Information
Editors
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.
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]