05-04-2008, 10:29 AM
A- Chlamydia trachomatis
Lymphogranuloma venereum
-papule or herpetiform ulcer on the genitalia, the pain is due to LNs enlargment....
-"Nodes are palpated in the inguinal and femoral areas"; this is the Groove sign: LNs to both sides of the inguinal ligament and the other typical signs are the Constitutional symptoms, such as fever, chills, malaise, myalgias, and arthralgias, that are common in the second stage of the disease
Primary stage
The primary lesion is a small painless papule or herpetiform ulcer on the genitalia.
The lesion usually heals within a few days; therefore, it is identified in only approximately 10% of patients at initial presentation.
When present, lesions are found most typically on the glans penis or vaginal wall.
An associated mucopurulent discharge may be present affecting the urethra in men and the cervix in women.
Secondary stage
The most prominent physical finding at the secondary stage is unilateral painful inguinal lymphadenopathy.
Bilateral lymphadenopathy occurs in fewer than one third of patients.
The nodes most commonly involved are the horizontal group of inguinal nodes; however, the vertical inguinal and femoral nodes also may be affected.
A characteristic physical finding, termed the Groove sign, occurs in approximately one third of patients. This sign is caused by enlargement of the nodes ''''above and below the inguinal ligament.''''''
One third of the inguinal buboes become fluctuant and rupture, while the remaining two thirds involute to form a hard nonsuppurative inguinal mass.
A 10:1 predominance of buboes exists in men compared to women who reach this stage of disease.
Women often have primary involvement of the rectum, vagina, cervix, or posterior urethra, which drain to the deep iliac or perirectal nodes; therefore, only 20-30% have the classic finding of inguinal lymphadenopathy.
Tertiary stage
Physical findings at the tertiary stage include proctocolitis, perirectal abscess, fistulas, strictures, and hyperplasia of the intestinal and perirectal lymphatics (lymphorrhoids).
Chronic infection can result in extensive scarring with ischemia and tissue necrosis.
The end result can be esthiomene (elephantiasis of the female genitalia characterized by fibrotic labial thickening) in women or elephantiasis and deformation of the penis in men.
Lymphogranuloma venereum
-papule or herpetiform ulcer on the genitalia, the pain is due to LNs enlargment....
-"Nodes are palpated in the inguinal and femoral areas"; this is the Groove sign: LNs to both sides of the inguinal ligament and the other typical signs are the Constitutional symptoms, such as fever, chills, malaise, myalgias, and arthralgias, that are common in the second stage of the disease
Primary stage
The primary lesion is a small painless papule or herpetiform ulcer on the genitalia.
The lesion usually heals within a few days; therefore, it is identified in only approximately 10% of patients at initial presentation.
When present, lesions are found most typically on the glans penis or vaginal wall.
An associated mucopurulent discharge may be present affecting the urethra in men and the cervix in women.
Secondary stage
The most prominent physical finding at the secondary stage is unilateral painful inguinal lymphadenopathy.
Bilateral lymphadenopathy occurs in fewer than one third of patients.
The nodes most commonly involved are the horizontal group of inguinal nodes; however, the vertical inguinal and femoral nodes also may be affected.
A characteristic physical finding, termed the Groove sign, occurs in approximately one third of patients. This sign is caused by enlargement of the nodes ''''above and below the inguinal ligament.''''''
One third of the inguinal buboes become fluctuant and rupture, while the remaining two thirds involute to form a hard nonsuppurative inguinal mass.
A 10:1 predominance of buboes exists in men compared to women who reach this stage of disease.
Women often have primary involvement of the rectum, vagina, cervix, or posterior urethra, which drain to the deep iliac or perirectal nodes; therefore, only 20-30% have the classic finding of inguinal lymphadenopathy.
Tertiary stage
Physical findings at the tertiary stage include proctocolitis, perirectal abscess, fistulas, strictures, and hyperplasia of the intestinal and perirectal lymphatics (lymphorrhoids).
Chronic infection can result in extensive scarring with ischemia and tissue necrosis.
The end result can be esthiomene (elephantiasis of the female genitalia characterized by fibrotic labial thickening) in women or elephantiasis and deformation of the penis in men.