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Genital infections – donovanosis and venereal lymphogranuloma

What is donovanosis?

Donovanosis is a chronic bacterial disease transmitted mainly through sexual contact and very rarely through domestic transmission. The causative agent is called Donovia granulomatous. It was first described in India in 1882. It is also called the “fifth venereal disease” and occurs predominantly in tropical countries.

The pathogenesis consists in the penetration of the pathogen through skin defects and the occurrence of an inflammatory reaction of the dermis and hypodermis.

What is the clinic of donovanosis?

The incubation period of the disease ranges from 3 days to 3 months. However, cases with an incubation period of several years have been described. The entrance door of infection in women is the labia minora, perineum, and anus, and in men – the glans penis, and foreskin. In rare cases, the mucous membrane of the nose and oral cavity is also the front door.

The initial skin change is a raised nodule-like lesion. Gradually, it turns into a painless ulcer 3-4 cm in size, bright red in color, emitting a meager serous-purulent secret with an unpleasant odor. The ulcer grows slowly around the periphery and may cover large areas of the skin.

The second stage of the disease is observed after a different long period without complaints. It is characterized by lymphonodulopathy in the groin, fever, fatigue, lack of appetite, and headache.

The third stage proceeds toward the decay of the affected organs. In homosexual men, it is more often manifested by a lesion of the colon – proctitis. The disintegration of the affected tissues in the genital area can proceed without changing the size of the regional lymph nodes and the general condition.

The diagnosis is made by histological examination. Treatment is with antibiotics.

What is lymphogranuloma venereum?

Lymphogranuloma venereum is a sexually transmitted infectious disease that occurs with an increase in lymph nodes. The causative agent is Chlamydia trachomatis. Widespread throughout the world, but especially common in tropical countries. It is also called the “fourth venereal disease”.

The entrance door to the disease is damaged skin and mucous membranes of the genitourinary tract. After the initial intracellular reproduction of the pathogen by the lymphatic route, it reaches the lymph nodes and causes their inflammation.

What is the clinical picture of lymphogranuloma venereum?

The incubation period of the disease is from 5 to 21 days. It takes place in three stages:

The initial stage – a rash of small painful papules appears on the entrance doors (genitals), accompanied by urethritis and urination disorders;
The stage of painful lymphadenopathy – abscessing lesions covering the lymph nodes, most often appears unilaterally. The general condition of the patient is affected
Sclerotic stage – proceeds with strictures (narrowings) and fistulas – communication of abscessing lymph nodes with the surface of the skin or other organs.

The diagnosis of the disease is made on the basis of the clinical picture and cultural and histological examination. Both partners are treated with antibiotics. The prognosis is favorable with timely treatment. In chronically recurrent cases, an association with anorectal carcinomas has been observed.

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