This is behind Lymphogranuloma venereum

The LGV, which is one of the four "classic" venereal diseases, has been a problem in African, Asian and Latin American countries in recent decades. For about ten years more cases have been registered in major European cities. Since the disease is rather poorly known among physicians, a relatively high number of unrecognized infections must be assumed.

Of microbes and humans

The LGV is caused by a particular type of the genus Chlamydia, globally very common globular bacteria that can only multiply within the host cells and lead to different clinical pictures. One of its three key human species is Chlamydia trachomatis, which causes trachoma with its serotypes D-K, sexually transmitted infections of the urinary tract and reproductive organs and the world's leading cause of blindness.

The serotypes L1-L3, however, are responsible for the much rarer lymphogranuloma venereum. Unlike the other types, these germs tend to spread throughout the body, causing a so-called systemic infection. The transmission takes place during intercourse, in Europe mainly in unprotected anal intercourse. For the most part, homosexual men are affected here.

Not infrequently, patients also have other venereal diseases, such as syphilis and gonorrhea. Accurate disease numbers are due to the difficult laboratory diagnostics and the often unrecognized symptoms also not to be maintained by the WHO.

Symptoms and stages

The name already describes a part of the course of the disease: lymph node inflammation in the lymphatic drainage area of ​​the reproductive organs. But this is just one stage of the three stages:

  • Primary stage: At the point of entry of the germ, eg in the vagina, glans and foreskin, rectum or urethra, small vesicles or nodules form after about 3 weeks, which turn into an ulcer and heal again. Since this does not hurt, it is often not noticed. There may be inflammation of the urethra, cervix and rectum.
  • Secondary stage: About 6 weeks after the infection, the lymph nodes in the vicinity of the primary infection (usually in a groin) become painfully swollen ("bubo") and the overlying skin turns blue-red. The lymph nodes get bigger and begin to fester. In one third of those affected ulcers break outward. In addition, general symptoms such as fever, nausea, headache and body aches often appear. Rarely, inflammation of the meninges, liver, joints or pericardium can be added. If the pathogen was transmitted anal, it may lead to a painful infectious inflammation with bloody diarrhea.
  • Tertiary stage: Left untreated, there is a symptom-free period of several years, during which the pathogens continue to spread. They then cause chronic inflammation, especially on the genitals. These have fistulas, abscesses, transfer of the rectum and lymphatics with lymph congestion and sometimes massive swelling of the genital organs as well as inflammation of the anus and urethra with severe pain in bowel movements and urination ("anogenitorektales syndrome").

Proof and therapy

The diagnosis in the laboratory is difficult. It is done by cell culture of smears from the urethra, the rectum, the cervix or a lymph node. If chlamydia is detected, the present type must be determined. Unfortunately, it is not always possible to differentiate between the different species.

The treatment is with doxycycline, an antibiotic, usually taken over 3 weeks as a tablet. Sexual partners with contact within the last two months before the onset of symptoms should be investigated and, if necessary, treated. In some cases, the inflamed lymph nodes must be opened and extensive tissue destruction later surgically corrected. Sexual contact may only take place after treatment has been completed and the ulcers have completely healed.

In a nutshell

  • The LGV is above all a disease occurring in the tropics and subtropics, which is currently also increasingly occurring in Europe.
  • The infection occurs through all sexual practices associated with mucosal contacts, in Europe especially anal intercourse.
  • Protection offer condoms.
  • A complete cure by means of antibiotics is possible, otherwise it can come years later to serious complications.
  • The sexual partners should be treated if necessary.
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