Venereal lymphogranuloma

Introduction to sexually transmitted lymphogranuloma Lymphogranuloma Venereum (LGV), also known as the fourth sexually transmitted disease, is one of the first sexually transmitted diseases. Its pathogen is recently considered to be Chlamydia trachomatis, mainly transmitted by sexual contact, occasionally transmitted by accident or accidental transmission, and has genital Complications such as acne, regional lymphadenopathy, advanced elephantiasis and rectal stenosis have been extensively developed due to chemotherapy, and the disease is now rare. The pathogen of mycosis lymphogranuloma is the three serotypes of L1, L2 and L3 among the 15 serotypes of Chlamydia trachomatis. The L-form has a stronger invasiveness than other serotypes. Proper use of condoms can be a preventive effect. Continuously improve the level of health, strengthen health education, and avoid extramarital sexual contact, in order to truly prevent sexually transmitted lymphogranuloma. basic knowledge Proportion of the disease: the infection rate of multi-sex partners is about 1%-5% Susceptible people: people with unclean sex history Mode of transmission: sexual contact spread Complications: sexually transmitted diseases

Causes of sexually transmitted lymphogranuloma

Lymphogranuloma Venereum (LGV), also known as the fourth sexually transmitted disease, is one of the first sexually transmitted diseases. Its pathogen was recently considered to be a subgroup of Chlamydia trachomatis, Chlamydiatrachomatis, whose serotype is L1~ L3, most of which is caused by L2, has the same life cycle as other chlamydia, which can proliferate in chicken embryo yolk sac. Some strains can cause chicken embryos to die quickly and grow in tissues or cell culture. Inclusion of glycogen-containing inclusion bodies in the cytoplasm of infected cells, the susceptibility of cells to LGV, not enhanced by the pretreatment of DEAE-dextran, three serotypes of L1, L2 and L3 They have cross-antigens with trachoma varieties D and E. Recently, chlamydia causing proctitis has been found to have non-LGV strains, especially in male homosexuals. Recently, Ia, Da, L2a, D have been identified due to the development of monoclonal antibody technology. , I and other serotypes have been found in homosexual men, special types (D, G, L1, L2) are associated with rectal infections.

LGV has heat-labile endotoxin, heat-resistant and heat-labile antigens, and the heat antigen is not destroyed by heating at 100 ° C. It is an antigen shared with Chlamydia psittaci, and LGV is injected into the brain of mice or monkeys. It can cause meningitis in animals, and it is not infected in the brain of inoculated birds.

After infection with LGV, complement-binding antibodies appear in the serum. Humans are the only natural host of the disease, which invades the skin and lymph nodes. The serotype of LGV is more invasive, causing more systemic diseases, unlike other Chlamydia trachomatis serotypes. In the mucosa, LGV pathogens can invade macrophages, and cell-mediated immunity and humoral immunity can limit but not completely eliminate the spread of local and systemic infections, even in the late stages of isolation of pathogens from infected tissues.

The pathogen of the disease is less resistant, and the general disinfectant can kill it. It survives for 2-3 days in vitro, and can be inactivated in 1 minute at 50 ° C, 30 minutes or 90 ° C - 100 ° C, 70% ethanol, 2% come to Su, 2% chloramine, UV and dry room temperature can not survive.

It is mainly transmitted through sexual contact, occasionally through pollution or accidental transmission of the experiment, complications such as genital ulcer, local lymphadenopathy, advanced elephantiasis and rectal stenosis. Due to extensive development of chemotherapy, the disease is now rare.

Mainly sexually transmitted infections, the peak incidence of LGV is consistent with the peak age of sexual activity 20-30 years old. The infection rate of this disease is much lower than that of gonorrhea and syphilis. Early males are more common than females, while females often show up with late complications. .

Pathological change

Early sores: changes for non-specific inflammation.

Lymph nodes: There are special pathological changes - granuloma with stellate abscess formation, necrotic tissue in the center, polymorphonuclear leukocytes and macrophage infiltration, surrounding the perioid cells, visible plasma cells, abscess triangle or The quadrilateral shape has a reference significance for diagnosis, and the latter is extensive fibrosis and large area coagulative necrosis.

Latent period: the first sin on the genitals, the diameter is about 0.3-0.6cm, no pain, after the erosion, ulceration into the first sore ulcer, often single, sometimes 2-3, about 1 week to start healing, no Leave scars.

Mid-term period: 1-4 weeks after the onset of the initial sore, unilateral or bilateral inguinal lymph nodes become swollen, become transverse pox. Such scorpions began to occur in isolation and later merged into a group. The texture began to be hard, and after a few weeks, it became soft and ruptured, forming a rash.

Late stage: 1-2 years of onset, due to the above-mentioned lesions caused by the obstruction of lymphatic reflux, male patients will appear penis and scrotum like skin swelling, local swelling, rough skin and hard. There is a rectal stenosis in homosexuals.

research process

In the 1930s, researchers took smears from the lesions and extracted liquid from the brain, spinal cord, testis, and lymph glands of experimental animals for smear staining. They all found deep blue bodies and treated with acetone. After a minute, it is still a pale blue that does not fade (the blue particles seen in normal tissue cells can be decolored after treatment with acetone), and the diameter of the pathogen is about 0.3 m by the method of passing through the fire-cotton film. The pathogen was observed to be spherical and 400 mum in diameter.

In the 1960s, the pathogen was studied by electron microscopy and cell culture. The results showed that the corpuscle had a little similarity with the traits of trachomatis and parrot fever, but it was different from the typical virus. For broad-spectrum antibiotics and sulfonamides. Sensitive, it has been identified as a subgroup of Chlamydia trachomatis, whose serotype is L1~L3, most of which is caused by L2. Like other Chlamydia, it has a unique life cycle and can be used in chicken embryos. Proliferation in the yolk sac, some strains can cause the chicken embryo to die quickly, and can also grow in tissue or cell culture. The glycogen-containing inclusion bodies appear in the cytoplasm of the infected cells, and the susceptibility of the cells to LGV is not caused. Whether the cells are enhanced by DEAE-pretreatment of dextran, three serotypes of L1, L2 and L3, which have cross-antigens with trachoma variants D and E. Recently, chlamydia causing proctitis has been found to have non-LGV strains, especially Among male homosexuals, serotypes such as Ia, Da, L2a, D, I have also been identified due to the development of monoclonal antibody technology, and have been found in gay men, special types (D, G, L1, Type L2) is associated with rectal infection.

LGV has heat-labile endotoxin, heat-resistant and heat-labile antigens, and the heat antigen is not destroyed by heating at 100 ° C. It is an antigen shared with Chlamydia psittaci, and LGV is injected into the brain of mice or monkeys. It can cause meningitis in animals, and it is not infected in the brain of inoculated birds.

After infection with LGV, complement-binding antibodies appear in the serum. Humans are the only natural host of the disease, which invades the skin and lymph nodes. The serotype of LGV is more invasive, causing more systemic diseases, unlike other Chlamydia trachomatis serotypes. In the mucosa, LGV pathogens can invade macrophages, and cell-mediated immunity and humoral immunity can limit but not completely eliminate the spread of local and systemic infections, even in the late stages of isolation of pathogens from infected tissues.

The pathogen of the disease is less resistant, and the general disinfectant can kill it. It survives for 2-3 days in vitro, and can be inactivated in 1 minute at 50 ° C, 30 minutes or 90 ° C - 100 ° C, 70% ethanol, 2% come to Su, 2% chloramine, UV and dry room temperature can not survive.

Sexually transmitted lymphogranuloma prevention

Precaution

Sexually transmitted lymphogranuloma can be avoided by the following precautions:

1, sexually transmitted lymphogranuloma mainly through sexual intercourse, cleansing is the best means to stay away from the disease.

2, the diagnosis of this disease often requires a number of laboratory tests, such as complement fixation test, immunofluorescence test, pathogen culture, and even biopsy, so once you suspect the disease, you must go to a regular hospital, so as not to delay treatment.

3, sexually transmitted lymphogranuloma develops to different stages, often confused with certain diseases. Such as early easy to be confused with early syphilis, genital herpes, soft chancre and other diseases; advanced often need to be differentiated from malignant tumors, tuberculosis, mononucleosis and other diseases. Therefore, after the illness, you must go to a regular hospital for a system check to avoid diagnosis and treatment errors.

4, after suffering from this disease must be treated early, it is possible to avoid multiple organ stenosis that often requires surgery in the late stage.

Sexually transmitted lymphogranuloma complications Complications

1. The genital elephant is swollen.

2. Rectal stenosis.

3. A small number of patients can be cancerous in the periphery of the anus.

Symptoms of sexually transmitted lymphogranuloma Common symptoms Inguinal lymphadenopathy Rectal stenosis, erythema nodules, hemorrhoids, hepatosplenomegaly, granuloma, swelling in the groin or closed hole

First, the incubation period: there is a history of unclean sexual intercourse, the incubation period is 7-10 days.

Second, early symptoms: early sores occur in male penile body, glans, coronary sulcus and foreskin, female vaginal vestibule, labia minora, vaginal opening, 5-6mm blister around the urethral orifice, ulcers, often single, sometimes Several, no obvious symptoms, not healed for a few days, no scars after the recovery, can also occur in the perianal, oral and so on.

Third, the mid-term symptoms, 1-4 weeks after the onset of the first sore, male inguinal lymphadenopathy (fourth sexually transmitted disease), pain, tenderness, adhesion, fusion, visible "groove sign" (inguinal ligament will enlarge the lymph nodes Separate, the skin appears in a groove-like shape. After a few weeks, the lymph nodes soften and rupture, and the yellow serum or bloody pus is discharged, forming a multiple fistula, which is like a "watering bottle-like", which is not cured for several months, leaving scars after the healing. Female acne occurs in the lower part of the vagina, refluxing to the sacral and rectal lymph nodes, causing lymphadenitis, proctitis, clinical blood in the stool, mucus and blood, abdominal pain, diarrhea, urgency and back pain, forming perianal swelling, fistula, Rectal stenosis and size of the labia are like skin swelling.

Fourth, advanced symptoms: after several years or decades, long-term recurrent inguinal lymphatic (knot) inflammation can cause genital elephantiasis, rectal stenosis and so on.

V. Systemic symptoms: swollen lymph nodes may have chills, high fever, joint pain, fatigue and hepatosplenomegaly and other systemic symptoms, as well as erythema multiforme, nodular erythema, conjunctivitis, aseptic arthritis , pseudo meningitis.

Examination of sexually transmitted lymphogranuloma

The diagnosis of this disease depends on the isolation of pathogens and serological examination. Genetic diagnosis is very important for establishing the disease.

1. Chlamydia culture: The pus in the fluctuating lymph nodes is inoculated into the brain tissue of the mouse or the chicken embryo yolk sac or McCoy cells (the cells have replaced the former two) to isolate the pathogen, but the sensitivity is not high.

2. Serological examination: The most helpful serological method at present is the complement fixation test. This test is very sensitive. It is positive after 4 weeks of infection. It is diagnostic when high level antibody (1:64) is found, but this The test is not specific for sexually transmitted lymphogranuloma and should be analyzed in combination with clinical analysis.

3. Micro-immunofluorescence assay and enzyme-linked immunosorbent assay have also been applied. They have certain sensitivity and specificity and can be used for identification and screening.

4. Genetic diagnosis.

Diagnosis and diagnosis of sexually transmitted lymphogranuloma

Diagnose based on

1. There is a history of unclean sexual intercourse, and the incubation period is 7-10 days.

2. Early genital vesicles, erosions and ulcers, inguinal lymph nodes can be seen after 1-4 weeks, men have "grooves", most of the fistulas are like "spray-like", there are scars after the feces, women can occur around the rectum Inflammation, late appearance of elephantiasis and rectal stenosis.

3. When lymph nodes occur, there may be systemic symptoms such as chills, high fever and joint pain.

4. Pathological changes have a star-shaped abscess in the lymph nodes.

5. The complement fixation test was positive after 4 weeks of infection, with a titer of 1:64 or more.

6. Tissue culture, chlamydia (L1, L2 and L3 serotypes) can be isolated.

7. PCR detection of Chlamydia DNA positive.

Differential diagnosis

1. Genital herpes: This disease is differentiated from sexually transmitted lymphogranuloma.

2. Hard squat: syphilitic inguinal lymph nodes are hard, not painful, not ruptured, and can be found to distinguish syphilis.

3. Soft chancre: inguinal lymphadenitis is more painful, more pus, pathogen examination is Haemophilus ducrei.

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