Lymphogranuloma inguinale is a venereal disease caused by the pathogen Chlamydia trachomatis. However, the STD is rare in the Western world.
What is lymphogranuloma inguinale?
Lymphogranuma inguinale is also known as lymphogranuloma venereum, venereal granuloma, or Nicola Durand-Favre disease. The disease is sexually transmitted. It is extremely rare in the western world. It occurs predominantly in the tropics. The pathogens are different forms of Chlamydia trachomatis. If left untreated, the disease can become chronic. Treatment is usually with antibiotics.
Causes
Lymphogranuloma inguinale is transmitted during sexual intercourse. Thus, it belongs to the group of sexually transmitted diseases (STDs). The trigger of the disease is the bacterium Chlamydia trachomatis. It is a gram-negative bacterium that lives intracellularly. It occurs in different serotypes and thus also causes different diseases. Serotypes L1 to L3 are the cause of lymphogranuloma venerum. Chlamydia trachomatis is one of the most common pathogens of sexually transmitted infections worldwide. There are about 90 million new infections with Chlamydia every year. However, most of these are other serotypes. The incidence of lymphogranuloma inguinale tends to decrease worldwide. However, the disease is still common in Africa, Asia, South America, and the Caribbean. Most infections occur between the ages of 20 and 30. As a rule, people with a lower social status are more frequently affected. In Germany, some infections have been found again since the year 2000. Especially HIV-infected men are affected. Predominant here is the seroytp L2.
Symptoms, complaints, and signs
Three to twelve days pass from infection to the appearance of the first symptoms. A painless vesicle forms at the site of infection. The clinical manifestation of this primary stage depends on the site of entry of Chlamydia trachomatis. If the penis or vagina is infected, the vesicle disintegrates quite quickly. An ulcer forms. This is only a few millimeters in size and is also painless. After a few days, the ulcer regresses spontaneously. If the pathogen was transmitted during anal intercourse, the rectum is affected. Here, the primary stage usually goes unnoticed. After oral intercourse, the oral and pharyngeal mucosa may also be affected. If lymphogranuloma inguinale is not treated in the first stage, the secondary stage follows. After a latency period of a few days to several weeks, the pathogens spread throughout the body via the lymphatic channels. Inflammation of the lymphatic channels (lymphangitis) and inflammation of the lymph nodes (lymphadenitis) occur. The lymph nodes in particular are extremely painful. This is also referred to as pressure-dolent “bubones”. If the site of entry is in the genital area, the genital lymph nodes, the inguinal lymph nodes and the lymph nodes around the anus are affected. In the course of the inflammation, tissue fusion occurs. The result is abscesses and fistulas. The skin over the lymph nodes turns blue. The tissue in the area of inflammation becomes thinner and thinner until finally the abscesses break through and empty their pus to the outside. These symptoms are usually accompanied by fever, muscle pain, headache, and joint pain. In women, inflammation of the uterus (cervicitis) or ovaries (salpingitis) may also occur. Inflammation of the uterus causes pain and itching. A purulent vaginal discharge is also characteristic. Salpingitis is also accompanied by pain and discharge. Rectal infection may result in proctitis or proctocolitis. Without treatment, the disease becomes chronic and progresses to the tertiary stage. Typical here is fistula formation in the affected sections of the lymphatic system. Parts of the system also undergo connective tissue remodeling (fibrosis). As a result, lymphatic drainage is disturbed, so that lymphedema can develop. Very pronounced lymphedema can result in elephantiasis in the genital area.
Diagnosis and course of the disease
The aim of diagnosis is to detect the pathogen. The DNA of the pathogen is detected by PCR from a smear of the vesicles or from fluid from a lymph node.However, methods such as immunofluorescence direct detection (DFA) or the ELISA screening test can also be used. However, the cultivation of the pathogen on special media is rather difficult and very costly and is therefore only performed in exceptional cases. It is important in making the diagnosis to distinguish it from similar diseases such as granuloma venereum, syphilis, or ulcus molle.
Complications
In lymphogranuloma inguinale, affected individuals primarily suffer from discomfort in the genitals. This discomfort is very uncomfortable for most people, causing them to feel ashamed of it and possibly suffering from inferiority complexes or lowered self-esteem. Similarly, blisters form on the genitals, causing pain. An ulcer may also form in the process and significantly reduce the quality of life of the affected person. Furthermore, the sexual intercourse of the affected person is also significantly limited by the lymphogranuloma inguinale, so that it can lead to tension with the partner. Furthermore, the disease can also spread to the mouth area. Patients also suffer from joint pain or headaches. Lymphogranuloma inguinale also significantly reduces the ability of the affected person to cope with stress, and in women inflammation of the uterus can occur. Usually, lymphogranuloma inguinale can be treated with the help of antibiotics. No complications occur in this process. As a rule, the symptoms disappear after a few days and there is a positive course of the disease. The life expectancy of the affected person is usually not affected by lymphogranuloma inguinale.
When should you see a doctor?
With skin changes in the intimate area should always go to the urologist or gynecologist. Especially ulcers and pus blisters must be clarified quickly, as there is an acute risk of inflammation. The physician can determine or exclude lymphogranuloma inguinale and subsequently initiate therapeutic measures. Medical clarification is necessary for reasons of infection risk alone. At the latest when muscle pain, pronounced lymphedema or signs of fibrosis occur, an appointment with the doctor’s office must be made so that lymphogranuloma inguinale can be diagnosed. Lymphogranuloma inguinale occurs predominantly after unprotected sexual intercourse. It mainly affects people between 20 and 30, mainly coming from lower educational backgrounds. Mere contact with an infected person can be enough to transmit the pathogen. Anyone who suspects an illness in view of these risk factors should consult their family doctor. Other contacts are the dermatologist, urologist, gynecologist or lymphologist. If there is mental discomfort as a result of the infection, the advice of a therapist should be sought.
Treatment and therapy
Treatment of inguinal lymphogranuloma is by oral antibiotic administration. Antibiotics such as erythromycin, tetracycline, or doxycycline are used. The medication must be taken by the affected person for at least three weeks. It is important that the sexual partner or partners are also treated. Otherwise, the so-called ping-pong effect occurs, i.e. a new infection with an STI through sex with an earlier sexual partner who was not also treated. The pathogen is thus “played back and forth” as it were like ping-pong.
Outlook and prognosis
The sexually transmitted disease has a favorable prognosis if the sufferer consults a physician immediately and has treatment measures initiated. The administration of medications usually results in freedom from symptoms as well as recovery within a few weeks. The active substances in the drugs help the organism to cope with the disease. The pathogen is killed, transported away and subsequently eliminated from the body. The symptoms recede steadily over the next three weeks until a cure is achieved. If the course of the disease is unfavorable, an ulcer forms. Normally, it also gradually recedes during drug therapy. If this does not succeed, removal of the tissue changes is indicated in individual cases. This is a routine procedure that is nevertheless associated with the usual risks of surgery. If left untreated, the pathogen can spread unhindered in the organism. The prognosis is significantly worse in these cases.The bacterium triggers a variety of complaints and discomfort. In addition, it is contagious and can be transmitted to the partner during the sexual act. The quality of life is severely limited and a chronic course of the disease can occur. Lymphedema forms, which has a significant impact on the health of the affected person. Movement restrictions are possible and secondary diseases develop.
Prevention
There is no vaccination against inguinal lymphogranuloma. The disease can only be prevented by contraception. For this purpose, it is important to conduct educational work in developing countries as well, because this is the only way to contain the spread of sexually transmitted diseases. However, safe sex should also be a matter of course in Germany, because condoms not only protect against lymphogranuloma inguinale, but also against many other sexually transmitted diseases.
Aftercare
It is important to make sure that the prescribed medications are taken regularly and fully as recommended by the doctor. This is the only way to safely fight the infection and prevent recurrence. If this is ensured, lymphogranuloma inguinale usually remains inconsequential and requires no further treatment. Inadequate treatment or lack of treatment may, under certain circumstances, result in infertility for both men and women. Nevertheless, follow-up care should include avoidance of the so-called “ping-pong effect.” Ping-pong effect refers to the infection of other partners with whom sexual intercourse and intimacy were performed. These partners should be informed immediately about the diagnosis of lymphogranuloma inguinale and should themselves be examined for possible infection. It is advisable to inform all sexual partners in the last 60 days before diagnosis of the infection. In case of an existing pregnancy, the unborn child should also be tested – there is a risk of infection. Regular gynecological and urological examinations and the use of condoms during sexual intercourse are essential aftercare. During drug treatment, sexual intercourse should also be avoided.
What you can do yourself
Patients with inguinal lymphogranuloma suffer from a reduced quality of life due to the disease and often feel shame and inferiority complexes because of the venereal disease. However, self-help measures are only possible to a limited extent with this disease, since effective therapy primarily requires the administration of antibiotics. Therefore, despite their feelings of shame, those affected contact a doctor as soon as possible to initiate treatment. Without treatment, patients suffer from vesicles, inflamed and painful lymph nodes, and purulent abscesses. In addition, exercise tolerance is severely limited and there is pain in the head and muscles. To alleviate the physical discomfort, patients temporarily stop working if possible and allow themselves plenty of sleep and rest at home. However, even if the symptoms seem bearable, it is essential to see a doctor. Patients take the antibiotic as prescribed and report any side effects to the doctor. Essential for successful therapy is co-treatment of the sexual partner who transmitted the disease. Otherwise, if the patient has sexual intercourse with that person again, he or she will become infected with the disease and the therapy will start all over again. Therefore, it is important to encourage the partner to see a doctor quickly as well.
