Penis and scrotum - Lymphogranuloma venereum

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Penis and scrotum

Infectious disorders

Lymphogranuloma venereum

Reviewers: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)

Revised: 18 February 2010, last major update February 2010

Definition

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● Sexually transmitted disease caused by Chlamydia trachomatis, an obligate intracellular parasite

Epidemiology

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● Incidence highest in the tropics and subtropics, although outbreaks have occurred in West among men who have sex with men (MMWR 2004;53:985)

Etiology

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● Sexually transmitted disease caused by Chlamydia trachomatis, an intracellular bacteria

● Different genovars produce specific clinical manifestations; i.e., types A, B, Ba, and C cause trachoma, types LGV-I, -II, and –III (serovars L1, L2 and L3) cause LGV, and types D to K cause oculogenital diseases

Clinical features

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● Causes either inguinal, rectal or rarely pharyngeal syndrome

● Inguinal syndrome: painless papule or ulcer at inoculation site appears and rapidly disappears; followed 1-2 weeks later by enlarged inguinal lymph nodes with suppurative inflammation; followed by lymphocytic hyperplasia and massive plasma cell infiltration; then get stellate abscess; then suppurative granuloma with sinuses and tracts

● Rectal syndrome: most patients have proctitis, many with severe symptoms (Clin Infect Dis 2007;44:26)

● LGV infection may facilitate transmission of HIV

● Diagnosis: based primarily on clinical findings, can be supported by culture (30-50% sensitive), complement fixation (80% sensitive but does not distinguish different serovars) or PCR (limited availability)

Treatment

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● Tetracycline (except during pregnancy) or erythromycin

Clinical images

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Various images

Images: sinus tract

Micro description (Histopathology)

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● Nonspecific features of ulceration and granulation tissue in dermis

● Suppurative inflammation of inguinal lymph nodes (neutrophils in necrotic foci); followed by lymphocytic hyperplasia and massive plasma cell infiltration; then stellate abscess from merging of microfoci of suppuration; then suppurative non-necrotizing granuloma with epithelioid and multinucleated giant cells

● Sinuses and tracts can develop and fibrosis may ultimately replace most of lymph node architecture

● In lymph nodes, appear as intravacuolar organisms, associated with necrosis and suppuration

● Etiological agent is not apparent with routine stains

● Organisms are 0.2 to 2.0 micrometers in diameter, stain Gram negative with the Brown-Hopps tissue Gram stain, faintly blue with hematoxylin and eosin stain, and black with Warthin-Starry stain (Mod Pathol 1995;8:924)

Micro images

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Lymph nodes

Cytology images

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Inclusions in cell culture

Electron microscopy descriptions

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● Elementary and reticulate bodies and intermediate forms characteristic of the genus Chlamydia

Electron microscopy images

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Entry of Chlamydia trachomatis LGV Chlamydia trachomatis elementary body (EB) entering a

elementary bodies (E) into HeLa cells. HeLa cell. Tannic acid stained to enhance visualization

Note the host cell microvilli enveloping of clathrin. Note the clearly demarcated outer envelope

the elementary bodies. The bar of the EB and the surrounding membrane (m) of the

represents 0.25 microns. vacuole. Note the small size of the clathrin coated pit (ccp)

compared to the endosome. The bar is 0.1 microns.

Additional references

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● Wikipedia, eMedicine #1; #2

End of Penis and scrotum > Infectious disorders > Lymphogranuloma venereum

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