[Lymphogranuloma venereum]

Lymphogranuloma venereum (LGV) or Nicolas-Favre disease is a sexually transmitted disease (STD) which occurs throughout Africa and mostly affects men. The true prevalence of LGV in tropical countries is not known. The most prominent clinical signs of LGV are inguinal and rectal syndrome, with the inguinal syndrome being the most frequent sign in men. Inguinal adenitis is mostly unilateral. The glands are at first hard and tender but soon become matted together. Fistulae may develop within the glands in swollen areas, some of which break through the reddish-purple overlying skin in chronic cases. The groin fold often separates the glands into upper and lower groups. The rectal syndrome is not common in African patients. It is the second most common sign of LGV, but is not specific to this STD. Fluctuant, discharging, painful and often unilateral adenitis with or without a history of primary ulcerative lesion is most likely to be confused with cat-scratch fever, pyrogenic infections, tuberculosis, adenitis caused by syphilis, mycetoma and histoplasmosis. The diagnosis of LGV should be confirmed by culture, which can be used to isolate the L strain of Chlamydia trachomatis or by PCR (polymerase chain reaction). The histological features of adenitis and rectal lesions are not specific. Tetracycline antibiotics are the most effective treatment for LGV.