Inguinal Bubo - Causes, Symptoms, Diagnosis, Treatment, and Complications

What Is Inguinal Bubo?

It is an acute inflammation of the lymph nodes in the inguinal and femoral regions. It causes swelling in the inguinal lymph nodes, which is painful and moves on palpation. Inguinal buboes occur as a result of sexually transmitted infections. Men are affected more than females. Internal buboes are a common predisposing factor for HIV infections.

What Is the Cause of Inguinal Bubo?

• The most common cause is sexually transmitted infections.

• Frequently associated with bacterial infections like lymphogranuloma venereum (LGV) and chancroid.

• Infections of lower limbs.

• Infections of the genital area, with ulceration.

• Syphilis and HIV infections.

• Slow-growing fatty lump present over the skin in the inguinal region.

• Cancerous conditions of lymph nodes.

What Are the Symptoms?

• Enlargement of lymph nodes in the inguinal and groin region.

• Painful, enlarged lymph nodes.

• Fluctuant swelling of lymph nodes.

• Fever.

• Malaise.

• Headache.

• Tender regional adenopathy.

What Are the Characteristics of Lymphogranuloma Venereum (LGV)?

A sexually transmitted disease caused by Chlamydia trachoma bacteria. Sexually active individuals in the age group of 15 to 40 years are mostly affected. Both men and women can get infected, but men are affected more. People with HIV are at a higher risk of developing LGV.

LGV can be transmitted through vaginal sex and oral and anal sex.

What Are the Symptoms of Lymphogranuloma Venereum (LGV)?

Symptoms usually start after three to twelve days of infection and occur in three stages.

1. First Stage: Development of small blisters of size up to six millimeters, fluid-filled on the penis or vagina. Initial blisters are usually painless and heal quickly.

2. Second Stage: Starts after two to six weeks of the initial development of blisters. Symptoms include the following:

• Swollen and tender lymph nodes in the groin region.

• Painful swelling of lymph nodes.

• Swelling in the pelvis, vagina, and rectum region.

• Ulceration of skin over the swollen lymph nodes.

Other symptoms include

• Abdominal pain and anal pain.

• Back pain and pelvic pain

• Constipation.

• Fatigue.

• Headache and fever.

• Rectal bleeding and itching in the rectal area.

• Painful urination (dysuria).

• Weight loss.

• Inflammation of the anus and rectum (proctitis).

3. Third Stage: The third stage occurs in people who did not receive proper treatment. During the third stage, the blisters heal and leave scars. Other symptoms include.

• Anal fistula.

• Narrowing of the rectum.

• Abscesses.

• Swelling of genitals.

What Are the Diagnosis of LGV?

In suspected lymphogranuloma venereum, the following tests are done to confirm the infection.

• Blood Test- To identify antibodies against the pathogen.

• Nucleic Acid Amplification Test (NAAT): To confirm the presence of the pathogen.

What Are the Management and Treatment of LGV?

• Primary treatment starts with the antibiotic doxycycline.

• Needle biopsy of the lymph nodes filled with pus (buboes). It helps with relief from pain and discomfort.

What Are the Characteristics of Chancroid?

Chancroid causes ulcers with soft edges and is called soft chancres. It is a sexually transmitted bacterial disease, most common in developing countries.

What Are the Signs and Symptoms of Chancroid?

The incubation period for chancre to develop symptoms is about three to seven days.

• Raised bumps which are painful.

• Ulcers developed from the bumps.

• Reddened skin.

• Spreading of the ulcer to a larger area.

How Is the Diagnosis of Chancroid Done?

The diagnosis of chancroid is quite difficult and does not provide an accurate diagnosis. So chancroid has been diagnosed if the patient has the following conditions.

• Presence of multiple genital ulcers that are painful.

• Swollen painful lymph nodes in groins (inguinal bubo).

• Negative test result for herpes simplex virus (HSV) and treponema pallidum.

What Is the Management and Treatment of Chancroid?

Primary treatment starts with antibiotics. Significant changes were seen after one to two weeks. After that, the soft chancre will start to clear up.

How Are Inguinal Buboes Diagnosed?

• Proper communication with the patient and asking for history of any infections.

• Looking for symptoms like groin pain, genital ulcer, or swelling in lower limbs or other body parts.

• Recent or past history of genital infection.

• Examine lymph nodes to confirm if they are tender, fluctuant and warm.

• If bubo is present, inspect the glans penis in men and the external genitalia and mucous surface of the labia in women to rule out the presence of an ulcer.

• The examination is conducted to confirm the presence of bubo, exclude the presence of ulcers, and confirm the patient has no sexually transmitted infection.

How Is Inguinal Bubo Treated?

Patients with an inguinal ulcer are managed according to the GUD flowchart.

• Patients with bubo, with absent genital ulcers, are treated with:

• Doxycycline 100 mg orally every 12 hours for 14 days.

• Ciprofloxacin 500 mg orally in a single dose STAT.

• The partners of the patient should start with the same treatment.

• If the partner is a pregnant or lactating mother,

• Erythromycin 500mg orally, four times a day for 14 days.

• Fluctuant buboes are aspirated, as they reduce pain and swelling.

• If necessary, repeat aspiration after two to three days.

• Surgical incision and drainage are not done, as it delays healing.

• If a patient presents with ruptured inguinal bubo and no ulceration in the genital area, treatment is done for inguinal bubo.

• Patients with a bubo and genital ulcer managed for both genital ulcer diseases (GUD).

• Sexual abstinence during treatment.

• Offer HIV counseling and testing for both.

• Review the patient after seven days.

What Are the Complications of Inguinal Bubo?

The possible complications include:

• Formation of fistula and sinus tract.

• Abscess.

• Scarring.

• Lymphatic obstruction, where there is blockage of lymph vessels that drain tissue fluid throughout the body.

• Stenosis and infertility.

How Are Inguinal Bubo and Sexually Transmitted Diseases Prevented?

• Educate and counsel the client and sex partners regarding safe sex practices, sexually transmitted infections, and proper treatment.

• Treatment is provided for the sexual partner also.

• Provide condoms and their correct usage.

• Voluntary counseling for periodic testing for HIV, syphilis, and hepatitis B.

• Immunization against hepatitis B.

• Proper follow-up.

• If symptoms persist, contact the doctor for assessment and restart treatment.

Conclusion

Inguinal bubo is a sexually transmitted infection mostly associated with lymphogranuloma venereum (LGV) and chancroid. Diagnosis is made based on clinical examination. Antibiotics are given as the first line of treatment followed by regular follow-up.