section name header

Information

Editors

EijaHiltunen-Back

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

First-line: ceftriaxone 250 mg i.m. or azithromycin 1 g as a single dose
Second-line: ciprofloxacin 500 mg twice daily for 3 days or erythromycin 500 mg three to four times daily for 7 days

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
- Alternatively doxycycline 100 mg twice daily or erythromycin 500 mg four times daily (treatment period as above)

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]