Lymphogranuloma inguinale is a sexually transmitted disease caused by the pathogen Chlamydia trachomatis. In the western world, however, the sexually transmitted disease is rather rare.
What is Inguinal Lymphogranuloma?
According to Polyhobbies, lymphogranuma inguinale is also known by the names lymphogranuloma venereum, venereal granuloma, or Nicola Durand Favre disease. The disease is sexually transmitted. It is extremely rare to find in the western world. It occurs mainly in the tropics. 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. It is therefore one of the sexually transmitted diseases (STD). The disease is caused by the bacterium Chlamydia trachomatis. It is a gram-negative bacterium that lives intracellularly. It occurs in different serotypes and thus causes different diseases.
Lymphogranuloma venerum is caused by the serotypes L1 to L3. Chlamydia trachomatis is one of the most common causes of sexually transmitted infections worldwide. There are around 90 million new infections with chlamydia every year. In most cases, however, these are other serotypes. The incidence of lymphogranuloma inguinale is declining worldwide. However, the disease is still widespread 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 affected more often. In Germany there have been some infections since the year 2000. Men infected with HIV are particularly affected. The serotype L2 is predominant here.
Symptoms, Ailments & Signs
It takes three to twelve days from infection to the appearance of the first symptoms. A painless blister 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 affected, the blister 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. Oral sex can also infect the mucous membranes of the mouth and throat. However, this variant of the disease is rather rare. If the 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 through the body via the lymphatic system. There is inflammation of the lymphatic system ( lymphangitis ) and inflammation of the lymph nodes (lymphadenitis).
The lymph nodes in particular are extremely painful. One also speaks of pressure-sensitive “buboes”. If the portal of entry is in the area of the genitals, then the genital lymph nodes, the inguinal lymph nodes and the lymph nodes around the anus are affected. In the course of the inflammation, the tissue melts down. The consequences are abscesses and fistulas. The skin over the lymph nodes turns blue. The tissue in the area of the inflammation becomes thinner and thinner until 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 ) can also occur. Inflammation of the uterus causes pain and itching. A purulent vaginal discharge is also characteristic. Salpingitis is also associated with pain and discharge.
A rectal infection can result in proctitis or proctocolitis. Without treatment, the disease becomes chronic and enters the tertiary stage. Fistula formation in the affected sections of the lymphatic system is typical here. Parts of the system are also remodeled with connective tissue ( fibrosis ). This disrupts the lymphatic drainage, which can lead to lymphedema. Very pronounced lymphedema can lead to elephantiasis in the genital area.
Diagnosis & course of disease
The aim of the diagnosis is to detect the pathogen. The DNA of the pathogen is detected by means of PCR from a smear of the vesicles or from the fluid from a lymph node. However, methods such as direct immunofluorescence 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 time-consuming and is therefore only carried out in exceptional cases. When making a diagnosis, it is important to distinguish it from similar diseases such as granuloma venereum, syphilis or ulcus molle.
Complications
In the case of lymphogranuloma inguinale, those affected primarily suffer from symptoms in the genitals. These ailments are very uncomfortable for most people, making them ashamed and possibly suffering from an inferiority complex or low self-esteem. Blisters also form on the genitals, which lead to pain.
An ulcer can also develop and significantly reduce the quality of life of those affected. Furthermore, the sexual intercourse of those affected is significantly restricted by the lymphogranuloma inguinale, so that tensions with the partner can arise. The disease can also spread to the mouth.
Patients continue to suffer from joint pain or headaches. Lymphogranuloma inguinale also significantly reduces the resilience of those affected, and in women, inflammation of the uterus can occur. Lymphogranuloma inguinale can usually be treated with antibiotics.
There are no complications. As a rule, the symptoms disappear after a few days and the disease progresses positively. The life expectancy of those affected is usually not affected by inguinal lymphogranuloma.
When should you go to the doctor?
With skin changes in the intimate area, you should always go to the urologist or gynecologist. Above all, ulcers and pus blisters must be clarified quickly, as there is an acute risk of inflammation. The doctor can determine or rule out lymphogranuloma inguinale and then initiate therapeutic measures. A medical examination is necessary solely for reasons of the risk of infection. At the latest when muscle pain, pronounced lymphedema or signs of fibrosis appear, an appointment must be made with the doctor’s office so that the lymphogranuloma inguinale can be diagnosed.
Lymphogranuloma inguinale occurs mainly after unprotected sexual intercourse. It mainly affects people between the ages of 20 and 30, mainly from a lower educational background. Mere contact with a sick person can be enough to transmit the pathogen. Anyone who suspects a disease based on these risk factors should consult their family doctor . Other contacts are the dermatologist, urologist, gynecologist or lymphologist. If the infection causes psychological problems, the advice of a therapist should be sought.
Treatment & Therapy
Lymphogranulomas inguinale are treated by oral administration of antibiotics. Antibiotics such as erythromycin, tetracycline or doxycycline are used. The drugs must be taken by those affected 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 renewed infection with a sexually transmitted disease through sex with a previous sexual partner who was not treated at the same time. The pathogen is “played back and forth” almost like in ping-pong.
Outlook & Forecast
The sexually transmitted disease has a favorable prognosis if the patient immediately consults a doctor and has treatment measures initiated. The administration of medication usually achieves freedom from symptoms and recovery within a few weeks. The active ingredients in the medicines support the organism in overcoming the disease. The pathogen is killed, transported away and then excreted from the body. The symptoms progressively recede over the next three weeks until healing occurs.
With an unfavorable course of the disease, there is the formation of an ulcer. Normally, it also gradually regresses during drug therapy. If this is unsuccessful, in individual cases a removal of the tissue changes is indicated. This is a routine procedure, which is nevertheless associated with the usual risks of an operation. If left untreated, the pathogen can spread unhindered in the organism.
In these cases, the prognosis is significantly worse. The bacterium triggers a variety of ailments and inconveniences. In addition, it is contagious and can be transmitted to a partner during sex. The quality of life is severely limited and the disease can become chronic. Lymphedema develops, which has a significant impact on the health of those affected. Movement restrictions are possible and secondary diseases develop.
Prevention
There is no vaccination against inguinal lymphogranuloma. The disease can only be prevented by prevention. It is important to do educational work in developing countries as well, because this is the only way to curb the spread of sexually transmitted diseases. But safer 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 that the prescribed medication is taken regularly and in full as recommended by the doctor. This is the only way to safely combat the infection and avoid recurrence. If this is guaranteed, the lymphogranuloma inguinale usually has no consequences and does not require any further treatment.
Inadequate treatment or no treatment at all can result in infertility for both men and women. Nevertheless, aftercare should also include avoidance of the so-called “ping-pong effect”. The ping-pong effect refers to the contagion of other partners with whom sexual intercourse and intimacy has taken place. They should be informed immediately about the diagnosis of inguinal lymphogranuloma and themselves should be examined for possible infection.
It is good practice to inform all sexual partners within the last 60 days before diagnosis of the infection. In the case of an existing pregnancy, the unborn child should also be tested – there is a risk of infection. A future regular gynecological or urological examination as well as the use of condoms during sexual intercourse are essential aftercare. Sexual intercourse should also be avoided during drug treatment.
You can do that yourself
Patients with lymphogranuloma inguinale suffer from a reduced quality of life due to the disease and often feel shame and inferiority complexes due to the sexually transmitted 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 start treatment.
Without treatment, patients suffer from blisters, inflamed and painful lymph nodes, and purulent abscesses. In addition, the resilience is severely limited and there is pain in the head and muscles. In order to alleviate the physical symptoms, the patients temporarily stop working if possible and allow themselves plenty of sleep and relaxation at home. But even if the symptoms seem tolerable, it is important to see a doctor.
Patients take the antibiotic as prescribed and report any side effects to the doctor. The co-treatment of the sexual partner who transmitted the disease is essential for a successful therapy. Otherwise, if he has sexual intercourse with that person again, the patient will become infected again with the disease and the therapy will start all over again. That’s why it’s important to get your partner to see a doctor as soon as possible.