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==Overview==
==Overview==
After an incubation period of 3 - 30 days for ''Chlamydia trachomatis'', a [[papule]] develops at the point of [[inoculation]] and may [[Ulcer|ulcerate]]. The lesion is self-limited and heals in approximately a week. [[Lymphadenopathy]] of the [[inguinal]] and [[femoral]] lymph nodes develops 2 - 6 weeks after onset the primary lesion. [[Inguinal]] lymph nodes may develop into fluctuant, suppurative [[buboes]] or nonsuppurative [[abscesses]]. [[Iliac]] and [[perirectal]] lymphadenopathy may also develop in patients with rectal exposure, accompanied by hemorrhagic [[proctocolitis]]. Chronic inflammation may lead to perirectal [[fistulas]] and/or [[strictures]], as well as sclerosing [[fibrosis]] that results in [[elephantiasis]] of genitalia, esthiomene in women, and frozen pelvis syndrome. Systemic spread may result in [[arthritis]], [[hepatitis]] or [[perihepatitis]], [[pneumonitis]], cardiac involvment (rare), [[aseptic meningitis]] (rare), ocular inflammatory disease (rare). Prognosis is poor without treatment. However, spontaneous [[remission]] is possible. Death can occur from bowel obstruction or [[perforation]].
==Natural History==
==Natural History==
===Primary stage===
===Primary Stage===
LGV may begin as a self-limited painless [[genital ulcer]] that occurs at the contact site 3–12 days after infection. Women rarely notice a primary infection because the initial ulceration where the organism penetrates the [[mucosal]] layer is often located out of sight, in the vaginal wall. In men fewer than 1/3 of those infected notice the first signs of LGV. This primary stage heals in a few days. [[Erythema nodosum]] occurs in 10% of cases.
*Incubation period of ''Chlamydia trachomatis'' is approximately 3 to 30 days, after which a [[papule]] develops at the point of [[inoculation]].
*The papule may [[Ulcer|ulcerate]].
*The lesion is self-limited and heals in approximately 1 week.
*Individuals with rectal exposure may develop [[proctitis]].<ref name="pmid25870512">{{cite journal| author=Ceovic R, Gulin SJ| title=Lymphogranuloma venereum: diagnostic and treatment challenges. | journal=Infect Drug Resist | year= 2015 | volume= 8 | issue=  | pages= 39-47 | pmid=25870512 | doi=10.2147/IDR.S57540 | pmc=PMC4381887 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25870512  }} </ref><ref name="Mabey2002">{{cite journal|last1=Mabey|first1=D|title=Lymphogranuloma venereum|journal=Sexually Transmitted Infections|volume=78|issue=2|year=2002|pages=90–92|issn=13684973|doi=10.1136/sti.78.2.90}}</ref>


===Secondary stage===
===Secondary Stage===
The secondary stage most often occurs 10–30 days later, but can present up to six months later. The infection spreads to the lymph nodes through [[lymphatic drainage]] pathways. The most frequent presenting clinical manifestation of LGV among males whose primary exposure was genital is unilateral (in 2/3 of cases) [[adenitis|lymphadenitis]] and [[lymphangitis]], often with tender [[inguinal]] and/or [[femoral]] [[lymphadenopathy]] because of the drainage pathway for their likely infected areas. Lymphangitis of the dorsal penis may also occur and resembles a string or cord. If the route was anal sex the infected person may experience lymphadenitis and lymphangitis noted above. They may instead develop [[proctitis]], inflammation limited to the [[rectum]] (the distal 10–12&nbsp;cm) that may be associated with anorectal pain, [[tenesmus]], and rectal discharge, or [[proctocolitis]], [[inflammation]] of the colonic [[mucosa]] extending to 12&nbsp;cm above the anus and associated with symptoms of proctitis plus [[diarrhea]] or abdominal cramps.
*[[Lymphadenopathy]] develops approximately 2 to 6 weeks after onset of the primary lesion.
*If the site of inoculation is on the anterior area of genitalia, patients most commonly develop [[inguinal]] and/ or [[femoral]] [[lymphadenitis]].<ref name="Mabey2002"></ref>
:*Inflammation is more common in men and occurs in approximately 20% of women.
:*[[Lymphadenopathy]] is unilateral is two-thirds of patients.
:*Lymph nodes may develop into fluctuant, suppurative [[buboes]] or nonsuppurative [[abscesses]]
:*Approximately 20% of patients develop "Groove sign" (separation of the inguinal and femoral lymph nodes by the inguinal ligament).<ref name="pmid11589803">{{cite journal| author=Roest RW, van der Meijden WI, European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization| title=European guideline for the management of tropical genito-ulcerative diseases. | journal=Int J STD AIDS | year= 2001 | volume= 12 Suppl 3 | issue=  | pages= 78-83 | pmid=11589803 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11589803  }} </ref>
*If site of inoculation is the posterior area of genitalia or anorectal area, patients commonly develop anorectal syndrome.<ref name="pmid25870512"></ref>
:*Patients may develop [[lymphadenopathy]] of the [[iliac]] or [[perirectal]] nodes.
:*Patients may develop hemorrhagic [[proctocolitis]].


In addition, symptoms may include inflammatory involvement of the perirectal or perianal [[lymphatic tissue]]s. In females, [[cervicitis]], [[perimetritis]], or [[salpingitis]] may occur as well as lymphangitis and lymphadenitis in deeper nodes. Because of lymphatic drainage pathways, some patients develop an abdominal mass which seldom [[suppurate]]s, and 20–30% develop inguinal lymphadenopathy. Systemic signs which can appear include fever, decreased appetite, and malaise. Diagnosis is more difficult in women and men who have sex with men (MSM) who may not have the inguinal symptoms.
===Tertiary Stage===
*Chronic [[proctocolitis]] may lead to the formation of perirectal [[fistulas]], [[strictures]], and rectal [[stenosis]].<ref name="pmid24352129">{{cite journal| author=de Vries HJ, Zingoni A, White JA, Ross JD, Kreuter A| title=2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. | journal=Int J STD AIDS | year= 2013 | volume= 25 | issue= 7 | pages= 465-474 | pmid=24352129 | doi=10.1177/0956462413516100 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24352129  }} </ref>
*Chronic [[lymphadenopathy]] may cause sclerosing [[fibrosis]] that results in [[elephantiasis]] of genitalia, esthiomene in women, and frozen pelvis syndrome.<ref name="pmid25870512"></ref>


Over the course of the disease, lymph nodes enlarge, as may occur in any infection of the same areas as well. Enlarged nodes are called '''buboes'''. Buboes are commonly painful. Nodes commonly become inflamed, thinning and fixation of the overlying skin. These changes may progress to [[necrosis]], fluctuant and suppurative lymph nodes, [[abscess]]es, fistulas, strictures, and sinus tracts. During the infection and when it subsides and healing takes place, [[fibrosis]] may occur. This can result in varying degrees of lymphatic obstruction, chronic [[edema]], and [[stricture]]s. These late stages characterised by fibrosis and edema are also known as the third stage of LGV and are mainly permanent.
==Complications==
*[[Strictures]] and/or [[fistulas]] that cause rectal [[stenosis]]<ref name="pmid9640444">{{cite journal| author=Papagrigoriadis S, Rennie JA| title=Lymphogranuloma venereum as a cause of rectal strictures. | journal=Postgrad Med J | year= 1998 | volume= 74 | issue= 869 | pages= 168-9 | pmid=9640444 | doi= | pmc=PMC2360843 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9640444  }} </ref>
:*Fistulas of, but not limited to, the penis, [[urethra]], [[vagina]], [[uterus]], or [[rectum]] may develop
*[[Fibrosis]] causing genital [[elephantiasis]] or esthiomene
*Follicular [[conjunctivitis]] due to autoinoculation of infectious [[discharge]]
*Systemic spread may result in the following:<ref name="pmid25870512"></ref>
:*[[Arthritis]]
:*[[Hepatitis]] or [[perihepatitis]]
:*[[Pneumonitis]]
:*Cardiac involvment (rare)
:*[[Aseptic meningitis]] (rare)
:*Ocular inflammatory disease (rare)


==Complications==
Genital [[elephantiasis]] or esthiomene, which is the dramatic end-result of lymphatic obstruction, which may occur because of the [[stricture]]s themselves, or [[fistula]]s.  This is usually seen in females, may ulcerate and often occurs 1-20 years after primary [[infection]]. Fistulas of, but not limited to, the penis, [[urethra]], [[vagina]], [[uterus]], or [[rectum]]. Also, surrounding [[edema]] often occurs. Rectal or other strictures and scarring. Systemic spread may occur, possible results are [[arthritis]], [[pneumonitis]], [[hepatitis]], or [[perihepatitis]].
==Prognosis==
==Prognosis==
Highly variable. [[Spontaneous]] [[remission]] is common. Complete cure can be obtained with proper [[antibiotic]] treatment. Course is more favorable with early treatment. Bacterial superinfections may complicate course. Death can occur from bowel obstruction or [[perforation]]. [[Follicular conjunctivitis]] due to autoinoculation of infectious [[discharge]].
*Prognosis is usually poor without treatment. However, spontaneous [[remission]] is common.
*Complete cure can be obtained with proper [[antibiotic]] treatment (more favorable with early treatment).
*Death can occur from bowel obstruction or [[perforation]].<ref>Lymphogranuloma venereum. Wikipedia (December 3, 2015). https://en.wikipedia.org/wiki/Lymphogranuloma_venereum Accessed February 23, 2016.</ref>
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Sexually transmitted diseases]]
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[[Category:Needs overview]]
[[Category:Disease]]
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[[Category:Gynecology]]
[[Category:Gynecology]]
[[Category:Infectious disease]]
[[Category:Needs content]]


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Latest revision as of 18:00, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Overview

After an incubation period of 3 - 30 days for Chlamydia trachomatis, a papule develops at the point of inoculation and may ulcerate. The lesion is self-limited and heals in approximately a week. Lymphadenopathy of the inguinal and femoral lymph nodes develops 2 - 6 weeks after onset the primary lesion. Inguinal lymph nodes may develop into fluctuant, suppurative buboes or nonsuppurative abscesses. Iliac and perirectal lymphadenopathy may also develop in patients with rectal exposure, accompanied by hemorrhagic proctocolitis. Chronic inflammation may lead to perirectal fistulas and/or strictures, as well as sclerosing fibrosis that results in elephantiasis of genitalia, esthiomene in women, and frozen pelvis syndrome. Systemic spread may result in arthritis, hepatitis or perihepatitis, pneumonitis, cardiac involvment (rare), aseptic meningitis (rare), ocular inflammatory disease (rare). Prognosis is poor without treatment. However, spontaneous remission is possible. Death can occur from bowel obstruction or perforation.

Natural History

Primary Stage

  • Incubation period of Chlamydia trachomatis is approximately 3 to 30 days, after which a papule develops at the point of inoculation.
  • The papule may ulcerate.
  • The lesion is self-limited and heals in approximately 1 week.
  • Individuals with rectal exposure may develop proctitis.[1][2]

Secondary Stage

  • Inflammation is more common in men and occurs in approximately 20% of women.
  • Lymphadenopathy is unilateral is two-thirds of patients.
  • Lymph nodes may develop into fluctuant, suppurative buboes or nonsuppurative abscesses
  • Approximately 20% of patients develop "Groove sign" (separation of the inguinal and femoral lymph nodes by the inguinal ligament).[3]
  • If site of inoculation is the posterior area of genitalia or anorectal area, patients commonly develop anorectal syndrome.[1]

Tertiary Stage

Complications

Prognosis

  • Prognosis is usually poor without treatment. However, spontaneous remission is common.
  • Complete cure can be obtained with proper antibiotic treatment (more favorable with early treatment).
  • Death can occur from bowel obstruction or perforation.[6]

References

  1. ↑ 1.0 1.1 1.2 1.3 Ceovic R, Gulin SJ (2015). "Lymphogranuloma venereum: diagnostic and treatment challenges". Infect Drug Resist. 8: 39–47. doi:10.2147/IDR.S57540. PMC 4381887. PMID 25870512.
  2. ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
  3. ↑ Roest RW, van der Meijden WI, European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization (2001). "European guideline for the management of tropical genito-ulcerative diseases". Int J STD AIDS. 12 Suppl 3: 78–83. PMID 11589803.
  4. ↑ de Vries HJ, Zingoni A, White JA, Ross JD, Kreuter A (2013). "2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens". Int J STD AIDS. 25 (7): 465–474. doi:10.1177/0956462413516100. PMID 24352129.
  5. ↑ Papagrigoriadis S, Rennie JA (1998). "Lymphogranuloma venereum as a cause of rectal strictures". Postgrad Med J. 74 (869): 168–9. PMC 2360843. PMID 9640444.
  6. ↑ Lymphogranuloma venereum. Wikipedia (December 3, 2015). https://en.wikipedia.org/wiki/Lymphogranuloma_venereum Accessed February 23, 2016.

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