Nicolas-Favre disease is a sexually transmitted disease, caused by microorganisms called Chlamydia trachomatis, being characteristic to tropical and subtropical areas (Asia, Africa) and less common in European countries. It is known as the inguinal Lymphogranulomatosis, benign Lymphogranulomatosis or LGV. It is more common in men than in women, the ratio being of 6/1, and the most affected age group is of 23-30 years. That is exactly when people are more likely to have sex.
The incubation period ranges from 6-21 days after appearing one or more small, painless papules. Or in other words, it is trying to sneak into our existence as "quietly".
The disease has 3 stages:
1.-the stage of lymphogranulomatosis chancre. After an incubation period of 6-21 days, the genital mucosa develops one or more papules or vesicles that ulcerate quickly forming the lymphogranulomatosis chancre, painless, healing fast and going most times unnoticed. Ulceration can locate in the vulva, vagina, penis, but also in perianal area (around the anus).
2.-the secondary stage, characterized by the occurrence of an inguinal adenopathy (name given to the disease of glands or lymph glands, manifested by increasing their volume and their inflammation). After 1-3 weeks, there appears the inguinal adenopathy, which in two thirds of cases is painful, the upper skin (tissue that is covering the body in humans and animals) become purplish, forming inguinal lymph node abscesses (pus accumulation, well defined by a membrane), which subsequently fistulize (break) in a characteristic way: "in a sprinkler" (with multiple openings draining pus). Untreated, the suppuration restores spontaneously in 2-3 months, but the cure may be accompanied by significant fibrosis reaction (exaggerated pathological development of connective tissues).
3.-the tertiary genito-ano-rectal stage. Occurs after one or more years from contamination and it affects both the genitals and anus, rectum.
Symptoms. Clinical manifestations for which the patients usually address to the doctor are:
-leaks or abnormal secretions in the genital area;
-papules, vesicles or painless ulcers, located most commonly in the vulva and vagina in women, and in men in the penis, and in the groin or in the perianal area;
-painful inguinal lymphadenopathy: painful inflammation of inguinal plica (fold of skin or of anatomical walls mucous), sometimes the skin becoming red-purple;
-important, tough vulvar edema (when touched, the tissues have rubber consistency);
-other symptoms: fever, anal pain in defecation, when walking or sitting, as well as dyspareunia (acute pain during intercourse).
Since the initial ulcer is painless and restores quickly (often it goes by unnoticed), the infected individuals usually seek medical care much later, when the disease is installed in the secondary phase. Judging from the behavior of these micro-organisms, it seems that the idea of evil, has the same philosophy regardless of the development degree of life forms.
Diagnosis. It may be suspected based on clinical signs, but it requires differentiation from other genital ulcers:
-Syphilis: hard chancre (ulceration), painless, enlarged lymph nodes, and later cutaneal rash appearance, without itchiness (no itching symptoms) on the body;
- inguinal granuloma (Donovanosis): subcutaneous nodules that burst forming red, fleshy, painless ulcers;
-tuberculosis: red node, sore, which goes to seed and ulcerates, its surface being irregular, covered with necrotic material and accompanied inconsistently by inguinal lymphadenopathy;
-soft chancre (Cankerous): painful ulcers accompanied by inguinal lymph node abscess, unilaterally.
When evolving with systemic manifestations, there should be excluded: meningitis, arthritis, pleurisy, peritonitis, etc... The localizations and rectal complications sometimes require biopsy to exclude the idea of ano-rectal cancer.
A diagnostic of certainty requires isolation of Chlamydia trachomatis cultures and serotype identification by serological tests.
Treatment. The disease can be cured with appropriate antibiotics. Antibiotic treatment should be followed for 21 days. In advanced stages, painful lymphadenopathy may persist also after the elimination of bacteria from the body, in this case being also necessary drainage and surgical maneuvers that improve symptoms. For stage 3 complications, it may be required surgery: excision of fistula, excision of lymph compression or rectal expansions.