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·       Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlaimydia trachomatis.

Clinical features

·       Primery genital lesion occurs from 3 days to 3 weeks after exposure. It is small , painless vesicle or non-indurated ulcer or papule located on the external genitalia.

·       Inguinal syndrome is characterized by painful inguinal lymph-adenopathy beginning 2-6 weeks after presumed exposure . The infuinal lymphadenopathy is usually unilateral. The nodes are initially discrete which later become matted, fluctuant and suppurative. The overlying skinbecomes fixed, inflamed and thinned . Finally, multiple draining fistulae develop. Ectensive enlargement of inguinal lymph nodes abeve anf below the inguinal lymph nodes above and below the inguinal ligament can occur (‘groove sign’).

·       Constitutional symptoms include fever, chills , headache, anorexia, meningismus, myalgias and arthralgias.

Diagnosis

·       Isolation of the LGV strain of Chlamydia from aspirated bubo pus, rectum , urethra ,endocervix or from other infected tissue.

·        Frei skin test is of little value.

·       Serological tests (e.g microimmunofluorescence test , complement fixation test) to detect anti bodies.

·       Direct immunofluorescent antibody test to identify antigens associated with the bacteria in the smear.

·       Nucleic acid probes and PCR to detect antigens.

Treatment

·       Tetracycline hydrochloride 500 mg QID for 3weeks or doxycycline 100 mg BID for three weeks or erythromycin 500 mg QID for 3 weeks.

·       Fluctuant buboes should be aspirated with a syringe and needle.

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