Venereal lymphogranuloma is a chronic purulent—inflammatory lesion of the lymph nodes caused by chlamydia infection. Venereal lymphogranuloma begins with the formation and healing of erosion, after which purulent inflammation of regional (more often inguinal) lymph nodes occurs, ending with their opening and scarring. In the diagnosis of venereal lymphogranuloma, detection of the pathogen by bacposev, ELISA, PCR and RIF is used; examination of the anorectal zone and genitourinary organs of the patient. Therapy of venereal lymphogranuloma is carried out with antibiotics and immunomodulators. If necessary, surgical treatment is carried out.
Venereal lymphogranuloma is most widespread in tropical and subtropical climates, among the population of Africa, Latin America, Asia and Australia. As a rule, the disease is observed in people aged 20-40 years who are sexually active. Men have cases of venereal lymphogranuloma more often than women. Mostly they are sailors, military personnel, homosexuals, travelers.
Previously, disease was considered a viral infection. However, studies conducted in venereology have proved that the causative agent of venereal lymphogranuloma is the bacterium Chlamydia trachomatis, which also causes the development of chlamydia.
Infection with inguinal lymphogranulomatosis occurs both from a sick person and from the carrier of the infection. Women pose a great epidemiological danger. They develop symptoms of venereal lymphogranuloma 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 membranes or damaged skin of the genitals. Most often there is a sexual way of transmission of infection, but contact infection through intimate objects is also possible.
Symptoms of venereal lymphogranuloma
The development of this disease occurs on average after 2 weeks from the moment of infection, but may occur after a few days or months. There are 3 periods in the clinical picture of the disease.
The primary period of venereal lymphogranuloma is characterized by the appearance of a rounded ulcer or erosion at the site of the introduction of the causative agent (primary affect). Its healing takes several days and does not leave any 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 to consult a doctor. Usually the primary affect is located in the area of the external genitalia, but it can be localized in the anus, urethra, rectum. After oral sexual contact, the affect can be detected on the mucous membrane of the mouth, lips, tonsils, larynx.
The secondary period of venereal lymphogranuloma manifests itself after 14-30 days from the first symptoms of the disease. It is associated with the spread of chlamydia along the lymphatic pathways, leading to the development of regional lymphangitis and lymphadenitis. When sexually infected, there is a lesion of the inguinal and femoral lymph nodes. When the primary affect is localized in the mouth and larynx, the submandibular and cervical lymph nodes are affected. The defeat of the lymph nodes in inguinal lymphogranulomatosis is manifested by pronounced inflammatory signs: an increase and soreness of the lymph nodes, swelling and redness of the skin above them. Gradually, the nodes turn into large lumpy tumors, fuse with the underlying tissues and lose mobility.
Over time, purulent melting 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 can spread to the underlying tissues with skin lesions (pyoderma), bones (osteomyelitis), joints (purulent arthritis). The period of suppuration is often accompanied by a violation of the general condition of the patient: fever, chills, headache, myalgia and arthralgia. Then there is a slow subsiding of inflammatory manifestations with a decrease in the size of lymph nodes and scarring of fistulas. However, the spread of infection to nearby lymph nodes leads to a new exacerbation of venereal lymphogranuloma. Such a course of the disease with periods of subsidence and exacerbation can take several years. Then, in the absence of treatment, venereal lymphogranuloma proceeds to the next stage.
The tertiary period is associated with a pronounced violation of the lymph circulation of the pelvic organs, leading to lymphostasis and genitorectal elephantiasis with impaired functioning of the pelvic organs. In this period of venereal lymphogranuloma, chronic ulceration of the pelvic organs (vagina, urethra, rectum) can be observed, leading to the formation of vaginal fistulas, vesico-rectal fistulas. Localization of ulceration in the urethra may be accompanied by urethral strictures with difficulty urinating or urinary incontinence. If the rectum is affected, ulcerative colitis, paraproctitis, intestinal obstruction may develop.
Diagnosis of venereal lymphogranuloma
Identification of the causative agent of venereal lymphogranuloma is carried out by back-seeding of the separated urethra, vagina, rectum, lymph node punctate. PCR studies on chlamydia, ELISA and REEF are also used. A biopsy of the lymph node in the affected area is performed for the purpose of histological examination to exclude its malignant metastasis.
To assess the condition of the pelvic organs and exclude lymphadenitis of other etiology if venereal lymphogranuloma is suspected, a venereologist needs the conclusions of related specialists: gynecologist, urologist, proctologist, lymphologist; gynecological examination data, colposcopy, urethroscopy, rectoromanoscopy, ultrasound of the pelvic organs, ultrasound of the lymphatic vessels of the pelvis.
Differential diagnosis of venereal lymphogranuloma is carried out with inguinal lymphadenitis, genital tuberculosis, secondary syphilis, metastases of malignant tumors in the lymph nodes in cancer of the anus, rectum, penis, testicle, vagina.
Treatment of venereal lymphogranuloma
Antibiotic therapy of this disease is carried out with tetracyclines, macrolides or fluoroquinolones. Treatment is combined with restorative and immunomodulatory therapy. In advanced cases of venereal lymphogranuloma, with the formation of fistulas, urethral strictures or the development of intestinal obstruction, surgical intervention is required.