Lymphogranuloma inguinale

　　It is a communicable disease caused by unclean sexual contact, mainly transmitted through sexual contact, and occasionally infected by contaminated objects (such as primary lesions such as pustules, ulcers, and ulcerative lymph nodes on the skin and mucosa of the genital organs, and rectal ulcer effluents). The primary focus in the genital area of the disease is generally not discovered due to mild symptoms, until the inguinal lymph nodes or female patients in the late stage appear with symptoms of scrotum, anus, and rectal abscesses, ulcers, and stricture syndrome.

　　The main complications of lymphogranuloma venereum include the following: 1. Genital elephantiasis. 2. Rectal stricture. 3. Some patients may develop secondary cancer around the anal margin. It is necessary to treat it in a timely manner.

　　I. Early symptoms

　　1. About 1/3 to 1/2 of male patients have primary lesions. Initially, they are very small blisters, vesicles, or ulcerative erosions. Males are more common on the shaft of the penis, glans, coronal sulcus, prepuce, and urethra. Females occur in the vestibule, labial frenulum, clitoral minora, vaginal orifice, and periorificial area. The skin lesions are often solitary, sometimes several, with regular edges, surrounded by erythema, without obvious symptoms, not painful or itchy, often neglected, healing spontaneously in 1-3 weeks without scarring. Homosexuals or sexual inversion may manifest as hemorrhagic proctitis (purulent discharge and intestinal bleeding). Direct examination may show inflammation, congestion, localized desquamation, or granulation tissue of the rectal mucosa, which may lead to perirectal abscesses, rectovaginal fistulas, and rectal stricture.

　　2. At the same time as the lymphadenopathic lesions occur, systemic symptoms may also occur, such as fever, night sweats, malaise, weight loss, headache, migratory joint pain, polyarthritis, myalgia, enlargement of the liver and spleen, pseudomeningitis, and conjunctivitis. Skin manifestations include erythema multiforme, nodular erythema, scarlatiniform rash, papulovesicular lesions, and photosensitivity.

　　II. Late symptoms

　　1. The time from early to late stage is 1 to 2 years, and some may last for several years, mainly manifested as genital elephantiasis and anal-rectal syndrome.

　　2. The genital elephantiasis of lymphogranuloma venereum is a severe damage that occurs in the late stage of the disease. Chronic lymphangitis leads to elephantiasis of the labia, penis, and scrotum, with verrucous proliferation and polypoid growth on the skin surface, which may form rectovaginal or urethral fistulas, leading to destructive ulcers and scars.

　　3. The anal-rectal syndrome of lymphogranuloma venereum is a common complication of the disease. Both women and male homosexuals can develop a genital-anal-rectal syndrome. The early stage of this syndrome is caused by direct inoculation or ulceration of perirectal lymph nodes, leading to edema, hemorrhage, and desquamation of the anal and rectal mucosa, and diarrhea, tenesmus, abdominal pain, and alternating constipation. Due to progressive stricture, constipation and abdominal pain may occur. In the late stage, there may be tubular or annular rectal stricture near the anal ring, as well as rectovaginal and/or anal fistulas, and perirectal abscesses. The penis, scrotum, and vulva may develop rubbery swelling and ulcers. Oral-genital sexual contact may lead to ulcerative glossitis and lymphadenopathy. Canceration may also occur in the late stage.

　　1, Firstly:It is still important to practice normative sexual behavior. Lymphogranuloma venereum is mainly transmitted through sexual contact, although the incidence rate in China is not high, but if promiscuity is not eliminated and casual sexual encounters are made, there is still a possibility of infection.

　　2, Secondly:Preventing contact transmission is also very important: do not bathe in bath tubs in public bathhouses, try not to use public toilet seats, do not borrow others' underwear or swimsuits, wash hands before using the toilet, and these are issues that should be paid attention to in daily life. Clean the external genitalia daily, wash your own underwear separately, and do not share towels, basins, and other items with others.

　　3, Finally:Do not have sexual intercourse after the spouse is infected and during treatment.

　　1, Chlamydia culture:The pus from fluctuating lymph nodes can be inoculated into the brain tissue of mice or the yolk sac of chicken embryos or McCoy cells (which have replaced the former two), and the pathogen can be isolated, but the sensitivity is not high.

　　2, Serological examination:The most helpful serological method at present is the complement fixation test. This test is very sensitive and a positive result appears after 4 weeks of infection. It is of diagnostic significance when high levels of antibodies (1:64) are detected, but this test is not specific for lymphogranuloma venereum and clinical analysis should be combined.

　　3, Minimally fluorescent antibody test:And enzyme-linked immunosorbent assays have also been applied, which have certain sensitivity and specificity and can be used for identification and screening.

　　Dietary principles: high calorie, high vitamin, low-fat diet. During this period, patients' conditions may start to improve and they may have an appetite. They can be nourished according to the principles of cold and hot, deficiency and excess in traditional Chinese medicine, and the four properties and five flavors of food. Foods that invigorate the spleen and regulate the qi, benefit the lung and kidney should be chosen, and spicy foods, fish, shrimp, crab, geese, and other seafood that are easy to produce dampness, phlegm, and heat should be avoided. Recommended foods include soybean soup, lotus root powder, mung bean noodles, eggs, vegetable juice, etc.; side dishes include olives, lemons, figs, water chestnuts, yam, winter melon, radish, etc.

　　First, Western Medicine Treatment

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

　　2, Tetracycline: 500mg, four times a day, for 21-28 days. Tetracycline is effective in the acute stage, can stop the progression of the disease, or recover within a few weeks.

　　3, Erythromycin: 500mg, four times a day, for 14-21 days. Erythromycin can be used for pregnant women and children.

　　4, Sulfamethoxazole Trimethoprim: Start with 2g twice a day, then 1g each time, for a total of 3 weeks. Doxycycline is an alternative treatment.

　　5. Sulfathiazole, initial dose of 4.0 grams, then 1.0 gram every 6 hours, for 3 weeks.

　　2. Traditional Chinese medicine therapy

　　1. The etiology and pathogenesis of sexually transmitted lymphogranuloma venereum in traditional Chinese medicine:

　　(1) Initially, it is caused by unclean sexual contact and infection, with damp-heat descending, obstructing the genital area, fighting with Qi and blood, forming fish mouth or stool toxin.

　　(2) After the heat-toxin stage, toxic heat accumulates in the liver meridian, causing liver Qi stagnation, Qi stagnation damages the spleen, the spleen loses its healthy function, internal phlegm-heat accumulates, and masses form in the hip and thigh, resulting in transverse abscess.

　　(3) In the later stage of the disease, the liver is depressed and transforms into fire, which injures the Yin of the kidney. If it persists for a long time, pus and fluid will leak continuously, and the wound will not heal for a long time.

　　2. Lymphogranuloma venereum with damp-heat and toxin syndrome may present with papules or vesicles on the genitals, or surface erosion with exudate. It may be accompanied by fever, decreased appetite, red tongue, yellow coating, and slippery rapid pulse. This is due to the invasion of damp-heat and toxin into the liver meridian, as the liver meridian runs around the genitals, causing papules or vesicles on the genitals, surface erosion with exudate, fever, decreased appetite, red tongue, yellow coating, and slippery rapid pulse, all of which are clinical manifestations of damp-heat and toxin syndrome. Treatment should focus on clearing heat, resolving dampness, and detoxifying. Common medication includes: 10g Phellodendron, 10g Atractylodes, 30g Coix seed, 10g Plantago asiatica, 30g Smilax glabra, 30g Taraxacum mongolicum. Phellodendron and Atractylodes are the main herbs, which clear heat and dry dampness; Coix seed and Plantago asiatica are used with the main herbs to clear heat and resolve dampness; Smilax glabra and Taraxacum mongolicum clear heat and detoxify. For severe dampness-heat, add 10g Scutellaria baicalensis; for severe toxic heat, add 10g Dendranthema indicum. Lymphogranuloma venereum with phlegm-toxin accumulation, characterized by enlarged inguinal lymph nodes, skin and gland connected, some nodes may fuse into lumps, not movable when pushed, pain, red tongue, yellow coating, wiry slippery pulse. This is due to the accumulation of phlegm-toxin and blood stasis. Treatment should focus on soothing the liver, resolving depression, softening hardness, and dispersing masses. Medication: 10g Bupleurum, 10g Angelica sinensis, 10g Radix paeoniae alba, 10g Atractylodes macrocephala, 20g Poria, 20g Scrophularia ningpoensis, 30g Calcined Oyster shell (decoct first), 10g Fritillaria thunbergii, 10g Cyperus rotundus, 10g Radix glycyrrhizae, 6g. Bupleurum is used to soothe the liver and resolve depression; Angelica sinensis and Radix paeoniae alba nourish the blood and soothe the liver; Atractylodes macrocephala and Poria invigorate the spleen and resolve dampness; Scrophularia ningpoensis, Calcined Oyster shell, and Fritillaria thunbergii soften hardness and disperse masses; Cyperus rotundus, Radix glycyrrhizae, and other herbs are used to regulate Qi, resolve phlegm, and harmonize the spleen and stomach. For those with Yin deficiency, add 10g Rehmannia glutinosa and 10g Adenophora; for those with excessive liver fire, add 10g Scutellaria baicalensis and 10g Indigo naturalis.

　　3. The symptom of lymphogranuloma venereum due to insufficient liver and kidney, characterized by skin and gland ulceration that does not heal for a long time, with symptoms such as hectic fever, bone steam, pale complexion, fatigue, dizziness, shortness of breath, heat in the palms and soles, red tongue with thin coating, and thready rapid pulse. This is due to insufficient liver and kidney, with internal excess of虚 fire. Treatment should focus on nourishing the liver and kidney. Medication: 10g Rehmannia glutinosa, 10g Fructus Corni, 10g Rhizoma Dioscoreae, 10g Alisma orientale, 10g Poria, 10g Moutan bark, 10g Ophiopogon japonicus, 10g Adenophora, 10g Cortex mori, 10g Radix glycyrrhizae. The main herbs are Rehmannia glutinosa, Fructus Corni, and Rhizoma Dioscoreae, which nourish the Yin of the liver and kidney; Alisma orientale, Poria, and Moutan bark are used with the main herbs to eliminate excess; Ophiopogon japonicus, Adenophora, and Cortex mori clear and drain虚 heat; Cortex mori and Radix glycyrrhizae harmonize the spleen and stomach. For those with poor pus discharge, add 10g Borneol; for those with toxic heat, add 10g Taraxacum mongolicum.

　　28. For the topical treatment of lymphogranuloma venereum, different drugs and different treatment methods are commonly used according to different clinical stages. Generally speaking, early stage should use liquid for washing the affected area, middle stage should use ointment to disperse nodules and detoxify, and late stage should use powder or ointment to remove gangrene and promote muscle growth.

　　27. Common Monographic Prescriptions

　　26. Take 10g of Pu Gong Ying (Herba Taraxaci), 10g of Ye Ju Hua (Flos Chrysanthemi Indici), 10g of Tian Kui Zi (Semen Cucumis Melo), 10g of Xuan Shen (Radix Scrophulariae), 10g of Chuan Bei Mu (Bulbus Fritillariae Thunbergii). Decoct them, take once a day. Their function is to clear heat and detoxify, soften hard lumps and disperse nodules. (From 'Modern Integrated Chinese and Western Dermatology')

　　25. Take 9g of Chao Bai Jiang Can (Bombyx Batryticus), 9g of Dang Gui (Radix Angelicae Sinensis), 9g of Sheng Da Huang (Radix et Rhizoma Rhei), 4.5g of Gan Cao (Licorice Root), 4.5g of Chuan Shan Jia (Scutellariae Radix), grind them into fine powder, take 9 to 12g with an empty stomach after drinking wine. (From 'Practical Chinese Medicine for Venereal Diseases' by Yang Dianxing et al.)

　　24. Take 3g of Jiutou Shizicao (Herba Serratulae), 9g of Chuan Bei Mu (Bulbus Fritillariae Thunbergii), decoct them in water. (From 'Practical Chinese Medicine for Venereal Diseases' by Yang Dianxing et al.)

　　23. Take 5kg of fresh willow leaves, boil them with water for 2 hours, remove the residue, and concentrate the filtrate into a paste. Add 30g of Zhang Dan, 6g of 梅片 (Meyenii), 10g of 雄黄 (Realgar), 10g of 煅龙骨 (Calcinated Dragon Bone), 10g of 儿茶 (Catechu), 3g of 珍珠 (Pearl), 6g of 轻粉 (Litharge), 10g of 松香 (Tolu), 10g of 炉甘石 (Calamine), grind them into fine powder, mix them evenly with the willow leaf paste, store them in bottles for later use. (From 'Practical Chinese Medicine for Venereal Diseases' by Yang Dianxing et al.)

　　22. Take 250g of fresh purple garlic and 250g of fresh ginger, wash them clean with cold water, slice them, mix them into a disinfected container, crush them, add an appropriate amount of 95% alcohol, stir them to form a paste, seal them, soak them in a cool place for 3 to 5 hours, filter them with a disposable gauze, and they can be used.