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LYMPHOGRANULOMA

Lymphogranuloma Pictures

| General | Symptoms | Diagnosis | Treatment | Transmission | Prevention | Prognosis | Support |

Lymphogranuloma inguinale is also known as:

• Lymphogranuloma venereum (LGV)
• Nicholas-Favre Disease
• Sixth VenerealDisease
• Tropical Bubo

Lymphogranuloma inguinale is an infection of the lymph tissue in the genital area caused by a strain of Chlamydia trachomatis, the bacterium that produces Nongonococcal Urethritis (NGU).

The disease occurs most often  in

• Africa
• Central America
• South America
• Southeast Asia
• The Caribbean

Lymphogranuloma inguinale infects an average of about 250-400 people a year in the United States.

Symptoms

Lymphogranuloma inguinale has three stages:

Stage 1

• A small, painless sore similar to a pimple, blister/lesion/soft bump occurring at the point where the bacterium entered the body (usually the penis or vagina) that often goes unnoticed
• Some people do not experience this and if they do healing is usually rapid without scarring
• The infection then spreads to the lymph nodes in the groin area and from there to the surrounding tissue, where it causes painful swelling closest to the point of infection
• Discharge from the penis or vagina from 3-30 days after exposure

Lymphogranuloma inguinale is found:

In Males

• On the coronal sulcus of males

In Females

• On the cervix

• On the fourchette

• On the posterior vaginal wall

• On the vulva

Lesions have also occurred:

• In the oral cavity (tonsil)

Stage 2  (1-2 weeks after initial symptoms appear)

• Inflammation and swelling of lymph nodes and surrounding tissue

• Lymph nodes closest to the infection continue to swell until a pus-filled bulge is created, called a bubo 

• Throbbing pain and fever

The buboes can:

• Grow very big, until the skin covering them turns blue
• Open through the skin, drain continuously and remain open (about 30% of cases)
• Can become infected by other bacteria

In Women the buboes may cause:

• Erosion of the skin and tissue between the legs
• Erosion of the vagina or rectum walls
• Painful swelling in the groin

Buboes near the anus may cause:

• Discharge from the rectum
• Infection of the penis
• Infection of the rectum 
• Swelling, bleeding and erosion of the lining of the rectum, which can spread upwards into the colon
• The rectum may swell almost shut

Buboes in the penis or vagina

• Affect the nodes on either or both sides of the groin
• May cause sores or pus-filled sacks to develop on the genitals

Buboes in the throat affect:

• The nodes in the jaw and neck

Transmission

Lymphogranuloma inguinale is spread by direct sexual contact with the:

• genitals
• mouth
• rectum

Note

• An individual is infectious for as long as the lesions remain active
• Ejaculation is not necessary for the disease to be spread
• The germ is passed from partner to partner as long as there are sores
• The infection is spread by unprotected sexual contact

In Pregnancy and Birth

Infected mothers can transmit the disease to their babies at birth

It can not be spread from person to person by casual contact, such as

• clothing
• door knobs
• eating utensils
• swimming pools
• toilet seats

Diagnosis

Diagnosis is usually ascertained by:

• A blood test
• A sample of the discharge for a culture test 
• Visual observation

to rule-out or check for other STDs such as:

• Chancroid
• Gonorrhea
• Herpes
• Syphilis

As Chlamydiae are intracellular organisms samples must contain cellular material. This can be obtained:

• By aspiration from fluctuant lymph nodes or buboes with a needle

• From the base of the ulcer

• From rectal tissue  

Methods

Most methods are usually unable to distinguish Lymphogranuloma inguinale strains from other chlamydial strains

Culture Test

Culture on Cycloheximide treated cells from suspected lesions is the most specific method

The method

• has a sensitivity of 75-85%

• has a sensitivity of 30-50% in the case of bubo aspirates (the pus has a toxic effect on the culture cells)

• is expensive

• is labor intensive

• is not not readily available 

Direct Immuno-fluorescence (DIF) 

Material from a suspected lesion is used to detect Chlamydia trachomatitis.  A fourfold rise in antibodies (both IgM and IgG) usually shows active infection.

This method

• is labor intensive

• is sensitive

• is only performed in a few specialized laboratories 

• requires the proper expertise for interpretation

Enzyme immunoassay (EIA)

This method is suitable for ulcer scrapes or bubo aspirates, but not for rectal samples.

The method

• is convenient

• is objective

• has a lower sensitivity than other methods

• should be confirmed by a blocking test or another method

• is not suitable for Test of Cure (TOC)

Other Methods

Ligase chain reaction (LCR) or polymerase chain reaction (PCR) 

These methods are used to detect nucleic acid (DNA) by amplification techniques and are used for testing urethral, cervical or urine samples but are not often used for Lymphogranuloma inguinale.

Note

Screening for other possible causes of genital ulcerative disease should be carried out, such as for: 

• HIV 

• Herpes simplex

• Haemophilus ducreyi

• Klebsiella/Calymmatobacterium granulomatis

• Serological syphilis

• Treponema pallidum