
- primary stage:
- painless papule, abrasion or ulceration at the site of inoculation
- most patients do not present with this finding
- lesions resolve without treatment
- secondary stage
- systemic manifestations
- local manifestations
- inguinal syndrome
- inguinal lymphadenopathyabove & below the inguinal ligament[4]
- bubo near the inguinal ligament
- lower abdominal & back pain
- anogenitorectal syndrome
- draining fistulas
- proctitis
- tenesmus & rectal pain
- perianal condylomata
- inguinal syndrome
- systemic skin manifestations
Laboratory
- positive skin test with Frei antigen
- serology:
- positive complement fixation test with Frei antigen
- serovars L1, L2, & L3 specific testing
- culture bubo aspirate
Complications
- rectal strictures & fissures[4]
- elephantiasis of the genitals (esthiomene)
- generally in females
- may ulcerate
- may occur 20 years after primary infection
Differential diagnosis
- primary stage
- inguinale syndrome
- anogenitorectal syndrome
- esthiomene
- hidradenitis suppurativa if all lesions could be associated with hair follicles[6]
Management
- prevention: condom use
- antimicrobial therapy
- cures infection, prevents ongoing tissue damage
- tissue reaction & residual scarring may occur
- doxycycline* 100 mg PO BID for 21 days
- erythromycin 500 mg PO QID for 21 days
- sulfisoxazole 500 mg PO QID for 21 days or Bactrim DS 1 PO BID for 21 days
- sexual partners should be referred for evaluation even if the partners have no symptoms
- 100 mg of doxycycline BID x 7 days,
- 1000 mg azithromycin (single dose)
- buboes may require aspiration or incision & drainage
* treatment of choice
More general terms
Additional terms
References
- ↑ DeGowin & DeGowin's Diagnostic Examination, 6th edition, RL DeGowin (ed), McGraw Hill, NY 1994, pg 908
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
- ↑ Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 896-898
- ↑ 4.0 4.1 4.2 Prescriber's Letter 12(8): 2005 Lymphogranuloma Venereum Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210820&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Martin-Iguacel R, Llibre JM, Nielsen H et al Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries. Eur J Clin Microbiol Infect Dis. 2010 Aug;29(8):917-25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20509036
- ↑ 6.0 6.1 NEJM Image Challenge: http://www.nejm.org/image-challenge