LYMPHOGRANULOMA VENEREUM SEXUAL TRANSMITTED DISEASES

LYMPHOGRANULOMA VENEREUM [LGV] SEXUAL TRANSMITTED DISEASES [STDs]


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LGV is a sexual infectious disease, which produces specific involvement with acute and chronic inflammation of the lymph channels and nodes of the genital and rectum. The disease is transmitted by sexual contact.
Early manifestations include an evanescent genital lesion followed by sub-acute regional lymphadenitis progressing to suppuration and sinus formation.
Later, progressive inflammatory disease of the local lymphatics and surrounding tissues leads to lymph-edema, ulceration and disfigurement of the genitals, and to proctitis, perianal fistulas and rectal stricture.

Etiology, the cause of the disease:
The causative agents of LGV is chlamydia trachomatis. LGV strains are unique: they are usually invasive, produce disease in lymphatic tissue, and grow in cell culture systems and macrophages. LGV microorganism is pathogenic for the chick embryo and produces meningo-encephalitis on intra-cerebral inoculation into mice.

Epidemiology, the spread of the disease:
• Although LGV was long considered a disease of warm climates, there is ample evidence of its world-wide distribution.
• Most common sexually transmitted diseases [STDs] world-wide estimated incidence 92 million in 1999, and in the United States is about 4 million cases per year in 2002.
• As with other venereal diseases, the prevalence of the infection is determined by the promiscuity of the population and is greatest in young adults. Clinical spectrum parallels that of Neisseria gonorrhea is about 40 %..
• Infertility due to fallopian tube scarring has been strongly linked to antecedent Chlamydia trachomatis infection.

Symptoms and signs
:
• After a variable incubation period of from 3 to 20 days, an initial lesion such as vesicular, popular or ulcerative may occur at the site of infection. Most commonly, the first evidence of the disease is involvement of the inguinal lymph nodes beginning 2 weeks to 3 months after exposure, the primary lesion having been unnoticed or absent.
• The inguinal adenitis, unilateral or bilateral, is a sub-acute diffuse process affecting the entire chain of lymph nodes, an often the femoral group as well, producing the “the sign of the groove”.
• Urethritis, epidydimitis, proctitis in the male; cervicitis, salpingitis, and pelvic inflammatory disease [PID] in the female.
Chlamydia trachomatis is recovered from the urethra of up to 70 % of men.
Late manifestations of LGV include disfiguring lesions of the external genitals [elephantiasis] and the anorectal syndrome which is initiated early in the disease by proctitis with tenesmus and a bloody or purulent discharge. Later, chronic cicatrizing inflammation of the rectum and peri-rectal tissues leads to obstipation.
Benign anorectal stricture, contracture, or stenosis results from trauma or infection. It is a common problem of women and may cause difficulty in achieving or completing a bowel movement, pain, and small or ribbon-like stools.
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Diagnosis:
• Isolation of the organism in cell culture; the Frei test and the complement fixation test are positive.
• Chlamydial antigens or nucleic acid can be detected by direct immuno-fluorescent antibody[DFA] slide tests.
• In LGV, aspirate fluctuant buboes through normal skin for testing. Detection of antibody in serum or in local secretions is of limited usefulness except in LGV.

Treatment:
• Ofloxacin [400 mg per oral twice daily for 14 days]; plus metronidazole [500 mg per oral twice daily for 14 days]
• LGV treatment: Doxycycline [100 mg per oral twice daily] or erythromycin base [500 mg 4 times daily] for at least 3 weeks.
• Trachoma and adult inclusion conjunctivitis treatment: Public health programs consists of mass application of tetracycline or erythromycin ophthalmic ointment into the eyes of all children in affected communities for 21-60 days.
• Tetracycline 500 mg 4 times daily, combined with sulfonamides 3 gram daily for 3-6 weeks may prove more effective than either alone.



Prevention:
Avoidance of illicit sexual contact is the surest of all preventive methods.
The standard rubber condom is effective but protects covered parts only. The exposed parts should be washed with soap and water as soon after contact as possible. This applies to both sexes.