That is behind lymphogranuloma venereum

That is behind lymphogranuloma venereum

LGV, one of the four “classic” STDs, has been a problem in African, Asian and Latin American countries for the past few decades. More cases have been registered in major European cities for about ten years. Since the disease is not very well known, even among doctors, it must be assumed that the number of undetected infections is relatively high.

Of microbes and humans

LGV is caused by a particular type of the genus Chlamydia. These spherical bacteria are prevalent worldwide and can only multiply within the host cells, and can lead to various clinical pictures. One of the three species that are important to humans is Chlamydia trachomatis, which, with its serotypes D–K, causes sexually transmitted infections of the urinary tract and genitals as well as the world’s most common cause of blindness, trachoma.

The serotypes L1-L3, on the other hand, are responsible for the much rarer lymphogranuloma venereum. Unlike the other types, these germs tend to spread throughout the body, causing what is known as a systemic infection. Transmission takes place during sexual intercourse, in Europe, predominantly during unprotected anal intercourse. It is, therefore, mainly homosexual men who are affected here.

It is not uncommon for patients to have other sexually transmitted diseases, such as syphilis and gonorrhoea, at the same time. Due to the problematic laboratory diagnostics and the often misunderstood symptoms, exact numbers of the disease cannot be obtained from the WHO.

 

symptoms and stages

The name already describes part of the course of the disease: inflammation of the lymph nodes in the lymph drainage area of ​​the genital organs. But this is only one stage of the three stages:

  • Primary stage:  After about three weeks, small blisters or nodules form at the entry point of the germ, e.g. in the vagina, on the glans and foreskin, rectum or urethra, which turn into an ulcer and heal again. Since this does not hurt, it is often not noticed. Inflammation of the urethra, cervix and rectum can occur.
  • Secondary stage: About six weeks after infection, the lymph nodes in the vicinity of the initial infection (usually in the groin) swell painfully (“bubo”), and the overlying skin turns blue-red. The lymph nodes enlarge and start to rot. In a third of those affected, the ulcers rupture outwards. General symptoms such as fever, nausea, headache and body aches often accompany this. Rarely, meninges, liver, joints or pericardium inflammation can also occur. If the pathogen was transmitted anally, there might be a painful inflammation of the rectum with bloody diarrhoea.
  • Tertiary stage:  If left untreated, a symptom-free period of several years follows, during which the pathogens continue to spread. They then cause chronic inflammation, especially in the genitals. These result in fistulasabscesses, obstruction of the rectum and lymph vessels with lymphatic congestion and, in some cases, massive swelling of the genitals, as well as inflammation of the anus and urethra with severe pain during defecation and urination (“anogenitorectal syndrome”).

detection and therapy

Diagnosis in the laboratory is difficult. It is carried out by a cell culture of swabs from the urethra, the rectum, the cervix or a lymph node. If chlamydia is detected, the type present must be determined. Unfortunately, it is not always possible to differentiate between the different types.

Treatment is with doxycycline, an antibiotic, usually taken as a tablet for three weeks. Sexual partners who have been in contact within the last two months before the onset of symptoms should be evaluated and treated if necessary. In some cases, the inflamed lymph nodes must be opened, and extensive tissue damage must later be surgically corrected. Sexual contact may only take place after the treatment has been completed and the ulcers have completely healed.

 

In a nutshell

  • LGV is a disease that occurs primarily in the tropics and subtropics and is currently also increasingly occurring in Europe.
  • Infection occurs through all sexual practices associated with contact with mucous membranes, in Europe primarily anal intercourse.
  • Condoms offer protection.
  • Complete healing with antibiotics is possible. Otherwise, serious complications can occur years later.
  • The sexual partners should be treated if necessary.

 

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