Lymphogranuloma Venereum

Pathophysiology

1) cause is infection with obligate intracellular Chlamydia trachomatis 2) occurs in primary, secondary, and tertiary phases

Signs and Symptoms

1) primary phase – small painless vesicle at area of inoculation, which forms several days to several weeks after infection (vesicle may ulcerate) 2) secondary phase – in men, usually bilateral (but sometimes unilateral), matted, and suppurative inguinal lymph nodes; in women, rectal inflammation occurs 3) tertiary phase – systemic manifestation of headache, fever, myalgia, and arthralgia

Histology/Gross Pathology

1) caused by L type serotypes only (L1-L3) 2) involved lymph node tissue shows necrotizing granulomata with striking inflammation of neutrophils with a necrotic central area

Associated Conditions

if untreated can progress to – 1) lymphatic scarrring and fibrosis 2) genital elephantiasis 3) rectal scarring 4) rectovaginal fistulas 5) urethral strictures

Epidemiology/Inheritance

1) affects colon in male homosexuals through anal sex 2) sexually transmitted and endemic in tropical areas 3) introduced via break in the epithelial surface

Treatment

tetracycline

Tips for USMLE

if patient has stellate abscesses formed by granulomas with suppurative bases, think lymphogranuloma venereum