Inguinal Swelling (Bubo)

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It is an STI syndrome presenting as localised swellings or enlarged lymph glands in the groin and femoral area.

Causes

• Chlamydia strains: lymphogranuloma venerium (LGV)
• Heamophilus ducreyi: chancroid
• Treponema pallidum: syphilis

Clinical features

• Excessively swollen inguinal glands
• Pain, tenderness
• Swellings may become fluctuant if pus forms

Differential diagnosis

• Other causes of swollen inguinal lymph nodes, e.g. leg ulcer
• Obstructed inguinal hernia

Investigations

• As for Genital Ulcers
• C&S of pus

Management

Treatment

• Examine for genital ulcers, rule out infection of the foot, leg or buttock and exclude inguinal hernia
• If genital ulcer is present, treat as per above protocol
• Give doxycycline 100 mg 12 hourly for 14 days
• Treat partner

If partner is pregnant

• Give erythromycin 500 mg every 6 hours for 14 days

If bubo persisting, and partner was not treated

• Continue treatment for 14 days

If not improving

• Refer for specialist management

Caution

• Do not incise bubo. Aspirate through normal skin with a large bore needle gauge <20 every 2 days until resolution
• Alternative to doxycycline: azithromycin 1 g single dose