What Is Lymphogranuloma Venereum?

Lymphogranuloma, also known as the fourth sexually transmitted disease, is one of the first generations of sexually transmitted diseases. The pathogen is recently considered to be a subgroup of Chlamydia trachomatis. Its serotype is L1 ~ L3, most of which are caused by L2, and other chlamydia. Similarly, there is a unique life cycle that can multiply in the yolk sac of chicken embryos, and some strains can make chicken embryos die quickly. Can also grow in tissue or cell culture. Glycogen-containing inclusion bodies appear in the cytoplasm of infected cells. The susceptibility of cells to LGV is not enhanced by whether cells are pretreated with DEAE-dextran. There are three serotypes of L1, L2 and L3, which have cross antigens with trachoma variants D and E.

Lymphatic granuloma

Definition of sexual lymphogranuloma

Clinical manifestations of lymphatic granuloma

I. Incubation period: There is an unclean couple's life history, the incubation period is 7-10 days.

Second, early symptoms: the first sore mostly occurs in the male penis, glans, coronary sulcus and foreskin, female vaginal vestibule, labia minora, vaginal opening, 5-6mm extremely small vesicles, ulcers around the urethral opening, often single, sometimes Several, no obvious symptoms, healed for several days, no scars left after healing. Can also occur in the perianal area, oral cavity and other places.

3. Symptoms in the middle period. After 1-4 weeks of primary sores, male inguinal lymphadenopathy (fourth sexually transmitted diaphragmatic disease), pain, tenderness, adhesion, fusion, visible "groove sign" (inguinal ligament up and down the enlarged lymph node Separate, the skin appears grooved). After several weeks, the lymph nodes softened and ruptured, and the yellow serous fluid or bloody pus was discharged, forming multiple fistulas, like a "spouting bottle", which did not heal for several months, leaving scars after healing. Female first sores often occur in the lower part of the vagina and return to the iliac and rectal lymph nodes, causing lymphadenitis and proctitis in the area. Clinically, there may be blood in the stool, mucus and blood in the stool, abdominal pain, diarrhea, acute aftermath and low back pain, forming perianal swelling, fistula, Rectal stenosis and labia majora.

Fourth, advanced symptoms: years or decades later, long-term repetitive inguinal lymphadenitis can cause elephantiasis and rectal stenosis.

5. Systemic symptoms: There may be chills, high fever, joint pain, fatigue, and hepatosplenomegaly during the lymphadenopathy and pus. There are also erythema polymorpha, nodular erythema, conjunctivitis, aseptic arthritis, and pseudomeningitis.

Lymphogranuloma Prevention

Lymphogranuloma can be avoided with the following precautions:

1. Sexual lymphogranuloma is mainly transmitted through sexual intercourse. Cleaning yourself is the best way to stay away from the disease.

2. The diagnosis of this disease often requires multiple laboratory tests, such as complement binding test, immunofluorescence test, pathogen culture, and even biopsy. Therefore, if you suspect the disease, you should go to a regular hospital to avoid delay in treatment.

3. Sexual lymphogranuloma develops to different stages and is often easily confused with certain diseases. For example, it is easy to be confused with diseases such as early syphilis, genital herpes, and soft chancre; it is often necessary to distinguish it from malignant tumors, tuberculosis, and mononucleosis. Therefore, you must go to a regular hospital for a system check after illness to avoid diagnostic and treatment errors.

4. It is necessary to treat early after suffering from this disease, in order to avoid the multiple organ stenosis that often requires surgery in the late stage.

Reminder: The following treatment methods are for reference only, all treatments must be prescribed by a doctor

Western medicine treatment of sexual lymphogranuloma

The sooner the treatment of venereal lymphogranuloma is, the better the systemic symptoms can disappear quickly after the initial treatment, but the healing of local lymphadenopathy is limited. Treatment is difficult after severe complications in the later stages, and often require surgery. Treatment methods include systemic treatment and local treatment. Systemic treatment is mainly the timely application of antibacterial drugs.

Commonly used medicines are:

1. Doxycycline: 0.1g each time, twice a day for 21 days.

2. Tetracycline: 500mg, 4 times a day for 21-28 days. Tetracycline is effective in the acute phase and can stop development in the middle period or heal after a few weeks.

3. Erythromycin: 500mg, 4 times a day for 14-21 days. Pregnant women and children can choose erythromycin.

4. Compound Xinnuoming: start 2 times a day, 2g each time, 1g each time, even for 3 weeks. The alternative therapy is doxycycline.

5. Sulfadiazole, the first dose of 4.0 grams, and then 1.0 grams every 6 hours, for 3 weeks.

Advanced patients can use hormonal or antibiotics combined with corticosteroids (prednisone), which can reduce lower abdominal pain, reduce rectal secretions and reduce fibrosis.

For local treatment, the vulva can be washed with potassium permanganate water externally, and 10% fishstone fat ointment or erythromycin and sulfonamide ointment can be applied to those who have not purged. Those with softened lymph nodes (abscesses) can pierce the lesion to attract the pus and inject the sulfa solution into the pus cavity. Do not perform an incision, because it is not easy to heal. For those who have been purulent, puncture and pus may be taken, and antibiotics may be injected. Drainage may not be opened to prevent fistula formation and adverse healing. For those with deep ulcers, surgical treatment is available to remove necrotic lymph nodes. For those who have vaginal or rectal stenosis in the late stage, dilation must be performed regularly. Severe rectal stenosis requires a rectal resection. Foreskin and scrotal rubber swelling can also be removed by surgery. Local lesions can also be treated with physical therapy such as ultrasound, ultraviolet, infrared, or X-rays.

Chinese medicine treatment of sexual lymphogranuloma

According to clinical symptoms, traditional Chinese medicine often divides the disease into three types of treatments, namely, damp-heat syndrome, which is mainly seen in the early stages of the disease; sputum accumulation syndrome, which is seen in the middle of the disease; liver and kidney deficiency syndrome, which is seen in the later stages of the disease.

TCM etiology and pathogenesis of lymphogranuloma

(1) Beginning with unclean sexual intercourse poisoning, moist heat betting, interfering with genital area, fighting with qi and blood, forming fish mouth or stool poison.

(2) After the heat poisoning, the poison heat gathers the liver meridian, the liver qi stagnates, the qi stagnates the spleen, the spleen loses health, the sputum is endogenous, and it stagnates in the femoral palate to form the diaphragm.

(3) In the later stage of the disease, the liver stagnates and dispels fire, hurts the kidney and yin, and if the prolonged period of time, the pus drips and does not close for a long time.

Lymphogranuloma of venereal disease with damp heat syndrome shows papules or blisters on the genitals, or surface erosion with exudate. May be accompanied by fever, poor appetite, red tongue, yellow tongue coating, and slippery pulses. This is because the damp and hot poisoning invades the liver veins, and the liver veins and meridians run around the genitals. Therefore, genital pimples or blisters, or surface erosion, exudation, accompanied by fever, poor appetite, red tongue, yellow tongue coating, and veins. The slippage numbers are the clinical manifestations of damp heat pinch. Treatment should be Qingre Lishi detoxification. The prescriptions of Ermiao San are commonly added and subtracted: Cork 10g, Cangzhu 10g, Coix seed 30g, Psyllium seed 10g, Poria cocos 30g, and dandelion 30g. The prescriptions of Huangbai and Atractylodes macrocephala are heat-clearing and damp-drying. Coix seed and psyllium are combined with the main medicines to clear away heat and dampness, and Poria cocos and dandelion clear heat and detoxify. For those who are hot and humid, 10 g of gentian can be added. For those who are poisonous and hot, 10 g of wild chrysanthemum can be added.

The accumulation of phlegm and poisonous symptoms of venereal lymphogranuloma, swollen inguinal lymph nodes, connected skin and nucleus, and some tuberculosis fused with each other, pushed forward, conscious pain, red tongue, yellow tongue coating, slippery pulse strings. This is caused by accumulation of phlegm and qi and blood stasis. Treatment should be Shugan Jieyu, Ruanjian Sanjie. Recipe Yixiaoyao Sanhe Xiaozhan Pill Addition and Subtraction: Bupleurum 10g, Angelica 10g, Baiji 10g, Atractylodes 10g, Poria 20g, Black Ginseng 20g, Calcined Oyster 30g (Fried First), Fritillaria Zinc 10g, Fragrant 10g Chen Peel 10g White Silkworm 10g Green Peel 10g Method Half Summer 10g licorice 6g. Fangzhong Bupleurum is used as the main medicine to relieve liver stagnation; Angelica sinensis, Paeonia lactifolia nourish blood and soften liver, Atractylodes chinensis, Poria spleen and spleen and dampness; Xuanshen, Calcined Oyster, Fritillaria cirrhosa, soft and firm; Xiangxiang, Chenpi, Baiji Silkworm, green skin, Pinellia ternata, and licorice all cooperate with the main medicines for regulating qi and reducing phlegm. If Yin deficiency, add 10g each of raw land and A. ginseng; for liver and fire, add 10g each of Huang Zhi and Qing Dai.

Liver and kidney deficiency syndrome, lymphogranuloma, symptoms of ulceration of the epidermal nucleus, unhealed for a long time, hot flashes, bone steaming, less complexion, mental burnout, dizziness, shortness of breath, hot hands, feet, red tongue, less moss, veins Break down. This is due to lack of liver and kidneys, caused by fiery fire. Treatment should nourish liver and kidney. The prescription of Liuwei Dihuang Pill is: Addition and Subtraction of Dihuang Dihuang 10g, Radix Dioscoreae 10g, Yam 10g, Alisma 10g, Poria 10g, Danpi 10g, Ophiopogon 10g, Radix Ginseng 10g, Diospermum 10g, Chenpi 10g, Licorice 10g. Fang Zhongshu Dihuang, Shanhuang, and Yam are the main medicines to nourish the liver and kidney yin; Zexie, Poria, Danpi are combined with the main medicine, and there is more than diarrhea. Licorice tones the spleen and stomach. If the pus is difficult to penetrate, add pangolin 10g; if poisonous and hot, add dandelion 10g.

For the treatment of STD lymphogranuloma by external medicine, according to its different clinical stages, different drugs are commonly used and different treatment methods are applied. Generally speaking, it is advisable to wash the affected area with medicinal solution in the early stage, and to dissolve and detoxify with ointment in the middle stage, and to saprophytic muscle in the later stage with elixir or ointment.

(1) In the early days, 30 g of purslane, 30 g of wild chrysanthemum, 30 g of cork, and 30 g of dandelion can be used. Once a day for 30 minutes.

(2) Huanglian ointment and Qianzhi ointment (common medicine for clearing heat and detoxifying, dispersing and dispersing swelling) can be applied externally in the medium term.

(3) In the later period, Jiuyidan and Wuwudan (for preparations containing mercury and commonly used to remove saprophytic muscles) can be used to rot, and the Shengjiyuhong cream can be used to grow muscle.

The application of proprietary Chinese medicines is the same as the application of traditional Chinese medicine decoctions, which need to be treated according to symptoms based on symptoms. The treatment in early, middle and late stages is different. In the early stage, the liver, gall, dampness and heat should be cleared, and in the middle stage, the heat and kidney should be nourished. Commonly used proprietary Chinese medicines are:

(1) Longdan Xiegan Wan functions to clear the liver and gallbladder, and can be used for early treatment. 6g per serving, 2 times a day. (2) Plum Blossom Tong Dan can clear heat and detoxify, which can be used for mid-term treatment. Take 10 capsules twice daily. (3) Liuwei Dihuang Pills can nourish liver and kidney, and can be used for later treatment. Take 10g each time, 2 times a day.

Common one-way prescription

(1) 10g of dandelion, 10g of wild chrysanthemum, 10g of sky sunflower seed, 10g of black ginseng, 10g of Fritillaria chuanxiong. Decoction, once a day. Function of clearing heat and detoxifying, soft and firm. ("Modern Chinese and Western Medical Dermatology")

(2) Stir-fried white silkworm 9g, angelica 9g, raw rhubarb 9g, licorice 4.5g, pangolin 4.5g, finely ground, and 9-12g of fasting wine. (Yang Dianxing and other "Practical Traditional Chinese Medicine STD")

(3) Nine-headed lion grass 3g, Chuan Fritillaria 9g, decoction. (Yang Dianxing and other "Practical Traditional Chinese Medicine STD")

(4) Liu Dan paste: Collect 5 kg of fresh willow leaves, boil it with water for 2 hours, remove the residue, and concentrate the filtrate to paste. Zhangdan 30g, plum slices 6g, realgar 10g, calcined keel 10g, catechin 10g, pearl 3g, light powder 6g, rosin 10g, calamine 10g, finely ground together, mix thoroughly with willow paste, and store in a bottle for later use. (Yang Dianxing and other "Practical Traditional Chinese Medicine STD")

(5) Fresh purple peel garlic 250g, fresh ginger 250g, washed with cold water, sliced, mixed into a sterilization container and smashed, add an appropriate amount of 95% alcohol, stir to make a paste, sealed, and immerse in a cool place for 3 to 5 hours , Filter with sterile gauze, ready to use.