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Rare Sexually Transmitted Diseases: Chancres

Lymphogranuloma venereum (LGV)

Causative agent

  • Serovars L1, L2 or L3 of Chlamydia trachomatis
  • The regular chlamydial infection is caused by serovars D-K.

Epidemiology

  • In Europe, the infection is encountered almost only among men who have sex with men.
  • Several endemic regions exist in the tropics.

Clinical picture and diagnosis

  • Infection of the lymphatic tissue in the genital region
  • The incubation period is 1 to 2 weeks.
  • In Europe, LGV occurs in men as proctitis; inflammatory bowel diseases must be considered in differential diagnosis.
  • In the classic form, the initial symptom is a painless pustule, which erodes and then heals spontaneously. After a few weeks, inguinal lymph nodes may coalesce to form suppurating buboes.
  • The clinical picture may be accompanied by urethritis, proctocolitis and, at a later stage, by chronic and constricting fistulas and tight scars.
  • If LGV is suspected and the nucleic acid test for Chlamydia is positive, the laboratory may be requested to carry out the follow-up test to detect the specific C. trachomatis serovars.
  • Suspect in a man who has anal sex between men and has proctitis, atypical bowel disease or enlargement of lymph nodes in the anogenital region.

Treatment

  • Doxycycline 100 mg twice daily for 21 days or erythromycin 500 mg four times daily for 21 days
  • Follow-up appointment 4 weeks after treatment (C. trachomatis nucleic acid test)
  • Report the infection to relevant authorities according to the local regulations.
  • Test for other STDs.
  • Trace the infection to identify and treat other infected persons.

Soft chancre (ulcus molle, chancroid)

Causative agent

  • The gram-negative bacteria Haemophilus ducreyi

Epidemiology

  • Rare in Europe but encountered in the tropics, e.g. in Africa

Symptoms

  • Incubation period 3-7 days
  • One or more tender, eroding genital pustules with an erythematous halo
  • Unilateral, painful inguinal lymph node enlargements (buboes), which easily erode into suppurating abscesses, are frequent. No systemic infection.

Diagnosis

  • It is very difficult to culture the bacteria, and the method is not universally available. Detection of the bacteria with a nucleic acid test is available in some European laboratories.
  • Differential diagnosis must consider syphilis and genital herpes.

Treatment

Granuloma inguinale (donovanosis)

Causative agent

  • The Gram-negative intracellular bacteria Calymmatobacterium granulomatis

Epidemiology

  • Very rare; sporadic cases in India, Africa and the West Indian islands

Clinical picture and diagnosis

  • Incubation period about 50 days
  • A genital papule which erodes after a few days and increases in size; no lymph gland enlargement
  • Without treatment the disease progresses to a chronic, granulomatous and tissue-destructing infection.
  • Extragenital involvement may also occur rarely in donovanosis.
  • Histology will reveal the presence of Donovan bodies.

Treatment

  • First-line: azithromycin 1 g per week for 3-4 weeks or until the disease subsides

    References

    • Lautenschlager S, Kemp M, Christensen JJ, et al. 2017 European guideline for the management of chancroid. Int J STD AIDS 2017;28(4):324--329. [PubMed]
    • de Vries HJC, de Barbeyrac B, de Vrieze NHN, et al. 2019 European guideline on the management of lymphogranuloma venereum. J Eur Acad Dermatol Venereol 2019;33(10):1821-1828. [PubMed]