Lymphogranuloma venereum natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
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
- 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.[2]
- 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]
- Patients may develop lymphadenopathy of the iliac or perirectal nodes.
- Patients may develop hemorrhagic proctocolitis.
Tertiary Stage
- Chronic proctocolitis may lead to the formation of perirectal fistulas, strictures, and rectal stenosis.[4]
- Chronic lymphadenopathy may cause sclerosing fibrosis that results in elephantiasis of genitalia, esthiomene in women, and frozen pelvis syndrome.
Complications
Genital elephantiasis or esthiomene, which is the dramatic end-result of lymphatic obstruction, which may occur because of the strictures themselves, or fistulas. 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
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.
References
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
- ↑ 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.
- ↑ 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.