Lymphogranuloma venereum natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nate Michalak, B.A.
Overview
After an incubation period of 3 - 30 days for Chlamydia trachomatis, a papule develops at the point of inoculation and may ulcerate. The lesion is self-limited and heals in approximately a week. Lymphadenopathy of the inguinal and femoral lymph nodes develops 2 - 6 weeks after onset the primary lesion. Inguinal lymph nodes may develop into fluctuant, suppurative buboes or nonsuppurative abscesses. Iliac and perirectal lymphadenopathy may also develop in patients with rectal exposure, accompanied by hemorrhagic proctocolitis. Chronic inflammation may lead to perirectal fistulas and/or strictures, as well as sclerosing fibrosis that results in elephantiasis of genitalia, esthiomene in women, and frozen pelvis syndrome. Systemic spread may result in arthritis, hepatitis or perihepatitis, pneumonitis, cardiac involvment (rare), aseptic meningitis (rare), ocular inflammatory disease (rare). Prognosis is poor without treatment. However, spontaneous remission is possible. Death can occur from bowel obstruction or perforation.
Natural History
Primary Stage
- Incubation period of Chlamydia trachomatis is approximately 3 to 30 days, after which a papule develops at the point of inoculation.
- The papule may ulcerate.
- The lesion is self-limited and heals in approximately 1 week.
- Individuals with rectal exposure may develop proctitis.[1][2]
Secondary Stage
- Lymphadenopathy develops approximately 2 to 6 weeks after onset of the primary lesion.
- If the site of inoculation is on the anterior area of genitalia, patients most commonly develop inguinal and/ or femoral lymphadenitis.[2]
- Inflammation is more common in men and occurs in approximately 20% of women.
- Lymphadenopathy is unilateral is two-thirds of patients.
- Lymph nodes may develop into fluctuant, suppurative buboes or nonsuppurative abscesses
- Approximately 20% of patients develop "Groove sign" (separation of the inguinal and femoral lymph nodes by the inguinal ligament).[3]
- If site of inoculation is the posterior area of genitalia or anorectal area, patients commonly develop anorectal syndrome.[1]
- Patients may develop lymphadenopathy of the iliac or perirectal nodes.
- Patients may develop hemorrhagic proctocolitis.
Tertiary Stage
- Chronic proctocolitis may lead to the formation of perirectal fistulas, strictures, and rectal stenosis.[4]
- Chronic lymphadenopathy may cause sclerosing fibrosis that results in elephantiasis of genitalia, esthiomene in women, and frozen pelvis syndrome.[1]
Complications
- Strictures and/or fistulas that cause rectal stenosis[5]
- Fibrosis causing genital elephantiasis or esthiomene
- Follicular conjunctivitis due to autoinoculation of infectious discharge
- Systemic spread may result in the following:[1]
- Arthritis
- Hepatitis or perihepatitis
- Pneumonitis
- Cardiac involvment (rare)
- Aseptic meningitis (rare)
- Ocular inflammatory disease (rare)
Prognosis
- Prognosis is usually poor without treatment. However, spontaneous remission is common.
- Complete cure can be obtained with proper antibiotic treatment (more favorable with early treatment).
- Death can occur from bowel obstruction or perforation.[6]
References
- ↑ 1.0 1.1 1.2 1.3 Ceovic R, Gulin SJ (2015). "Lymphogranuloma venereum: diagnostic and treatment challenges". Infect Drug Resist. 8: 39–47. doi:10.2147/IDR.S57540. PMC 4381887. PMID 25870512.
- ↑ 2.0 2.1 Mabey, D (2002). "Lymphogranuloma venereum". Sexually Transmitted Infections. 78 (2): 90–92. doi:10.1136/sti.78.2.90. ISSN 1368-4973.
- ↑ Roest RW, van der Meijden WI, European Branch of the International Union against Sexually Transmitted Infection and the European Office of the World Health Organization (2001). "European guideline for the management of tropical genito-ulcerative diseases". Int J STD AIDS. 12 Suppl 3: 78–83. PMID 11589803.
- ↑ de Vries HJ, Zingoni A, White JA, Ross JD, Kreuter A (2013). "2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens". Int J STD AIDS. 25 (7): 465–474. doi:10.1177/0956462413516100. PMID 24352129.
- ↑ Papagrigoriadis S, Rennie JA (1998). "Lymphogranuloma venereum as a cause of rectal strictures". Postgrad Med J. 74 (869): 168–9. PMC 2360843. PMID 9640444.
- ↑ Lymphogranuloma venereum. Wikipedia (December 3, 2015). https://en.wikipedia.org/wiki/Lymphogranuloma_venereum Accessed February 23, 2016.