The anorectal aspect of venereal lymphogranuloma

Abstract

Venereal lymphogranuloma, often termed lymphogranuloma inguinale, lymphopathia venereum, etc., is a venereal disease probably caused by a filterable virus. The universal adoption of the term venereal lymphogranuloma would avoid confusion, designate its venereal origin, it would give some conception of the nature of the condition, and embrace the multiple localizations and aspects of the disease. A history of an initial lesion is difficult to elicit because of the evanescent nature of the primary sore. It occurs on the penis in males and usually within the vagina in females. The manifestations of the disease in the two sexes differ because of the different anatomic locations of the initial lesions. In the male, the superficial inguinal lymph nodes become involved; in the female, however, the deep pelvic nodes as well as the nodes surrounding the rectum become involved. Secondary perirectal involvement may occur in males due to the passage of the virus along collateral lymphatic vessels. In our cases, rectal involvement occurred about four times as frequently in females than in males. The most serious sequela of the disease is rectal stricture which is the result of peri-rectal involvement producing obliterating, inflammatory narrowing of the rectal lumen. This disease probably occurs with equal frequency in temperate and tropical climates. It occurs more frequently in the white race than has been suspected. Just as in syphilis, this disease occurs in people in all walks of life. The course of the stricture is very chronic; the average duration in our cases was eight years. Although there is a remarkable uniformity in the microscopic findings, a positive diagnosis cannot be made from biopsy alone. The Frei test is specific for venereal lymphogranuloma. All rectal strictures require this test. No specific for the treatment of rectal strictures due to venereal lymphogranuloma has been reported. We believe that these patients must eventually submit to colostomy.