INGUINAL SWELLING

(Bubo)

It is an STI syndrome presenting as localised swellings or enlarged lymph glands in the groin and femoral area.

Causes

  • Chlamydia strains: lymphogranuloma venerium (LGV)
  • Heamophilus ducreyi: chancroid
  • Treponema pallidum: syphilis

Clinical features

  • Excessively swollen inguinal glands
  • Pain, tenderness
  • Swellings may become fluctuant if pus forms

Differential diagnosis

  • Other causes of swollen inguinal lymph nodes, e.g. leg ulcer
  • Obstructed inguinal hernia

Investigations

  • As for Genital Ulcers
  • C&S of pus

Management

  • Examine for genital ulcers, rule out infection of the foot, leg or buttock and exclude inguinal hernia
  • If genital ulcer is present, treat as per above protocol
  • Give doxycycline 100 mg 12 hourly for 14 days
  • Treat partner

If partner is pregnant

  • Give erythromycin 500 mg every 6 hours for 14 days

If bubo persisting, and partner was not treated

  • Continue treatment for 14 days

If not improving

  • Refer for specialist management

Caution

  • Do not incise bubo. Aspirate through normal skin with a large bore needle gauge <20 every 2 days until resolution
  • Alternative to doxycycline: azithromycin 1 g single dose