Lyphogranuloma Venereum

SYNONYMS Durand-Nicholas-Favre disease, Lymphopathia Venereum, Lymphogranuloma Inguinale, Tropical Bubo, Poradenitis Inguinales

Definition Lymphogranuloma venereum (LGV) is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trachomatis, particularly chlamydia inguinale. LGV is more common in Central and South America than in North America. LGV is more common in men than women. The main risk factor is being HIV-positive. Incubation Period The incubation period is from 3 days to 6 weeks (on average 10-14 days). Risk Factors Unprotected sexual intercourse Receptive anal intercourse Sexual contacts in endemic areas Prostitution Multiple sexual partners Male gender Anal enema use

Mode of Transmission 1. LGV is passed from person to person through direct contact with lesions, ulcers or other area where the bacteria is located. 2. Transmission of the organism occurs during sexual penetration (vaginal, oral, or anal) and may also occur via skin-to-skin contact.

Pathophyisiology 1. An obligate intracellular pathogen (ie, the bacterium lives within human cells have been associated with infection. 2. LGV is primarily a disease of lymphatic tissue. Because Chlamydia species cannot traverse the intact epithelial barrier, access to lymphatic vessels is gained through microtrauma in the skin or mucous membranes. 3. The pathogen then enters the draining lymph nodes, causing lymphangitis or lymphadenitis. 4. The causal pathologic process involves thrombolymphangitis and

perilymphangitis and the consequent spread of the inflammatory reaction from the affected lymph nodes to surrounding tissues.

SIGNS AND SYMPTOMS Symptoms of LGV can begin a few days to a month after coming in contact with the bacteria. Symptoms include: Blood or pus from the rectum (blood in the stools) Drainage through the skin from lymph nodes in the groin Painful bowel movements Small painless sore on the male genitals or in the female genital tract Swelling and redness of the skin in the groin area Swelling of the labia Swollen groin lymph nodes on one or both sides; it may also affect lymph nodes around the rectum in people who have anal intercourse Observed during physical examination:

An oozing, abnormal connection (fisula) in the rectal area A sore on the genitals Drainage through the skin from lymph nodes in the groin Swelling of the vulva or labia in women Swollen lymph nodes in the groin (inguinal lymphadenopathy)

POSSIBLE COMPLICATIONS Abnormal connections between the rectum and vagina Brain inflammation (very rare) Infections in the joints, eyes, heart, or liver Long-term inflammation and swelling of the genitals Scarring and narrowing of the rectum Complications can occur many years after you are first infected.

DIAGNOSTIC PROCEDURES

Biopsy of the lymph node Blood test for the chlamydia bacteria Swab from the site of infection Culture of aspirated materials ELISA Direct fluorescent antibody test

MODALITIES OF TREATMENT Oral Antibiotics Tetracycline or Doxycycline (10-20days), Erythromycin or Trimethoprim sulfamethoxazole (14 days). Azithromycin may be given 1 g weekly for 3 weeks Surgical therapy Buboes may be drained percutaneously to relieve symptoms. Surgical excision is best avoided due to the risk of sinus or fistula formation

NURSING MANAGEMENT Practice universal precautions when examining the patient, giving patient care, and handling contaminated material. Double bag all soiled dressings and contaminated instruments. Examine and test the patients sexual contacts for chlamydial infections and suggest them to submit for HIV testing.

 Check the newborn of an infected mother for signs of an infection. Take specimens of culture from infants eyes, nasopharynx and rectum. Positive rectal cultures will peak by 5 to 6 weeks postpartum.

COMMON NURSING DIAGNOSES Anxiety Ineffective coping Sexual dysfunction Social Isolation Knowledge deficit