Lymphogranulomatosis Inguinalis

lymphogranuloma venereum, fifth venereal disease, fourth venereal disease (after syphilis, gonorrhea, and chancroid), Nicolas-Favre disease (named for the French physicians J. Nicolas and M. Favre, who described the disease in 1913), climatic bubo, lymphopathia venereum, a chronic, sexually transmitted infectious disease, most often found in hot climates.

The causative agent of lymphogranulomatosis inguinalis is a filterable lymphotropic virus. The interval from the moment of infection to the appearance of the first symptoms of the disease (the incubation period) is ten to 25 days. The primary lesion, in the form of a nodule, blister, or shallow skin defect (erosion), arises at the site of penetration of the virus. There are no subjective sensations. These symptoms disappear spontaneously after a few days.

The secondary stage usually begins five to 30 days later and is characterized by affection of the lymph nodes (most often, inguinal), which enlarge, indurate, and fuse, forming painful tuberous tumors. The skin over these turns a cyanotic red. Patients experience elevated temperature, headaches, exhaustion, and pain in the joints. Malacic foci develop and the skin over them becomes thin. Fistular apertures appear, discharging a thick yellow-green pus. The lymph nodes gradually decrease in size and the fistular apertures cicatrize, but neighboring lymph nodes become involved and new fistular apertures form. The secondary stage of the disease lasts from two or three months to several years. The scars formed sometimes lead to considerable disturbances of lymph circulation and to the development of elephantiasis. When the inguinal lymph nodes are affected, lymph circulation is disturbed in the gonads, perineum, and anal region.

The tertiary stage of the disease is characterized by papillomatous growths, abscesses, ulcers, and annular stenosis of the rectum, accompanied by intestinal obstruction (anorectal syndrome).

Lymphogranulomatosis inguinalis is treated with antibiotics and sulfanilamides. The anorectal form requires surgical intervention.

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