Venereal Lymphogranuloma or Inguinal lymphogranulomatosis (venereal lymphopathy, Nicola-Favre’s disease, tropical bubo) is a chronic suppurative inflammation of the lymph nodes caused by chlamydia infection.
Venereal granuloma begins with the formation and healing of erosion, after which there is purulent inflammation of the regional (usually inguinal) lymph nodes, ending with their dissection and scarring.
In the diagnosis of inguinal Hodgkin’s disease, identification of the pathogen by ELISA, PCR and RIF is used; examinations of the anorectal zone and urinary organs of the patient.
Therapy for inguinal lymphogranulomatosis is performed with antibiotics and immunomodulators. If necessary, surgical treatment is carried out.
Inguinal lymphogranulomatosis: what is lymphogranuloma?
The greatest distribution of venereal granuloma was received in a tropical and subtropical climate, among the population of Africa, Latin America, Asia and Australia.
The occurrence of cases of inguinal lymphogranulomatosis in USA is associated mainly with widely developed modern tourism. As a rule, the disease is observed in persons aged 20-40 years, leading an active sex life. In men, cases of inguinal lymphogranulomatosis are more common than in women. These are mainly sailors, military personnel, homosexuals, travelers.
Causes of venereal granuloma (Lymphogranuloma)
Previously, inguinal lymphogranulomatosis was considered a viral infection. However, studies in venereology proved that the causative agent of inguinal lymphoma granulomatosis is the bacterium Chlamydia trachomatis, which also causes the development of chlamydia.
Infection with inguinal lymphogranulomatosis occurs from both the sick person and the carrier of the infection. Greater epidemiological danger are women.
They have symptoms of inguinal lymphogranulomatosis develop later, as a result of which they can transmit the infection, without having any clinical manifestations and not knowing that they are infected. Infection with inguinal lymphogranulomatosis occurs through the mucous or damaged skin of the genital organs.
The most common is the sexual transmission of infection, but contact infection through intimate items is also possible.
Symptoms of Venereal Lymphogranuloma ( inguinal lymphogranulomatosis)
The development of inguinal lymphogranulomatosis occurs on average 2 weeks from the time of infection, but may occur several days or months later. In the clinical picture of the disease there are 3 periods.
The primary period of inguinal Hodgkin’s disease is characterized by the appearance of a round ulcer or erosion (primary affect) at the site of introduction of the pathogen.
Its healing takes several days and leaves no scar. Therefore, for the vast majority of patients (more than 70%), the onset of inguinal lymphogranulomatosis passes unnoticed and does not serve as a reason for seeking medical attention.
Typically, the primary affect is located in the external genitalia, but may be localized in the anus, urethra, rectum. After oral sexual contact affect can be detected on the mucous membrane of the mouth, lips, tonsils, larynx.
The secondary period of inguinal lymphogranulomatosis occurs after 14-30 days from the first symptoms of the disease. It is associated with the spread of chlamydia through the lymphatic system leading to the development of regional lymphangitis and lymphadenitis.
In sexually transmitted infections, the inguinal and femoral lymph nodes are affected. With the localization of primary affect in the region of the mouth and larynx (in case of orally transmitted infections), the submandibular and cervical lymph nodes are affected.
The defeat of the lymph nodes in the inguinal lymphogranulomatosis is manifested by pronounced inflammatory signs:
- an increase and tenderness of the lymph nodes,
- swelling and reddening of the skin over them.
Gradually, the nodes turn into large, lumpy tumors, soldering to the underlying tissues and losing mobility.
Over time, purulent fusion of the nodes occurs, accompanied by their softening, the formation of ulcers and fistulas, through which purulent contents come to the surface of the skin.
The process of suppuration may extend to the underlying tissues with skin lesions (pyoderma), bones (osteomyelitis), and joints (purulent arthritis).
The period of suppuration is often accompanied by a violation of the patient’s general condition:
- myalgia and arthralgia.
Then there is a slow subsidence of inflammatory manifestations with a decrease in the size of the lymph nodes and scarring of the fistula.
However, the spread of the infection to nearby lymph nodes leads to a new aggravation of the inguinal lymphoma. Such a course of the disease with periods of remission and exacerbation may take several years. Then, without treatment, the inguinal lymphogranulomatosis enters the next stage.
The tertiary period of inguinal lymphogranulomatosis is associated with severe impairment of the lymphatic circulation of the pelvic organs, leading to lymphostasis and genitorectal elephantiasis with impaired functioning of the pelvic organs.
In this period of inguinal Hodgkin’s disease, chronically occurring ulcerations of the pelvic organs (vagina, urethra, rectum) can occur, leading to the formation of fistulas of the vagina, cystic rectal fistula. Localization of ulceration in the urethra may be accompanied by urethral strictures with difficulty urinating or urinary incontinence. With the defeat of the rectum may develop ulcerative colitis, paraproctitis, intestinal obstruction.
Diagnosis of inguinal lymphogranulomatosis
Detection of the causative agent of the inguinal lymphogranulomatosis is carried out by bakposeva discharge urethra, vagina, rectum, punctate lymph node. Also used PCR study on chlamydia, ELISA and REEF. Biopsy of the lymph node in the area of the lesion is performed for the purpose of histological examination to exclude its malignant metastasis.
To assess the condition of the pelvic organs and the exclusion of lymphadenitis of other etiology in case of suspected inguinal lymphogranulomatosis, the venereologist needs the conclusions of related specialists:
- a gynecologist,
- a urologist,
- a proctologist,
- a lympologist.
Perhaps the following procedures are necessary:
- gynecological examination,
- ultrasound of the pelvic organs,
- USDG of the pelvic lymphatic vessels.
Differential diagnosis of inguinal lymphogranulomatosis is performed with inguinal lymphadenitis, genital tuberculosis, secondary syphilis, metastasis of malignant tumors to the lymph nodes in cancer of the anus, rectum, penis, testicle, vagina.
Treatment of inguinal lymphogranulomatosis
Granuloma is treated by antibiotics, but in difficult cases doctor night advice a surgery to remove the nodes. Antibiotic treatment of inguinal lymphogranulomatosis is carried out by tetracyclines, macrolides or fluoroquinolones.
Treatment is combined with fortifying and immunomodulatory therapy. In advanced cases of inguinal lymphogranulomatosis, with the formation of fistulas, strictures of the urethra or the development of intestinal obstruction, surgical intervention is required.