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Lymphogranuloma venereum

Review-Literatur: (Brown et al., 1999) (CDC Guidelines, 2006) (Mabey and Peeling, 2002) (Roest and van der Meijden, 2001)

Definition

Sexually transmitted disease due to infection with Chlamydia trachomatis (serovar L1-L3), leading to genital ulcers and inguinal lymphadenopathy.

Synonyms: Lymphogranuloma inguinale, Lymphopathia venerea, Nicolas-Durand-Favre disease.

Epidemiology of lymphogranuloma venereum

Occurrence especially in tropical countries. Very rare in Europe or North America.

Etiology of Lymphogranuloma venereum

Pathogen

Pathogen of lymphogranuloma venereum is Chlamydia trachomatis, a gram-negative obligate intracellular bacteria. Serotypes L1, L2, and L3 cause lymphogranuloma venereum.

Morphology of Chlamydia trachomatis:

Extracellular form of Chlamydia trachomatis are elementary bodies (diameter 0.3 μm). Intracellular infection and growth leads to intracellular inclusion bodies.

Signs and Symptoms

Genital ulcers:

After an incubation period of 5–21 days, a genital papule or pustule develops and leads to a singular ulcer (2–10 mm). The genital ulcers heal spontaneously.

Lymphadenopathy:

Tender and painful groin lumps are a typically symptom of lymphogranuloma venereum. At the time of presentation, the genital ulcer may have already healed. Lymphnodes may become purulent and cause inguinal ulcerations (Bubo). Further symptoms are fever and chills.

Diagnosis

Serologic testing:

Method of choice for the detection of Chlamydia trachomatis is via DNA testing from lymph node aspiration specimen or from the genital ulcer. Immunological detection methods for Chlamydia are also positive (DFA = direct fluorescent antibody, EIA = enzyme immunoassay).

Chlamydia trachomatis can be cultured using various cell culture techniques.

Partner study:

Accurate history and examination of any sexual partners is necessary.

Differential Diagnosis

Please refer to section differential diagnosis of genital ulcers.

Therapy of Lymphogranuloma Venereum

• First choice: Doxycycline 100 mg p.o. 1-0-1 for 21 days.
• Alternatives: Tetracycline 500 mg p.o. 1-1-1-1 or erythromycin 500 mg p.o. 1-1-1-1 for 21 days.
• Treatment of sexual partners.

References

Mabey und Peeling 2002 MABEY, D. ; PEELING, R. W.: Lymphogranuloma venereum.
In: Sex Transm Infect
78 (2002), Nr. 2, S. 90–2

Roest und van der Meijden 2001 ROEST, R. W. ; MEIJDEN, W. I. van der: European guideline for the management of tropical genito-ulcerative diseases.
In: Int J STD AIDS
12 Suppl 3 (2001), S. 78–83