Lymphogranuloma Venereum

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This is characterized by transitory primary ulcerative lesion followed by suppurative lymphadenitis. It is caused by serotypes of Chlamydia trachomatis L1, L2, L3 which are distinct from those causing trachoma, urethritis, cervicitis and inclusion conjunctivitis.

Clinical FeaturesThe incubation period is 3 to 12 days. A small, transient, non-indurated vesicular lesion is formed that rapidly ulcerates, heals quickly and may pass unnoticed. Usually, the first symptoms are unilateral, tender enlarged inguinal lymph nodes, enlarging above and below the inguinal ligament giving rise to the characteristic groove sign. They progress to form a large, tender fluctuant mass that adheres to the deep tissues and inflates the overlying skin. Multiple sinuses may develop and discharge purulent or bloodstained material. Healing eventually occurs with scar formation. The patient may have constitutional symptoms of fever, malaise, joint pain, anorexia, and vomiting. Backache is common in women in whom the lesion may be on the cervical or upper vagina resulting in the enlargement and suppuration of perirectal and pelvic lymph nodes. This results in the formation of rectovesical and rectovaginal fistulas. Aspirate suppurating glands with a wide bore needle through intact skin. Avoid incision and drainage through a fluctuant area which results in chronic sinus formation.

Treatment Drugs
Doxycycline 100mg orally twice daily for 14 days or 

Alternative and/or in pregnancy  Erythromycin 500mg orally 6 hourly for 14 days.

All sexual partners should be examined. The patient should be kept under observation for 6 months after apparently successful treatment.