Venereal lymphogranulomatosis (venereal lymphopathy, venereal lymphogranuloma, tropical bubo) is a chronic infectious disease, mostly sexually transmitted and characterized by soft tissue damage to the urogenital area and lymph nodes. The causative agent of venereal lymphogranulomatosis is Chlamidia trachomatis. The most common disease occurs in countries with a tropical and subtropical climate (Latin America, Australia, Asia, Africa)
Venereal lymphogranulomatosis causes
To date, the causes of the onset and subsequent development of lymphogranulomatosis are not fully understood. In the 20th century, most scientists tended to the tubercular nature of the disease. At the moment, the genetic and viral theory of origin is being discussed, but according to the International Classification of Tumors of Lymphoid and Haematopoietic Tissue (World Health Organization of 1976), venereal lymphogranulomatosis is considered a type of malignant lymphoma. In addition, the hereditary, immune and viral theories of the origin of this disease continue to be considered. Many researchers continue to adhere to the viral theory due to the presence of Epstein-Barr virus in patients with venereal lymphogranulomatosis, but others say this is not evidence of its effect on the onset of the disease
Venereal lymphogranulomatosis symptoms
The duration of the incubation period can vary considerably and depends on a number of factors: from concomitant diseases and their treatment, on the number of pathogens infiltrated, on the state of immune defense, etc. Most often it lasts from three to seven days, but cases of duration from one up to twelve weeks. . At the end of the incubation period, prodromal events occur in the form of general malaise, weakness, fever and headaches .
: There are three periods of the course of venereal lymphogranulomatosis :
Primary - the appearance of primary symptoms occurs at the site of implantation.
Secondary - against the background of the general reaction of the body peripheral lymph nodes are affected.
Tertiary - severe manifestations of the disease, when in the perianal region, on the mucous membrane of the rectum and on the genital organs, hypertrophic, inflammatory - elephantiatic and ulcerative processes are formed, resulting in stenosis and scarring.
Primary lesion or lymphogranulomatous chancre in women often occurs on the labia or in the vagina, less often on the cervix; in men - on the head of the penis, less often - on the skin of the inguinal region or in the urethra. With oral or anal sexual intercourse, primary damage can occur on the fingers, tongue, lips and rectum. Primary lesions have the form of pustules, papules, superficial sores or erosion.
In most cases, the first sign of venereal lymphogranulomatosis is the appearance of a single vesicle that is then transformed into erosion or a superficial sore with a rounded shape with even edges that is prone to self-healing without treatment for several days, followed by scar formation. After a few days from the time of the onset of the primary lesion, some regional lymph nodes begin to increase, possibly the appearance of a mildly expressed lymphangitis.
After a rather short period of time (from several days to three weeks) after the onset of the primary lesion, the most characteristic symptom for the venereal lymphogranulomatosis (secondary period) is the regional lymph node involvement. Lymph nodes become painful, thickened, soldered together. In the inguinal region a tuberous, dense infiltrate is formed, exceeding the size of a large lemon, painful sensations appear. Skin covers in the infiltration area acquire color from pink to blue-red and become painful on palpation. On the infiltrated surface develop foci of suppuration, which are isolated isolated numerous softening.
In the absence of adequate timely treatment, the disease continues to progress, moving into the Tertiary period, characterized by the development of severe destructive changes in both lymph nodes and surrounding organs and tissues, the spleen and liver increase. The main sign of the Tertiary period is the genitoanorectal syndrome that develops one to two years after the onset of venereal lymphogranulomatosis. Due to the anatomical features of the genital organs, in women this syndrome develops more often
Venereal lymphogranulomatosis complications
Early complications: rectal - vaginal fistula, anus fistula, pararectal abscess, ischium - rectum fistula, vesicular - rectum fistula, fistula of the penis, ulcerative lesion of the penis, fistula of the scrotum, fistula of the urethra.
Late complications: edema and chronic induction of the penis and external female genital organs (due to obstruction of lymphatic vessels); elephantia of the genitals, stricture of the urethra and rectum; in women - ulceration of the external genitalia, etc.
Diagnosis of venereal lymphogranulomatosis is established based on laboratory data (serological reactions, bacteriological study, microscopic examination, skin tests) and based on the clinical picture
Venereal lymphogranulomatosis treatment
In case of timely treatment, modern medicine is able to completely cure this disease. Currently, the treatment is carried out with antibiotics of the tetracycline series, sulfanilamide preparations and macrolides. The recommended course of taking antibiotics and sulfonamides is 21 days. A good effect in the early stages of the disease has etiotropic therapy. With deep fibrotic changes, a second course of treatment is shown after two weeks. In the presence of disfiguring scars, fistulas and other fibrotic degenerations, in addition to antibiotics and sulfonamide preparations, injections of lidase, vitreous or aloe are indicated.