Lymphogranuloma venereum occurs predominantly in tropical and subtropical regions of Africa, Asia and Latin America. In the western world, however, the venereal disease is rather rare.
In recent years, however, an increasing number of cases of lymphogranuloma venereum have also been reported in Europe and the USA. Those affected are mostly tourists from the tropics and their sexual partners as well as homosexual men. According to the Infection Protection Act (IfSG), there is currently no obligation to report lymphogranuloma venereum in Germany.
The causative agents of lymphogranuloma venereum are serotypes L1-L3 of the bacterial genus Chlamydia trachomatis. This spherical, gram-negative bacterium, about 0.5 micrometers (µm) in size, is sensitive to cold and dehydration.
The pathogen is therefore transmitted almost exclusively through mucosal contact during unprotected sexual intercourse. In Europe, infection mainly occurs during unprotected anal intercourse between homosexual men.
Serotypes L1-L3 tend to spread throughout the body and thus cause a systemic infection.
Lymphogranuloma venereum progresses in three stages in which the symptoms vary.
- Stage I: Small ulcers and blisters
In the so-called primary stage (stage I), the first characteristic symptoms appear at the earliest 3 days to around 3 weeks after infection.
Painless nodules or fluid-filled blisters form in the genital area, which develop into small ulcers. These heal on their own after a few days.
In men, they occur on the penis, the glans, the foreskin, the rectum or the urethra. In women, they occur in the vagina or urethra, for example.
As the ulcers do not hurt, they often go completely unnoticed.
- Stage II: swelling of the lymph nodes
Around 6 weeks after infection, swelling of the lymph nodes on one or both sides in the groin and/or genital area occurs.
These painful swellings of the lymph nodes are visible from the outside. The overlying skin sometimes turns blue-red. If the swellings remain untreated, they can ulcerate and rupture.
In addition, accompanying symptoms such as fever, headache and aching limbs, muscle and joint pain, chills and nausea may occur.
- Stage III: Chronic inflammation and ulcers
If lymphogranuloma venereum remains untreated, the disease can progress to a chronic, so-called tertiary stage (stage III).
This is followed by several symptom-free years during which the pathogens continue to spread in the body. Chronic inflammation and ulcers develop in the intestinal and genital area.
The consequences are
- Intestinal constrictions with difficult bowel movements
- Lymphatic drainage disorders with chronic lymphoedema Swelling of the genitals
- Abscesses and fistulas
Lymphogranuloma venereum is diagnosed both on the basis of the characteristic symptoms and by detecting the pathogen.
The lymph node swellings and ulcers typical of lymphogranuloma venereum are recognized by the urologist or gynaecologist during a physical examination.
To confirm the diagnosis, the doctor will also take a swab from the urethra, rectum or a lymph node.
With the help of this swab, laboratory staff then prepare a cell culture to determine and detect the exact pathogen.
A blood or urine test can also detect the causative pathogen of lymphogranuloma venereum.
Detection of the pathogen is also possible with a blood test @ Saiful52 /AdobeStock
Special antibiotics specifically combat and kill the bacterial pathogens.
These are used here:
- Doxycycline
- tetracycline
- erythromycin or
- azithromycin
The patient must take the antibiotic daily as a tablet over a period of usually 3 weeks. In severe cases of lymphogranuloma venereum, it may also be necessary to administer the antibiotic as an infusion.
Avoid reinfection
A laboratory test after completion of the antibiotic therapy should ensure that no causative pathogens of lymphogranuloma venereum are still present.
In order to prevent the spread of the infection and mutual re-infection (ping-pong effect), the sexual partners of the infected person should also undergo treatment.
Patients should also refrain from sexual intercourse until one week after the end of treatment.
If patients receive antibiotics promptly and consistently in the early stages, the infection heals quickly without leaving any consequential damage.
However,if the infection with lymphogranuloma venereumremains untreated, the disease can lead to painful swelling of the lymph nodes after a few weeks.
After several years, it leads to a chronic tertiary stage with severe complications and long-term consequences. Late effects include intestinal constriction or lymphatic drainage disorders.
