Definition
Lymphgranuloma inguinale is a manifestation of chlamydial infection. Chlamydia are bacteria of which different strains exist. The Chlamydia germ that causes the sexually transmitted lymph granuloma inguinale is C. trachomatis of type L1-3. Lymph granuloma inguinale initially causes painless ulcers in the genital area. Once these have healed, a purulent swelling of the lymph nodes occurs.
Causes
The cause of the occurrence of lymph granuloma inguinale is infection with a chlamydial strain called C. trachomatis. There are several subspecies of this germ. The types L1-3 trigger the lymphgranuloma inguinale. Lymphgranuloma inguinale is a sexually transmitted disease, i.e. the pathogen enters the genital region of the affected person through unprotected sexual intercourse.
Diagnosis
There are different ways to diagnose a Chlamydia infection. The gold standard is the detection of Chlamydia DNA from smear material of inflamed areas. It is also possible to culture the pathogen.
However, this procedure is more complex and provides a result after 4 days at the earliest. Another possibility is the detection of antibodies in the blood of the person concerned. However, these only become positive a few days after the infection and are therefore not suitable for acute diagnostics.
Symptoms
The disease can be divided into two stages. First, a painless ulcer develops at the point of entry of the pathogen. Since the infection is transmitted during sexual intercourse, it usually affects the penis or vagina.
After a few days, this skin condition recedes. If the infection has not been treated by then, the secondary stage can occur. The pathogen spreads via the lymph vessels in the groin region and yet leads to inflammation.
Within the scope of this lymph vessel and lymph node infestation, abscesses filled with pus can form. The genital, anal and groin regions can be affected. This stage is very painful and can be accompanied by other symptoms of infection such as fever and aching limbs.
Treatment
The treatment of choice for a chlamydia infection is antibiotic therapy. The antibiotic doxycycline is preferred. If the Chlamydia infection manifests itself in the form of lymph granuloma inguinale, this antibiotic is used for 21 days. Alternatively, antibiotics from the class of so-called macrolides can be used, such as azithromycin. Since chlamydiae are bacteria that live and multiply inside body cells, the antibiotic chosen must be able to cover this spectrum.
Duration and course
If lymph granuloma inguinale occurs in the course of a chlamydial infection, the painless ulcer at the site of entry occurs after about one week. If no therapy is initiated in this primary stage, the secondary stage occurs after about 3 weeks, in which the lymphatic system is involved. As this stage can be very painful, a doctor is usually consulted and antibiotic therapy is initiated.
If this is not the case, the secondary stage can turn into a tertiary stage. If the lymph nodes and vessels are inflamed for weeks or months, the process becomes chronic and a scarred remodelling of the inflammatory tissue occurs. A so-called fibrosis then occurs, in which the tissue hardens. Since the lymph fluid can then no longer properly drain off, lymphedema can occur.
