Painful Penile Lesions and Groin Swelling

• Published in: The Clinical Advisor : For Nurse Practitioners 2018-11, Vol.21 (11), p.47-56
• Main Authors: Mwanda, Alice O, Conner-Warren, Rhonda
• Format: Article
• Language: English
• Subjects: Bacteria; Chlamydia; Constipation; Fever; Infections; Inflammation; Lymphatic system; Pain; Patients; Sexually transmitted diseases; STD; Ulcers; Womens health
• ISSN: 1524-7317

Clinical guidelines recommend that clinicians consider LGV in the differential diagnosis when sexually active patients present with inguinal or femoral lymphadenopathy, buboes, or proctitis.2 The name "lymphogranuloma venereum" comes from Latin words that mean swelling of granular tissue in the lymph nodes resulting from sexual intercourse with an infected partner.3 LGV was considered rare before 2003; however, since that time large outbreaks have been reported in Western Europe and North America primarily in men having sex with men.4 LGV is acquired through sexual contact with contaminated exudates that contain an invasive form of Chlamydia trachomatis serovars L1, L2, and L3 from a person with active lesion(s).1 From an epidemiologic perspective, LGV has been seen in warm climates in parts of Africa, Asia, South America, and the Caribbean.5 HIV is recognized as a risk factor for LGV.6'7 Testing for HIV and other sexually transmitted infections (STIs) is essential for individuals with a diagnosis of LGV LGV is caused by C trachomatis bacteria penetrating tiny skin abrasions and mucous membrane tears.8 The bacteria spread to genital and rectal lymphatic tissue, causing marked inflammation, necrosis, buboes, abscesses on inguinal lymph nodes, and infection of surrounding tissues. Rectal strictures, perirectal abscesses, and fistulas represent the severe morbidity associated with LGV8 In female patients or men who have sex with men, signs and symptoms of more invasive infection are typically present; these include proctolitis (including mucoid and/or hemorrhagic rectal discharge), anal pain, constipation or painful bowel movements, fever, and/or ulcers and lymphadenopathy without proctitis.10,12 The fibrosis caused by chronic inflammation in the tertiary stage can lead to lymphatic obstruction and elephantitis of the genital area; this finding is usually seen in women.11 Case Patient Treatment and Follow-Up Goals of treatment of LGV are to cure the disease and to prevent ongoing tissue scarring that may cause additional complications. The patient was started on a treatment regimen of doxycyline 100 mg twice daily for 21 days (the recommended treatment for LGV) and acyclovir 400 mg 3 times a day for 5 days (for the new HSV-1 lesion).2 The patient was provided with discharge instructions from the Centers for Disease Control and Prevention on STIs including LGV, herpes, and chlamydia; he was instructed to notify his partner of the multiple diagnoses. Parra-Sánc