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Seminar on inguinal bubo syndrome.yih
1. Seminar on inguinal bubo
syndrome
By Yihienew Mequanint (clinical II student)
Adama science and technology university
Asella, Arsi, Ethiopia
1,13,2004E.C
4. Inguinal Bubo
• Swelling of inguinal lymph nodes as a result of STIs
• a painful, often fluctuant, swelling of the
lymph nodes in the inguinal region (groin)
• The common sexually transmitted pathogens
that are associated with inguinal bubo include
– C. trachomatis (serovar L1, L2 and L3): LGV:
– H. ducreyi: Chancroid
– K.Granulomatis (Calymmatobacterium granulomatis):
Granuloma ingunale
– T.pallidum: syphilis
• Rarely systemic symptoms except LGV
4
5. Lymphogranuloma Venereum
• 3 stages
– Primary stage(genital ulcer)
– Secondary satge(lymphadenitis and lymphangitis)
– Third stage(fibrosis and edema-genital elephantiasis)
6. Lymphogranuloma Venereum
• Early in the course of the disease, a vesicopustular eruption
may go undetected. This transient, primary, painless genital
or anorectal ulcer develops after 2-5 days.
• Multiple, large, confluent inguinal nodes develop 2 to 3
weeks later and eventually suppurate. Acute infection may
cause generalized systemic symptoms
• With inguinal (and genital) ulceration, lymphedema, and
secondary bilateral invasion, excruciating conditions arise.
Sitting or walking may cause pain
• During the inguinal bubo phase, the groin is exquisitely
tender
• LGV responds to 3-week regimens of doxycycline or
erythromycin in the usual doses
8. Chancroid (Soft Chancre)
• suppurative inguinal adenopathy with painful
ulcers is pathognomonic
• Culture positive for H ducreyi
• The early chancroid lesion is a vesicopustule
• Later, it degenerates into a saucer-shaped ragged
ulcer circumscribed by an inflammatory wheal
• Typically, the lesion is very tender and produces a
heavy, foul discharge that is contagious
10. Granuloma Inguinale (Donovanosis)
• Essentials of Diagnosis;
– chronic ulcerative granulomatous disease that usually
develops in the perineum and inguinal regions
– Donovan bodies revealed by Wright's or Giemsa's
stain
a painless, "beefy-red ulcer" with a characteristic
rolled edge of granulation tissue. The painless genital
ulcers can be mistaken for syphilis.
In contrast to syphilitic genital ulcers, inguinal
lymphadenopathy is generally absent
12. Syphilis
• Sometimes T. pallidum can be a cause of
inguinal lymphadenopthy
– unlike the other causes, it doesn't generally produce necrosis
and abscess collection in the lymph nodes.
– In conditions where the clinical examination doesn't reveal a
fluctuant bubo, syphilis should be additionally considered
and treated accordingly
– Surgical incisions are contraindicated and the pus should only
be aspirated using a hypodermic needle
– NB hard chancre is painless, non-exudative, hard (indurated) edge, unlike soft
chancre
12
14. Inguinal Bubo Flow Chart
• Men affected more than females
• Common predisposing factor for the spread of
HIV
• Complications:
– Abscess formation and PID
– Lymphatic obstruction
– Stenosis and Infertility
14
15. complains of inguinal swelling
Take history and Examine
Educate on RR
Inguinal/femoral No No Offer HCT
Other
bubo(s) present? STIs Condom use
Yes Yes
Ulcer(s) present?
Yes Use appropriate flowchart
No
Rx LGV, chancroid, GI
•Educate on RR Use GU
•Provide condoms flowchart
•Partner management
•Offer HIV testing
15
•Advise to return in 7days
Doxycycline 100 mg twice daily orally should be given for 21 days according to tolerance. If disease persists, the course should be repeated. An alternative regimen is erythromycin 500 mg orally 4 times daily for 21 days. Large lymph nodes should be aspirated to avoid chronic drainage. Surgical excision of scarred areas may be necessary.
(CDC) Recommended regimen—(a) azithromycin 1 g orally once; (b) ceftriaxone 250 mg intramuscularly (IM) as a single dose; (c) erythromycin base 500 mg orally 3 times daily for 7 days; and (d) ciprofloxacin 500 mg orally twice daily for 3 days. Fluctuant lymph nodes may need to be aspirated through normal adjacent skin. Incision and drainage of the nodes is not recommended because it will delay healing. Chancroid is a reportable disease. NB LGV is also reportable
The disease is almost nonexistent in the United States. It is most common in India, Brazil, the West Indies, some South Pacific islands, and parts of Australia, China, and Africa. The causative organism is Calymmatobacteriumgranulomatis (Donovan body). Donovan bodies are bacteria encapsulated in mononuclear leukocytes. Transmission is via coitus, and the incubation period is 8–12 weeks. NB IP for genital ulcer in LGV and chancroid is 2-5 days. Syphilis 3wks. Note for LGV buboes occur after 2to 3wks. Healing is very slow, and satellite ulcers may unite to form a large lesion. When smears are negative, a biopsy specimen should be taken. Biopsy of the lesion generally shows granulation tissue infiltrated by plasma cells and scattered large macrophages with rod-shaped cytoplasmic inclusion bodies (Mikulicz cells). Pseudoepitheliomatous hyperplasia often is seen at the margin of the ulcer.
